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Sample records for academic healthcare system

  1. PERCEPTION OF ACADEMIC PHARMACISTS TOWARDS THEIR ROLE IN HEALTHCARE SYSTEM OF A DEVELOPING COUNTRY, PAKISTAN: A QUANTITATIVE SIGHT.

    PubMed

    Li, Sheng; Azhar, Saira; Murtaza, Ghulam; Bin Asad, Muhammad Hassham Hassan; Shah, Syed Haider; Karim, Sabiha; Shi, Chenghe

    2015-01-01

    To investigate perception of academic pharmacists towards their role in healthcare system of a developing country, Pakistan, was the aim of this study. The study participants consisted of academic pharmacists from the government and private universities of Pakistan. Study was conducted for a period of three months, from January to March 2011, in Pakistan. Academic pharmacists were informed regarding the aim, objective and nature of the study. Verbal consent was given and execution of the study took place. Main sections of the questionnaire were comprised of series of statements pertaining to pharmacist perception and experience with the pharmacists. During the period, of January to April, the total number of questionnaires received from different government and private universities was 113. The response rate based on the 205 academic pharmacists working in universities during the study period was 63.9%. A majority (93.9%) of the respondents were satisfied working as academic pharmacist, 68.7% expressed that their interest in research is the reason to embark carrier as an academic pharmacist. Only half (55.7%) of the respondents agreed about pharmacy curriculum standard in Pakistan, and their satisfaction towards curriculum is less, as after the implementation of Pharm. D. (Doctor of Pharmacy). In the country, the curriculum is still focusing more towards theoretical knowledge rather than practical. In this case significant difference was noted with respect to university (p = 0.012). Academic pharmacists do have concern about the pharmacy profession in Pakistan. They ascertain the key issues facing the profession and its educators. Recommendations have been made to improve the current pharmacy curricula in order that future pharmacists in Pakistan practice effectively with the collaboration of other healthcare professionals.

  2. [Healthcare value chain: a model for the Brazilian healthcare system].

    PubMed

    Pedroso, Marcelo Caldeira; Malik, Ana Maria

    2012-10-01

    This article presents a model of the healthcare value chain which consists of a schematic representation of the Brazilian healthcare system. The proposed model is adapted for the Brazilian reality and has the scope and flexibility for use in academic activities and analysis of the healthcare sector in Brazil. It places emphasis on three components: the main activities of the value chain, grouped in vertical and horizontal links; the mission of each link and the main value chain flows. The proposed model consists of six vertical and three horizontal links, amounting to nine. These are: knowledge development; supply of products and technologies; healthcare services; financial intermediation; healthcare financing; healthcare consumption; regulation; distribution of healthcare products; and complementary and support services. Four flows can be used to analyze the value chain: knowledge and innovation; products and services; financial; and information.

  3. Australian academic primary health-care careers: a scoping survey.

    PubMed

    Barton, Christopher; Reeve, Joanne; Adams, Ann; McIntyre, Ellen

    2016-01-01

    This study was undertaken to provide a snapshot of the academic primary health-care workforce in Australia and to provide some insight into research capacity in academic primary health care following changes to funding for this sector. A convenience sample of individuals self-identifying as working within academic primary health care (n=405) completed an anonymous online survey. Respondents were identified from several academic primary health-care mailing lists. The survey explored workforce demographics, clarity of career pathways, career trajectories and enablers/barriers to 'getting in' and 'getting on'. A mix of early career (41%), mid-career (25%) and senior academics (35%) responded. Early career academics tended to be female and younger than mid-career and senior academics, who tended to be male and working in 'balanced' (teaching and research) roles and listing medicine as their disciplinary background. Almost three-quarters (74%) indicated career pathways were either 'completely' or 'somewhat unclear', irrespective of gender and disciplinary backgrounds. Just over half (51%) had a permanent position. Males were more likely to have permanent positions, as were those with a medical background. Less than half (43%) reported having a mentor, and of the 57% without a mentor, more than two-thirds (69%) would like one. These results suggest a lack of clarity in career paths, uncertainty in employment and a large number of temporary (contract) or casual positions represent barriers to sustainable careers in academic primary health care, especially for women who are from non-medicine backgrounds. Professional development or a mentoring program for primary health-care academics was desired and may address some of the issues identified by survey respondents.

  4. Curriculum Mapping with Academic Analytics in Medical and Healthcare Education

    PubMed Central

    Komenda, Martin; Víta, Martin; Vaitsis, Christos; Schwarz, Daniel; Pokorná, Andrea; Zary, Nabil; Dušek, Ladislav

    2015-01-01

    Background No universal solution, based on an approved pedagogical approach, exists to parametrically describe, effectively manage, and clearly visualize a higher education institution’s curriculum, including tools for unveiling relationships inside curricular datasets. Objective We aim to solve the issue of medical curriculum mapping to improve understanding of the complex structure and content of medical education programs. Our effort is based on the long-term development and implementation of an original web-based platform, which supports an outcomes-based approach to medical and healthcare education and is suitable for repeated updates and adoption to curriculum innovations. Methods We adopted data exploration and visualization approaches in the context of medical curriculum innovations in higher education institutions domain. We have developed a robust platform, covering detailed formal metadata specifications down to the level of learning units, interconnections, and learning outcomes, in accordance with Bloom’s taxonomy and direct links to a particular biomedical nomenclature. Furthermore, we used selected modeling techniques and data mining methods to generate academic analytics reports from medical curriculum mapping datasets. Results We present a solution that allows users to effectively optimize a curriculum structure that is described with appropriate metadata, such as course attributes, learning units and outcomes, a standardized vocabulary nomenclature, and a tree structure of essential terms. We present a case study implementation that includes effective support for curriculum reengineering efforts of academics through a comprehensive overview of the General Medicine study program. Moreover, we introduce deep content analysis of a dataset that was captured with the use of the curriculum mapping platform; this may assist in detecting any potentially problematic areas, and hence it may help to construct a comprehensive overview for the subsequent

  5. Buying a healthcare information system.

    PubMed

    Clegg, T A

    1998-01-01

    Replacing an antiquated computer system with state of the art equipment and software is a lengthy, at times frustrating, and never an easy decision. At Wesley Woods Center on Aging, Atlanta, an integrated provider of healthcare for the elderly affiliated with Emory University, the process consumed more than two and a half years. This article takes the reader through the entire process, from the initial decision to replace an existing system, through the final purchase and installation. It looks candidly at the problems that were encountered, including turnover among key personnel, difficulties with involving all of the user groups, changes in the technology and coordination with the University. The lessons Wesley Woods learned in its experience can be of benefit to any healthcare facility contemplating an information system change.

  6. National Healthcare Reform: Implications for the Military Healthcare System

    DTIC Science & Technology

    2010-05-16

    healthcare for certain non-active duty reservists and extended chiropractic care to active duty members placing yet additional pressures on defense health...coalition of lobbyists and elected representatives to implement reforms. The recent passage of the Patient Protection and Affordable Care Act (PPACA... Care Act (PPACA), Capitation, Health Savings Accounts (HAS), AHLTA, VistA, TRICARE, Military Healthcare System (MHS). 16. SECURITY CLASSIFICATION

  7. Architecture and implementation for a system enabling smartphones to access smart card based healthcare records.

    PubMed

    Karampelas, Vasilios; Pallikarakis, Nicholas; Mantas, John

    2013-01-01

    The healthcare researchers', academics' and practitioners' interest concerning the development of Healthcare Information Systems has been on a steady rise for the last decades. Fueling this steady rise has been the healthcare professional need of quality information, in every healthcare provision incident, whenever and wherever this incident may take place. In order to address this need a truly mobile health care system is required, one that will be able to provide a healthcare provider with accurate patient-related information regardless of the time and place that healthcare is provided. In order to fulfill this role the present study proposes the architecture for a Healthcare Smartcard system, which provides authenticated healthcare professionals with remote mobile access to a Patient's Healthcare Record, through their Smartphone. Furthermore the research proceeds to develop a working prototype system.

  8. Systems Architecture for a Nationwide Healthcare System.

    PubMed

    Abin, Jorge; Nemeth, Horacio; Friedmann, Ignacio

    2015-01-01

    From a national level to give Internet technology support, the Nationwide Integrated Healthcare System in Uruguay requires a model of Information Systems Architecture. This system has multiple healthcare providers (public and private), and a strong component of supplementary services. Thus, the data processing system should have an architecture that considers this fact, while integrating the central services provided by the Ministry of Public Health. The national electronic health record, as well as other related data processing systems, should be based on this architecture. The architecture model described here conceptualizes a federated framework of electronic health record systems, according to the IHE affinity model, HL7 standards, local standards on interoperability and security, as well as technical advice provided by AGESIC. It is the outcome of the research done by AGESIC and Systems Integration Laboratory (LINS) on the development and use of the e-Government Platform since 2008, as well as the research done by the team Salud.uy since 2013.

  9. Guest editorial. Integrated healthcare information systems.

    PubMed

    Li, Ling; Ge, Ri-Li; Zhou, Shang-Ming; Valerdi, Ricardo

    2012-07-01

    The use of integrated information systems for healthcare has been started more than a decade ago. In recent years, rapid advances in information integration methods have spurred tremendous growth in the use of integrated information systems in healthcare delivery. Various techniques have been used for probing such integrated systems. These techniques include service-oriented architecture (SOA), EAI, workflow management, grid computing, and others. Many applications require a combination of these techniques, which gives rise to the emergence of enterprise systems in healthcare. Development of the techniques originated from different disciplines has the potential to significantly improve the performance of enterprise systems in healthcare. This editorial paper briefly introduces the enterprise systems in the perspective of healthcare informatics.

  10. Decision-making in healthcare as a complex adaptive system.

    PubMed

    Kuziemsky, Craig

    2016-01-01

    Healthcare transformation requires a change in how the business of healthcare is done. Traditional decision-making approaches based on stable and predictable systems are inappropriate in healthcare because of the complex nature of healthcare delivery. This article reviews challenges to using traditional decision-making approaches in healthcare and how insight from Complex Adaptive Systems (CAS) could support healthcare management. The article also provides a system model to guide decision-making in healthcare as a CAS.

  11. Healthcare and healthcare systems: inspiring progress and future prospects

    PubMed Central

    2016-01-01

    Background Healthcare systems globally have experienced intensive changes, reforms, developments, and improvement over the past 30 years. Multiple actors (governmental and non-governmental) and countries have played their part in the reformation of the global healthcare system. New opportunities are presenting themselves while multiple challenges still remain especially in developing countries. Better way to proceed would be to learn from historical patterns while we plan for the future in a technology-driven society with dynamic demographic, epidemiological and economic uncertainties. Methods A structured review of both peer-reviewed and gray literature on the topic was carried out. Results On the whole, people are healthier, doing better financially and live longer today than 30 years ago. The number of under-5 mortality worldwide has declined from 12.7 million in 1990 to 6.3 million in 2013. Infant and maternal mortality rates have also been reduced. However, both rates are still considered high in Africa and some Asian countries. The world’s population nearly doubled in these 30 years, from 4.8 billion in 1985 to 7.2 billion in 2015. The majority of the increasing population was coming from the least developed countries, i.e., 3.66 to 5.33 billion. The world will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million. Health care expenditures among countries also show sharp differences. In high income countries, per person health expenditure is over USD 3,000 on average, while in poor countries, it is as low as USD 12, WHO estimate of minimum spending per person per year needed to provide basic, life-saving services is USD 44. The challenges faced by the global health system over the past 30 years have been increased in population and urbanization, behavioral changes, rise in chronic diseases, traumatic injuries, infectious diseases, specific regional conflicts and healthcare delivery security. Over the next 30 years

  12. Middleware for healthcare information systems.

    PubMed

    Spahni, S; Scherrer, J R; Sauquet, D; Sottile, P A

    1998-01-01

    Middleware is now a commonly used expression and anyone building distributed applications is referring to "middleware services". Nevertheless this notion lacks of sound theoretical foundation. This paper tries to clarify the relationship between the components of distributed environments, especially in healthcare, and to establish some classification aiming at gaining a common understanding of the functionalities and interdependency of the existing modules of distributed environments.

  13. Academic Radiology in the New Healthcare Delivery Environment

    PubMed Central

    Qayyum, Aliya; Yu, John-Paul J.; Kansagra, Akash P.; von Fischer, Nathaniel; Costa, Daniel; Heller, Matthew; Kantartzis, Stamatis; Plowman, R. Scooter; Itri, Jason

    2014-01-01

    Ongoing concerns over the rising cost of health care are driving large-scale changes in the way that health care is practiced and reimbursed in the United States. To effectively implement and thrive within this new health care delivery environment, academic medical institutions will need to modify financial and business models and adapt institutional cultures. In this paper, we review the expected features of the new health care environment from the perspective of academic radiology departments. Our review will include background on Accountable Care Organizations, identify challenges associated with the new managed care model, and outline key strategies—including expanding the use of existing information technology infrastructure, promoting continued medical innovation, balancing academic research with clinical care, and exploring new roles for radiologists in efficient patient management—that will ensure continued success for academic radiology. PMID:24200477

  14. Bridging from Technical to Academic Degrees: A Healthcare Example.

    ERIC Educational Resources Information Center

    Troutt-Ervin, Eileen; Morgan, Frederic L.

    Healthcare technicians may receive their training in hospitals/clinics, community colleges/vocational-technical institutes, universities/medical schools, proprietary schools, secondary schools, or government institutions. Most allied health and nursing organizations also require continuing education for relicensure and certification; however,…

  15. Engineering healthcare as a service system.

    PubMed

    Tien, James M; Goldschmidt-Clermont, Pascal J

    2010-01-01

    Engineering has and will continue to have a critical impact on healthcare; the application of technology-based techniques to biological problems can be defined to be technobiology applications. This paper is primarily focused on applying the technobiology approach of systems engineering to the development of a healthcare service system that is both integrated and adaptive. In general, healthcare services are carried out with knowledge-intensive agents or components which work together as providers and consumers to create or co-produce value. Indeed, the engineering design of a healthcare system must recognize the fact that it is actually a complex integration of human-centered activities that is increasingly dependent on information technology and knowledge. Like any service system, healthcare can be considered to be a combination or recombination of three essential components - people (characterized by behaviors, values, knowledge, etc.), processes (characterized by collaboration, customization, etc.) and products (characterized by software, hardware, infrastructures, etc.). Thus, a healthcare system is an integrated and adaptive set of people, processes and products. It is, in essence, a system of systems which objectives are to enhance its efficiency (leading to greater interdependency) and effectiveness (leading to improved health). Integration occurs over the physical, temporal, organizational and functional dimensions, while adaptation occurs over the monitoring, feedback, cybernetic and learning dimensions. In sum, such service systems as healthcare are indeed complex, especially due to the uncertainties associated with the human-centered aspects of these systems. Moreover, the system complexities can only be dealt with methods that enhance system integration and adaptation.

  16. Behavioral Reference Model for Pervasive Healthcare Systems.

    PubMed

    Tahmasbi, Arezoo; Adabi, Sahar; Rezaee, Ali

    2016-12-01

    The emergence of mobile healthcare systems is an important outcome of application of pervasive computing concepts for medical care purposes. These systems provide the facilities and infrastructure required for automatic and ubiquitous sharing of medical information. Healthcare systems have a dynamic structure and configuration, therefore having an architecture is essential for future development of these systems. The need for increased response rate, problem limited storage, accelerated processing and etc. the tendency toward creating a new generation of healthcare system architecture highlight the need for further focus on cloud-based solutions for transfer data and data processing challenges. Integrity and reliability of healthcare systems are of critical importance, as even the slightest error may put the patients' lives in danger; therefore acquiring a behavioral model for these systems and developing the tools required to model their behaviors are of significant importance. The high-level designs may contain some flaws, therefor the system must be fully examined for different scenarios and conditions. This paper presents a software architecture for development of healthcare systems based on pervasive computing concepts, and then models the behavior of described system. A set of solutions are then proposed to improve the design's qualitative characteristics including, availability, interoperability and performance.

  17. Infrastructuring Multicultural Healthcare Information Systems.

    PubMed

    Dreessen, Katrien; Huybrechts, Liesbeth; Grönvall, Erik; Hendriks, Niels

    2017-01-01

    This paper stresses the need for more research in the field of Participatory Design (PD) and in particular into how to design Health Information Technology (HIT) together with care providers and -receivers in multicultural settings. We contribute to this research by describing a case study, the 'Health-Cultures' project, in which we designed HIT for the context of home care of older people with a migration background. The Health-Cultures project is located in the city of Genk, Belgium, which is known for its multicultural population, formed by three historical migration waves of people coming to work in the nowadays closed coal mines. Via a PD approach, we studied existing means of dialogue and designed HIT that both care receivers and care providers in Genk can use in their daily exchanges between cultures in home care contexts. In discussing relevant literature as well as the results of this study, we point to the need and the ways of taking spatio-historical aspects of a specific healthcare situation into account in the PD of HIT to support multicultural perspectives on healthcare.

  18. An overview in healthcare information systems security.

    PubMed

    Bourka, A; Polemi, N; Koutsouris, D

    2001-01-01

    The scope of this paper is to present the current needs and trends in the field of healthcare systems security. The approach applied within the described review was based on three major steps. The first step was to define the point and ways of penetration and integration of security services in current healthcare related applications addressing technical, organisational and legal/regulatory issues. The second step was to specify and evaluate common security technologies applied in healthcare information systems pointing out gaps and efficient solutions, whereas the third was to draw conclusions for the present conditions and identify the future trends of healthcare information security. A number of EU RTD Projects were selected, categorised, analysed and comparatively evaluated in terms of security. The technical focus was on key security technologies, like Public Key Infrastructures (PKIs) based on Trusted Third Parties (TTPs) in conjunction with other state-of-the-art security components (programming tools, data representation formats, security standards and protocols, security policies and risk assessment techniques). The experience gained within this review will provide valuable input for future security applications in the healthcare sector, solving existing problems and addressing real user needs.

  19. Accelerating change: Fostering innovation in healthcare delivery at academic medical centers.

    PubMed

    Ostrovsky, Andrey; Barnett, Michael

    2014-03-01

    Academic medical centers (AMCs) have the potential to be leaders in the era of healthcare delivery reform, but most have yet to display a commitment to delivery innovation on par with their commitment to basic research. Several institutional factors impede delivery innovation including the paucity of adequate training in design and implementation of new delivery models and the lack of established pathways for academic career advancement outside of research. This paper proposes two initiatives to jumpstart disruptive innovation at AMCs: an institutional "innovation incubator" program and a clinician-innovator career track coupled with innovation training programs.

  20. Why and How Is Compassion Necessary to Provide Good Healthcare? Comments From an Academic Physician

    PubMed Central

    Lionis, Christos

    2015-01-01

    This is a short commentary to the editorial issued by Marianna Fotaki, entitled: "Why and how is compassion necessary to provide good quality healthcare." It introduces the necessity of a more cognitive approach to explore further the determinants of behavior towards compassionate care. It raises questions about the importance of training towards a more patient-care and values driven healthcare system. PMID:26673339

  1. Flexible solution for interoperable cloud healthcare systems.

    PubMed

    Vida, Mihaela Marcella; Lupşe, Oana Sorina; Stoicu-Tivadar, Lăcrămioara; Bernad, Elena

    2012-01-01

    It is extremely important for the healthcare domain to have a standardized communication because will improve the quality of information and in the end the resulting benefits will improve the quality of patients' life. The standards proposed to be used are: HL7 CDA and CCD. For a better access to the medical data a solution based on cloud computing (CC) is investigated. CC is a technology that supports flexibility, seamless care, and reduced costs of the medical act. To ensure interoperability between healthcare information systems a solution creating a Web Custom Control is presented. The control shows the database tables and fields used to configure the two standards. This control will facilitate the work of the medical staff and hospital administrators, because they can configure the local system easily and prepare it for communication with other systems. The resulted information will have a higher quality and will provide knowledge that will support better patient management and diagnosis.

  2. Human factors systems approach to healthcare quality and patient safety

    PubMed Central

    Carayon, Pascale; Wetterneck, Tosha B.; Rivera-Rodriguez, A. Joy; Hundt, Ann Schoofs; Hoonakker, Peter; Holden, Richard; Gurses, Ayse P.

    2013-01-01

    Human factors systems approaches are critical for improving healthcare quality and patient safety. The SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety is a human factors systems approach that has been successfully applied in healthcare research and practice. Several research and practical applications of the SEIPS model are described. Important implications of the SEIPS model for healthcare system and process redesign are highlighted. Principles for redesigning healthcare systems using the SEIPS model are described. Balancing the work system and encouraging the active and adaptive role of workers are key principles for improving healthcare quality and patient safety. PMID:23845724

  3. Ethics Leadership in Research, Healthcare and Organizational Systems: Commentary and Critical Reflections

    ERIC Educational Resources Information Center

    Gabriele, Edward F.

    2011-01-01

    In the last decades there has arisen a greater awareness of the ever present need for critical academic reflection on the nature of ethics leadership and committees in research, healthcare, and organizational systems. Yet what is meant by ethics itself? How is ethics understood as a historical phenomenon? What challenges must ethics leaders face…

  4. The healthcare system and provision of oral healthcare in European Union member states. Part 4: Greece.

    PubMed

    Damaskinos, P; Koletsi-Kounari, H; Economou, C; Eaton, K A; Widström, E

    2016-03-11

    This paper presents a description of the healthcare system and how oral healthcare is organised and provided in Greece, a country in a deep economic and social crisis. The national health system is underfunded, with severe gaps in staffing levels and the country has a large private healthcare sector. Oral healthcare has been largely provided in the private sector. Most people are struggling to survive and have no money to spend on general and oral healthcare. Unemployment is rising and access to healthcare services is more difficult than ever. Additionally, there has been an overproduction of dentists and no development of team dentistry. This has led to under or unemployment of dentists in Greece and their migration to other European Union member states, such as the United Kingdom, where over 600 Greek dentists are currently working.

  5. Service models for remote healthcare monitoring systems.

    PubMed

    Moorman, Bridget A

    2010-01-01

    These scenarios reflect where the future is heading for remote health monitoring technology and service expectations. Being able to manage a "system of systems" with timely service hand-off over seams of responsibility and system interfaces will become very important for a BMET or clinical engineer. These interfaces will include patient homes, clinician homes, commercial/civilian infrastructure, public utilities, vendor infrastructure as well as internal departmental domains. Concurrently, technology is changing rapidly resulting in newer software delivery modes and hardware appliances as well as infrastructure changes. Those who are able to de-construct the complex systems and identify infrastructure assumptions and seams of servicing responsibility will be able to better understand and communicate the expectations for service of these systems. Moreover, as identified in Case 1, prodigious use of underlying system monitoring tools (managing the "meta-data") could move servicing of these remote systems from a reactive approach to a proactive approach. A prepared healthcare organization will identify their current and proposed future service combination use cases and design service philosophies and expectations for those use cases, while understanding the infrastructure assumptions and seams of responsibility. This is the future of technical service to the healthcare clinicians and patients.

  6. Healthcare

    ERIC Educational Resources Information Center

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This report, provides detailed analyses and projections of occupations in healthcare fields, and wages earned. In addition, the important skills and work values associated with workers in those fields of healthcare are discussed. Finally, the authors analyze the implications of research findings for the racial, ethnic, and class diversity of the…

  7. Patient-centredness in integrated healthcare delivery systems - needs, expectations and priorities for organised healthcare systems

    PubMed Central

    Juhnke, Christin; Mühlbacher, Axel C.

    2013-01-01

    Introduction Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems. Methods A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales. Results Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser–Meyer–Olkin of 0.914 for the patients (experts: 38.427%, Kaiser–Meyer–Olkin = 0.797). Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination. Conclusion and Discussion The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes. PMID:24363639

  8. Prevalence and compensation of academic leaders, professors, and trustees on publicly traded US healthcare company boards of directors: cross sectional study

    PubMed Central

    Anderson, Timothy S; Good, Chester B

    2015-01-01

    Objective To identify the prevalence, characteristics, and compensation of members of the boards of directors of healthcare industry companies who hold academic appointments as leaders, professors, or trustees. Design Cross sectional study. Setting US healthcare companies publicly traded on the NASDAQ or New York Stock Exchange in 2013. Participants 3434 directors of pharmaceutical, biotechnology, medical equipment and supply, and healthcare provider companies. Main outcome measures Prevalence, annual compensation, and beneficial stock ownership of directors with affiliations as leaders, professors, or trustees of academic medical and research institutions. Results 446 healthcare companies met the study search criteria, of which 442 (99%) had publicly accessible disclosures on boards of directors. 180 companies (41%) had one or more academically affiliated directors. Directors were affiliated with 85 geographically diverse non-profit academic institutions, including 19 of the top 20 National Institute of Health funded medical schools and all of the 17 US News honor roll hospitals. Overall, these 279 academically affiliated directors included 73 leaders, 121 professors, and 85 trustees. Leaders included 17 chief executive officers and 11 vice presidents or executive officers of health systems and hospitals; 15 university presidents, provosts, and chancellors; and eight medical school deans or presidents. The total annual compensation to academically affiliated directors for their services to companies was $54 995 786 (£35 836 000; €49 185 900) (median individual compensation $193 000) and directors beneficially owned 59 831 477 shares of company stock (median 50 699 shares). Conclusions A substantial number and diversity of academic leaders, professors, and trustees hold directorships at US healthcare companies, with compensation often approaching or surpassing common academic clinical salaries. Dual obligations to for profit company

  9. Picture archiving and communications systems for integrated healthcare information solutions

    NASA Astrophysics Data System (ADS)

    Goldburgh, Mitchell M.; Glicksman, Robert A.; Wilson, Dennis L.

    1997-05-01

    The rapid and dramatic shifts within the US healthcare industry have created unprecedented needs to implement changes in the delivery systems. These changes must not only address the access to healthcare, but the costs of delivery, and outcomes reporting. The resulting vision to address these needs has been called the Integrated Healthcare Solution whose core is the Electronic Patient Record. The integration of information by itself is not the issue, nor will it address the challenges in front of the healthcare providers. The process and business of healthcare delivery must adopt, apply and expand its use of technology which can assist in re-engineering the tools for healthcare. Imaging is becoming a larger part of the practice of healthcare both as a recorder of health status and as a defensive record for gatekeepers of healthcare. It is thus imperative that imaging specialists adopt technology which competitively integrates them into the process, reduces the risk, and positively effects the outcome.

  10. Academic Research Integration System

    ERIC Educational Resources Information Center

    Surugiu, Iula; Velicano, Manole

    2008-01-01

    This paper comprises results concluding the research activity done so far regarding enhanced web services and system integration. The objective of the paper is to define the software architecture for a coherent framework and methodology for enhancing existing web services into an integrated system. This document presents the research work that has…

  11. OPTIMED Platform: Curriculum Harmonisation System for Medical and Healthcare Education.

    PubMed

    Komenda, Martin; Schwarz, Daniel; Vaitsis, Christos; Zary, Nabil; Štěrba, Jaroslav; Dušek, Ladislav

    2015-01-01

    This contribution introduces a new web-based OPTIMED platform for an effective harmonisation of medical and healthcare curriculum. Behind the engineering background stays an original methodology covering planning model based on formal parameterisation of curriculum, which fully support the outcome-based approach to education. With the use of developed system curriculum, designers and senior guarantors can provide a clear and transparent composition of compulsory and optional courses, and easily identify potential duplicities and overlaps across a domain of medical and healthcare education. For students, it means an absolutely new way of how to understand what is really taught during a learning period, including all necessary meta information. All members across the academic community are able to search and consequently display in detail the most important domains related to the particular year, term, course, medical discipline or topic. The presented solution significantly enhances the transparency and continuity of the environment in which the authors of the teaching materials as well as their consumers work daily. Suggestions for future improvements of the OPTIMED platform are discussed.

  12. Security threats categories in healthcare information systems.

    PubMed

    Samy, Ganthan Narayana; Ahmad, Rabiah; Ismail, Zuraini

    2010-09-01

    This article attempts to investigate the various types of threats that exist in healthcare information systems (HIS). A study has been carried out in one of the government-supported hospitals in Malaysia.The hospital has been equipped with a Total Hospital Information System (THIS). The data collected were from three different departments, namely the Information Technology Department (ITD), the Medical Record Department (MRD), and the X-Ray Department, using in-depth structured interviews. The study identified 22 types of threats according to major threat categories based on ISO/IEC 27002 (ISO 27799:2008). The results show that the most critical threat for the THIS is power failure followed by acts of human error or failure and other technological factors. This research holds significant value in terms of providing a complete taxonomy of threat categories in HIS and also an important component in the risk analysis stage.

  13. Personalized biomedical devices & systems for healthcare applications

    NASA Astrophysics Data System (ADS)

    Chen, I.-Ming; Phee, Soo Jay; Luo, Zhiqiang; Lim, Chee Kian

    2011-03-01

    With the advancement in micro- and nanotechnology, electromechanical components and systems are getting smaller and smaller and gradually can be applied to the human as portable, mobile and even wearable devices. Healthcare industry have started to benefit from this technology trend by providing more and more miniature biomedical devices for personalized medical treatments in order to obtain better and more accurate outcome. This article introduces some recent development in non-intrusive and intrusive biomedical devices resulted from the advancement of niche miniature sensors and actuators, namely, wearable biomedical sensors, wearable haptic devices, and ingestible medical capsules. The development of these devices requires carful integration of knowledge and people from many different disciplines like medicine, electronics, mechanics, and design. Furthermore, designing affordable devices and systems to benefit all mankind is a great challenge ahead. The multi-disciplinary nature of the R&D effort in this area provides a new perspective for the future mechanical engineers.

  14. Successfully integrating information systems into healthcare.

    PubMed

    Wallhouse, R

    1992-01-01

    Many hospital managers are currently looking at implementing hospital information systems (HIS) for the first time, or planning replacement of their first HIS. This article is intended as a resume of 'best practice' in terms of how to approach the selection and implementation of an integrated HIS--a "Do's and Don'ts Guide" for hospital managers. Emphasis is placed on the importance of management assuming overall responsibility for the HIS as a vital communications tool to support the provision of healthcare. Since the HIS underpins the 'business aims' of the institution, these need to be clearly defined at the outset. How to evaluate the benefits of an HIS supplier and aspects such as encouraging an atmosphere of ownership of the HIS by all staff are reviewed in the article.

  15. Hold that TIGER! A collaborative service-learning academic-practice partnership with rural healthcare facilities.

    PubMed

    Fairchild, Roseanne Moody

    2012-01-01

    Observing a renewed focus on community engagement as part of our university's strategic plan and the experiential learning partnerships encouraged by the TIGER (Technology and Information Guiding Education Reform) Initiative in health information technology, an academic-practice partnership was initiated between a group of Midwestern rural hospitals and a university's advanced practice nursing students via the graduate online nursing informatics course. Using a service-learning approach, the course features an emphasis on the collaborative design and implementation of student- and healthcare provider team-driven projects to support rural hospital staff and administrators in meeting the broad spectrum of challenges they face every day. The author discusses the adaptable course outline of foundational and service-learning course activities, recent service-learning projects and outcomes, and results of a cumulative 2-year course evaluation by internal/external stakeholders.

  16. Technology and the healthcare system: implications for patient adherence.

    PubMed

    Beni, Juliet B

    2011-01-01

    Patient nonadherence is a growing and costly problem in the healthcare system, especially for patients with chronic illness. Between 25% and 40% of patients are nonadherent to treatment, and estimated costs directly associated with patient nonadherence in the US healthcare system are $290 billion a year. Nonadherence to preventive and treatment regimens is correlated to negative consequences for patients; however, many barriers to the promotion of successful adherence remain. Some such barriers include financial constraints, physical disability, side effects, forgetfulness, age and complex multi-drug regimens. The implementation of technology in healthcare systems is changing the way in which healthcare providers and patients must approach adherence. The following review applies a framework, the Information-Motivation-Strategy Model?, developed by DiMatteo and colleagues, to the field to conceptualise the changing factors affecting patient adherence as global healthcare moves toward increasingly technology-based systems of care.

  17. The influence of power in the Canadian healthcare system.

    PubMed

    Seenandan-Sookdeo, Kendra-Ann I

    2012-01-01

    This article presents a review of the literature as it relates to the influence of the word power in the context of the Canadian healthcare system. The concept of power is used to explore issues of gender and the evolution of advanced nurse practice in the development of the Canadian healthcare system. Furthermore, issues related to the call for interprofessional collaboration are addressed. Healthcare workers, in particular nurses, are trusted in a society that seeks, promotes, and aspires for power and control. In addition, societal norms continue to shape our healthcare reform. As a consequence, the discussion centers on a call for true collaboration among our healthcare providers and concludes with implications for nursing.

  18. Utilizing Health Information Technology to Support Universal Healthcare Delivery: Experience of a National Healthcare System.

    PubMed

    Syed-Abdul, Shabbir; Hsu, Min-Huei; Iqbal, Usman; Scholl, Jeremiah; Huang, Chih-Wei; Nguyen, Phung Anh; Lee, Peisan; García-Romero, Maria Teresa; Li, Yu-Chuan Jack; Jian, Wen-Shan

    2015-09-01

    Recent discussions have focused on using health information technology (HIT) to support goals related to universal healthcare delivery. These discussions have generally not reflected on the experience of countries with a large amount of experience using HIT to support universal healthcare on a national level. HIT was compared globally by using data from the Ministry of the Interior, Republic of China (Taiwan). Taiwan has been providing universal healthcare since 1995 and began to strategically implement HIT on a national level at that time. Today the national-level HIT system is more extensive in Taiwan than in many other countries and is used to aid administration, clinical care, and public health. The experience of Taiwan thus can provide an illustration of how HIT can be used to support universal healthcare delivery. In this article we present an overview of some key historical developments and successes in the adoption of HIT in Taiwan over a 17-year period, as well as some more recent developments. We use this experience to offer some strategic perspectives on how it can aid in the adoption of large-scale HIT systems and on how HIT can be used to support universal healthcare delivery.

  19. The secure authorization model for healthcare information system.

    PubMed

    Hsu, Wen-Shin; Pan, Jiann-I

    2013-10-01

    Exploring healthcare system for assisting medical services or transmitting patients' personal health information in web application has been widely investigated. Information and communication technologies have been applied to the medical services and healthcare area for a number of years to resolve problems in medical management. In the healthcare system, not all users are allowed to access all the information. Several authorization models for restricting users to access specific information at specific permissions have been proposed. However, as the number of users and the amount of information grows, the difficulties for administrating user authorization will increase. The critical problem limits the widespread usage of the healthcare system. This paper proposes an approach for role-based and extends it to deal with the information for authorizations in the healthcare system. We propose the role-based authorization model which supports authorizations for different kinds of objects, and a new authorization domain. Based on this model, we discuss the issues and requirements of security in the healthcare systems. The security issues for services shared between different healthcare industries will also be discussed.

  20. Development of a medical academic degree system in China

    PubMed Central

    Wu, Lijuan; Wang, Youxin; Peng, Xiaoxia; Song, Manshu; Guo, Xiuhua; Nelson, Hugh; Wang, Wei

    2014-01-01

    Context The Chinese government launched a comprehensive healthcare reform to tackle challenges to health equities. Medical education will become the key for successful healthcare reform. Purpose We describe the current status of the Chinese medical degree system and its evolution over the last 80 years. Content Progress has been uneven, historically punctuated most dramatically by the Cultural Revolution. There is a great regional disparity. Doctors with limited tertiary education may be licensed to practice, whereas medical graduates with advanced doctorates may have limited clinical skills. There are undefined relationships between competing tertiary training streams, the academic professional degree, and the clinical residency training programme (RTP). The perceived quality of training in both streams varies widely across China. As the degrees of master or doctor of academic medicine is seen as instrumental in career advancement, including employability in urban hospitals, attainment of this degree is sought after, yet is often unrelated to a role in health care, or is seen as superior to clinical experience. Meanwhile, the practical experience gained in some prestigious academic institutions is deprecated by the RTP and must be repeated before accreditation for clinical practice. This complexity is confusing both for students seeking the most appropriate training, and also for clinics, hospitals and universities seeking to recruit the most appropriate applicants. Conclusion The future education reforms might include: 1) a domestic system of ‘credits’ that gives weight to quality clinical experience vs. academic publications in career advancement, enhanced harmonisation between the competing streams of the professional degree and the RTP, and promotion of mobility of staff between areas of excellence and areas of need; 2) International – a mutual professional and academic recognition between China and other countries by reference to the Bologna Accord

  1. Building a Healthcare System's Innovation Program.

    PubMed

    Conger, Michelle D

    2016-01-01

    OSF HealthCare, based in Peoria, Illinois, has developed an innovative strategy to adapt to the changes and forces disrupting the healthcare environment. This strategy evolved organically from the performance improvement efforts we began more than 15 years ago, as well as from the lessons we learned from years of research into the innovative practices and platforms of other healthcare institutions and of companies in other industries. More important, the strategy reflects our mission "to serve persons with the greatest care and love."The OSF innovation model has three components: internal innovations, partnering with external entities, and validating innovations through simulation. OSF has an ongoing and comprehensive commitment to innovation. Examples include our initiative to transform our model of care in primary care clinics by expanding access, reducing costs, and increasing efficiency; our partnerships with outside entities to find revolutionary solutions and products in which we can invest; and our establishment of a world-class simulation and education center.OSF HealthCare could not do any of this if it lacked the support of its people. To that end, we continue to work on embedding a culture of innovation across all of our facilities. Ours is a culture in which everyone is encouraged to voice creative ideas and no one is afraid to fail-all for the betterment of our organization and the patients we serve.

  2. ARTEMIS: towards a secure interoperability infrastructure for healthcare information systems.

    PubMed

    Boniface, Mike; Wilken, Paul

    2005-01-01

    The ARTEMIS project is developing a semantic web service based P2P interoperability infrastructure for healthcare information systems. The strict legislative framework in which these systems are deployed means that the interoperability of security and privacy mechanisms is an important requirement in supporting communication of electronic healthcare records across organisation boundaries. In ARTEMIS, healthcare providers define semantically annotated security and privacy policies for web services based on organisational requirements. The ARTEMIS mediator uses these semantic web service descriptions to broker between organisational policies by reasoning over security and clinical concept ontologies.

  3. Integrating hospital information systems in healthcare institutions: a mediation architecture.

    PubMed

    El Azami, Ikram; Cherkaoui Malki, Mohammed Ouçamah; Tahon, Christian

    2012-10-01

    Many studies have examined the integration of information systems into healthcare institutions, leading to several standards in the healthcare domain (CORBAmed: Common Object Request Broker Architecture in Medicine; HL7: Health Level Seven International; DICOM: Digital Imaging and Communications in Medicine; and IHE: Integrating the Healthcare Enterprise). Due to the existence of a wide diversity of heterogeneous systems, three essential factors are necessary to fully integrate a system: data, functions and workflow. However, most of the previous studies have dealt with only one or two of these factors and this makes the system integration unsatisfactory. In this paper, we propose a flexible, scalable architecture for Hospital Information Systems (HIS). Our main purpose is to provide a practical solution to insure HIS interoperability so that healthcare institutions can communicate without being obliged to change their local information systems and without altering the tasks of the healthcare professionals. Our architecture is a mediation architecture with 3 levels: 1) a database level, 2) a middleware level and 3) a user interface level. The mediation is based on two central components: the Mediator and the Adapter. Using the XML format allows us to establish a structured, secured exchange of healthcare data. The notion of medical ontology is introduced to solve semantic conflicts and to unify the language used for the exchange. Our mediation architecture provides an effective, promising model that promotes the integration of hospital information systems that are autonomous, heterogeneous, semantically interoperable and platform-independent.

  4. Socioeconomic Status and Satisfaction with Public Healthcare System in Iran

    PubMed Central

    Maharlouei, Najmeh; Akbari, Mojtaba; Akbari, Maryam; Lankarani, Kamran B.

    2017-01-01

    ABSTRACT Background: The users’ satisfaction is a method for evaluating the efficacy of healthcare system. We aimed to evaluate the association between the users’ socioeconomic status (SES) and satisfaction with the healthcare system in Shiraz, Iran. Methods: This cross-sectional study was conducted from December, 2013 to March, 2014, in Shiraz, Iran. 3400 households were recruited by multi-stage cluster random sampling. Information about demographic, insurance status, and users’ satisfaction was derived from face-to-face interviews. Satisfaction with healthcare system was assessed by using 5-point Likert scale statements, which ranged from “very dissatisfied” to “very satisfied”. All statistical analyses were performed using SPSS-21. Results: Overall, 1.6% (55) of the respondents were very satisfied, while 6% (203) were very dissatisfied with healthcare system. Participants were classified into high SES (26.3%), middle SES (47.9%) and low SES (25.8%). It was discovered that the better the SES, the more frequent were the respondents dissatisfied with healthcare system (P<0.001). Also, dissatisfied respondents were significantly older (P=0.036). Moreover, women were more dissatisfied with healthcare system (P=0.005). Also, dissatisfied respondents had significantly a higher level of education than satisfied ones (P<0.001). Furthermore, logistic regression revealed that age (P=0.04), marital status (P=0.01), insurance status (P<0.001), SES (P<0.001), and having supplemental insurance (P=0.02) were determinant factors of satisfaction with healthcare system. Conclusion: This study demonstrated that users’ sex, age, educational level, and SES were related to dissatisfaction with healthcare system. Meanwhile, clients’ age, SES, insurance status and marital status were recognized as determinant factors. PMID:28097175

  5. Some perspectives on affordable healthcare systems in China.

    PubMed

    Zhang, Y T; Yan, Y S; Poon, C C Y

    2007-01-01

    Consistent with the global population trend, China is becoming an aging society. Over one-fifth of the world's elderly population (aged 65 and over) lives in China. Statistics show that the elderly populace in China constitutes 8% of the total population in 2006 and the percentage will be tripled to become 24% in 2050. As a result, there is inevitably an increase in the prevalence of chronic disease that accounted for almost 80% of all deaths in China in 2005. On the other hand, from 1978 to 2003, the total expenditure on healthcare in China increased from 11.02 billion RMB up to 658.41 billion RMB, and in terms of GDP, it is an increase from 3.04% to 5.62%. The annual average increase (12.1%) in healthcare investment is therefore even higher than the annual rate of GDP increase (9.38%) during the last two decades. Meeting the long-term healthcare needs of this growing elderly population and escalating healthcare expenditure pose a grim challenge to the current Chinese healthcare system and the solvency of state budgets. In fact, the healthcare services in China have become less accessible since the early 1980s when its costs soared up. The rising costs have prevented many Chinese people from seeking early medical care. The phenomenon has created a wide disparity in seeking healthcare between urban and rural areas. These trends are of particular concern to the elderly, who have higher healthcare needs yet lesser means to afford the services. Furthermore, according to the 3rd National Health Service Survey, 79.1% of rural residents and 44.8% of urban citizens did not have any form of medical insurance. Such a low percentage of coverage of medical insurance indicates that many people may not be able to afford medical services when they suffer from severe diseases. Therefore, there is a great need of a more effective and low-cost healthcare system. A new system that can allow multi-level, multi-dimensional and standardized healthcare services for urban and rural

  6. Design principles for achieving integrated healthcare information systems.

    PubMed

    Jensen, Tina Blegind

    2013-03-01

    Achieving integrated healthcare information systems has become a common goal for many countries in their pursuit of obtaining coordinated and comprehensive healthcare services. This article focuses on how a small local project termed 'Standardized pull of patient data' expanded and is now used on a large scale providing a majority of hospitals, general practitioners and citizens across Denmark with the possibility of accessing healthcare data from different electronic patient record systems and other systems. I build on design theory for information infrastructures, as presented by Hanseth and Lyytinen, to examine the design principles that facilitated this smallscale project to expand and become widespread. As a result of my findings, I outline three lessons learned that emphasize: (i) principles of flexibility, (ii) expansion from the installed base through modular strategies and (iii) identification of key healthcare actors to provide them with immediate benefits.

  7. Mobile healthcare applications: system design review, critical issues and challenges.

    PubMed

    Baig, Mirza Mansoor; GholamHosseini, Hamid; Connolly, Martin J

    2015-03-01

    Mobile phones are becoming increasingly important in monitoring and delivery of healthcare interventions. They are often considered as pocket computers, due to their advanced computing features, enhanced preferences and diverse capabilities. Their sophisticated sensors and complex software applications make the mobile healthcare (m-health) based applications more feasible and innovative. In a number of scenarios user-friendliness, convenience and effectiveness of these systems have been acknowledged by both patients as well as healthcare providers. M-health technology employs advanced concepts and techniques from multidisciplinary fields of electrical engineering, computer science, biomedical engineering and medicine which benefit the innovations of these fields towards healthcare systems. This paper deals with two important aspects of current mobile phone based sensor applications in healthcare. Firstly, critical review of advanced applications such as; vital sign monitoring, blood glucose monitoring and in-built camera based smartphone sensor applications. Secondly, investigating challenges and critical issues related to the use of smartphones in healthcare including; reliability, efficiency, mobile phone platform variability, cost effectiveness, energy usage, user interface, quality of medical data, and security and privacy. It was found that the mobile based applications have been widely developed in recent years with fast growing deployment by healthcare professionals and patients. However, despite the advantages of smartphones in patient monitoring, education, and management there are some critical issues and challenges related to security and privacy of data, acceptability, reliability and cost that need to be addressed.

  8. Towards specialised middleware for healthcare information systems.

    PubMed

    Spahni, S; Scherrer, J R; Sauquet, D; Sottile, P A

    1999-01-01

    Middleware is now a commonly used expression and anyone building distributed applications is referring to 'middleware services'. Nevertheless this notion lacks of sound theoretical foundation. This paper tries to clarify the relationship between the components of distributed environments, especially in healthcare and to establish some classification aiming at gaining a common understanding of the functionality and interdependency of the existing modules of distributed environments. A case study is presented and the potential benefits of using a middleware approach are discussed.

  9. Healthcare Information Systems to Assess Influenza Outbreaks

    PubMed Central

    Figar, S.; Aliperti, V.; Salazar, E.; Otero, C.; Schpilberg, M.; Taliercio, V.; Otero, P.; de Quirós, F. González Bernaldo

    2011-01-01

    Objective To determine whether a private HIS could have detected the influenza epidemic outbreaks earlier through changes in morbidity and mortality patterns. Methods Data Source included a health information system (HIS) from an academic tertiary health care center integrating administrative and clinical applications. It used a local interface terminology server which provides support through data autocoding of clinical documentation. Specific data subsets were created to compare the burden of influenza during the epidemiological week (EW) 21 to 26 for years 2007 to 2009 among 150,000 Health Maintenance Organization members in Argentina. The threshold for identifying an epidemic was considered met when the weekly influenza-like illness (ILI) rate exceeded 200 per 100,000 visits. Case fatality rates and mortality rates of severe acute respiratory infection (SARI) from 2007 to 2009 were retrospectively compared. Case fatality rates and mortality rates for A/H1N1 influenza 2009 also were estimated. Results The HIS detected the outbreak in EW 23 while the government Ministry of Health (MoH) gave a national epidemic alert during EW 25. The number of visits for ILI increased more than fourfold when comparing 2009 to the period 2007-2008. The SARI mortality rate in 2009 was higher than in 2008 (RR 2.8; 95%CI 1.18-6.63) and similar to that of 2007 (RR 1.05; 95%CI 0.56-1.49). 2009 was the first year with mortalities younger than 65 years attributable to SARI. The estimated A/H1N1 case fatality rate for SARI was 6.2% (95%CI 2.5 to 15.5) and A/H1N1 mortality rate was 6 per 100,000 (95%CI 0 to 11.6). Conclusion Our HIS detected the outbreak two weeks before than the MoH gave a national alert. The information system was useful in assessing morbidity and mortality during the 2009 influenza epidemic H1N1 outbreak suggesting that with a private-public integration a more real-time outbreak and disease surveillance system could be implemented. PMID:23616861

  10. Cyberterrorism: is the U.S. healthcare system safe?

    PubMed

    Harries, David; Yellowlees, Peter M

    2013-01-01

    The Internet has brought with it many benefits; key among them has been its ability to allow the expansion of communication and transfer of all kinds of information throughout the U.S. healthcare system. As a consequence, healthcare has become increasingly dependent on the activities carried out in that environment. It is this very dependence that increases the likelihood of individuals or organizations conducting activities through the Internet that will cause physical and/or psychological harm. These activities have become known by the term "cyberterrorism." In the healthcare landscape this can appear in a variety of forms, such as bringing down a hospital computer system or publicly revealing private medical records. Whatever shape it takes, the general effects are the same: patient care is compromised, and trust in the health system is diminished. Fortunately no significant cyber attack has been successfully launched against a U.S. healthcare organization to date. However, there is evidence to suggest that cyber threats are increasing and that much of the U.S. healthcare system is ill equipped to deal with them. Securing cyberspace is not an easy proposition as the threats are constantly changing, and recognizing that cyberterrorism should be part of a broader information technology risk management strategy, there are several"best practices" that can be adopted by healthcare organizations to protect themselves against cyber attacks.

  11. Evaluation of academic detailing programme on childhood diarrhoea management by primary healthcare providers in Banke district of Nepal.

    PubMed

    Khanal, Saval; Ibrahim, Mohamed Izham B Mohamed; Shankar, Pathiyil Ravi; Palaian, Subish; Mishra, Pranaya

    2013-06-01

    Academic detailing is rarely practised in developing countries. A randomized control trial on healthcare service was conducted to evaluate the impact of academic detailing programme on the adherence of primary healthcare providers in Banke district, Nepal, to childhood diarrhoea treatment guidelines recommended by World Health Organization/United Nations Children's Fund (WHO/UNICEF). The participants (N=209) were systematically divided into control and intervention groups. Four different academic detailing sessions on childhood diarrhoea management were given to participants in the intervention group. At baseline, 6% of the participants in the control and 8.3% in the intervention group were adhering to the treatment guidelines which significantly (p < 0.05) increased among participants in the intervention (65.1%) than in the control group (16.0%) at the first follow-up. At the second follow-up, 69.7% of participants in the intervention group were adhering to the guidelines, which was significantly (p < 0.05) greater than those in the control group (19.0%). Data also showed significant improvement in prescribing pattern of the participants in the intervention group compared to the control group. Therefore, academic detailing can be used for promoting adherence to treatment guidelines in developing countries, like Nepal.

  12. Evaluation of Academic Detailing Programme on Childhood Diarrhoea Management by Primary Healthcare Providers in Banke District of Nepal

    PubMed Central

    Ibrahim, Mohamed Izham b. Mohamed; Shankar, Pathiyil Ravi; Palaian, Subish; Mishra, Pranaya

    2013-01-01

    Academic detailing is rarely practised in developing countries. A randomized control trial on healthcare service was conducted to evaluate the impact of academic detailing programme on the adherence of primary healthcare providers in Banke district, Nepal, to childhood diarrhoea treatment guidelines recommended by World Health Organization/United Nations Children's Fund (WHO/UNICEF). The participants (N=209) were systematically divided into control and intervention groups. Four different academic detailing sessions on childhood diarrhoea management were given to participants in the intervention group. At baseline, 6% of the participants in the control and 8.3% in the intervention group were adhering to the treatment guidelines which significantly (p<0.05) increased among participants in the intervention (65.1%) than in the control group (16.0%) at the first follow-up. At the second follow-up, 69.7% of participants in the intervention group were adhering to the guidelines, which was significantly (p<0.05) greater than those in the control group (19.0%). Data also showed significant improvement in prescribing pattern of the participants in the intervention group compared to the control group. Therefore, academic detailing can be used for promoting adherence to treatment guidelines in developing countries, like Nepal. PMID:23930342

  13. Comparing middleware concepts for advanced healthcare system architectures.

    PubMed

    Blobel, B; Holena, M

    1997-09-01

    Different approaches to middleware, supporting systems integration in healthcare, are described and evaluated, regarding concepts, architectural framework, and relevance for healthcare enterprises. This evaluation includes CORBA, DHE, and HL7. CORBA, promoted in the healthcare area through the efforts of CORBAmed, is a strictly object-oriented approach, whereas DHE is based on process-related concepts. The earlier HL7 approach, without any modelling and with proprietary communication management, is changing to a harmonised information interchange concept in healthcare, taking into account also other protocols and medical domains with orientation to an electronic patient record. The opening also includes the separation of message definition and message exchange format, enabling the migration of different EDI standards. HL7 will also support the integration of standardised platforms as 'networking mediator applications'. Finally, some recommendations for future developments are given.

  14. Information security requirements in patient-centred healthcare support systems.

    PubMed

    Alsalamah, Shada; Gray, W Alex; Hilton, Jeremy; Alsalamah, Hessah

    2013-01-01

    Enabling Patient-Centred (PC) care in modern healthcare requires the flow of medical information with the patient between different healthcare providers as they follow the patient's treatment plan. However, PC care threatens the stability of the balance of information security in the support systems since legacy systems fall short of attaining a security balance when sharing their information due to compromises made between its availability, integrity, and confidentiality. Results show that the main reason for this is that information security implementation in discrete legacy systems focused mainly on information confidentiality and integrity leaving availability a challenge in collaboration. Through an empirical study using domain analysis, observations, and interviews, this paper identifies a need for six information security requirements in legacy systems to cope with this situation in order to attain the security balance in systems supporting PC care implementation in modern healthcare.

  15. Thinking strategically: academic-practice relationships: one health system's experience.

    PubMed

    Wurmser, Teri; Bliss-Holtz, Jane

    2011-01-01

    Strategic planning and joint leverage of the strengths inherent in the academic and practice arenas of nursing are imperative to confront the challenges facing the profession of nursing and its place within the healthcare team of the future. This article presents a description and discussion of the implementation of several academic-practice partnership initiatives by Meridian Health, a health system located in central New Jersey. Included in the strategies discussed are creation of a support program for nonprofessional employees to become registered nurses; active partnership in the development of an accelerated BSN program; construction of support systems and academic partnerships for staff participation in RN-to-BSN programs; construction of on-site clinical simulation laboratories to foster interprofessional learning; and the implementation of a new BSN program, the first and only generic BSN program in two counties of the state. Outcomes of these academic-practice partnerships also are presented, including number of participants; graduation and NCLEX-RN pass rates; MH nurse vacancy rates; and nurse retention rates after first employment.

  16. ERP (enterprise resource planning) systems can streamline healthcare business functions.

    PubMed

    Jenkins, E K; Christenson, E

    2001-05-01

    Enterprise resource planning (ERP) software applications are designed to facilitate the systemwide integration of complex processes and functions across a large enterprise consisting of many internal and external constituents. Although most currently available ERP applications generally are tailored to the needs of the manufacturing industry, many large healthcare systems are investigating these applications. Due to the significant differences between manufacturing and patient care, ERP-based systems do not easily translate to the healthcare setting. In particular, the lack of clinical standardization impedes the use of ERP systems for clinical integration. Nonetheless, an ERP-based system can help a healthcare organization integrate many functions, including patient scheduling, human resources management, workload forecasting, and management of workflow, that are not directly dependent on clinical decision making.

  17. Healthcare

    DTIC Science & Technology

    2001-01-01

    sued. In 1974, Congress passed the Employee Retirement Income Security Act ( ERISA ) to protect employees in corporate-sponsored pension plans, health...that was denied.71 In the closely followed lawsuit of Pegram v. 21 Herdrich, the US Supreme Court ruled that ERISA -covered HMOs cannot be sued for...their families - are in ERISA -covered managed care systems. The proposed Patients’ Bill of Right would effectively remove the ERISA protection and make

  18. Mobile technology and healthcare: the adoption issues and systemic problems.

    PubMed

    Standing, Susan; Standing, Craig

    2008-01-01

    Although the benefits that are associated with mobile technology have been recognised as offering great potential in the healthcare sector, its widespread adoption has been lagging. We propose that fundamental systemic issues are likely to be the main barriers to adoption. We explain that the fragmented nature of the conservative healthcare system, the contradictory incentives and improper outcome measures conspire to make the innovative adoption of mobile technology problematic. Researchers can only gain a limited understanding of a technology's potential success by using technology adoption frameworks and need to supplement this with a 'systems' perspective that takes a more strategic view.

  19. Security in health-care information systems--current trends.

    PubMed

    Smith, E; Eloff, J H

    1999-04-01

    Ever since health-care information systems have been implemented, their security is being considered an important issue, especially in the light of the fact that their data are deemed to comprise extremely sensitive information. The prospect of storing health information in electronic form raises concerns about patient privacy and data security. Any attempt to introduce computerised health-care information systems should, therefore, guarantee adequate protection of the confidentiality and integrity of patient information. At the same time, the patient information also needs to be readily available to all authorised health-care providers, in order to ensure the proper treatment of the patient. The principal aim of the present paper is, however, not to make a new contribution to the subject of security per se, but rather to give an overview of current trends in the security aspects of health-care information systems. The final section of the paper will be devoted to a number of proposals for further research possibilities in the domain of health-care information systems security.

  20. Forming design teams to develop healthcare information systems.

    PubMed

    Saleem, Naveed; Jones, Donald R; Van Tran, Hien; Moses, Beulah

    2006-01-01

    Healthcare information systems are assuming an increasingly critical role in providing quality patient care in an effective and efficient manner. However, the success of these systems in achieving these goals remains a lingering concern. Consequently, investigating and devising strategies to enhance the likelihood of success of a healthcare information system continues to draw research interest. One strategy recommended by both researchers and practitioners alike is the participation of the target users in the design and development of the information system. However, practical considerations mandate representative, rather than universal, participation of users. Unfortunately, the information systems literature offers few guidelines for selecting user representatives to serve on a design team. This lack of guidelines easily results in system designers talking with the wrong users or managers assigning the wrong users to the design team. On the basis of the theoretical paradigms underlying the user participation and design team concepts, the authors examined and derived user characteristics that are considered the most critical criteria for selecting user members of a design team. They then report on a field survey they conducted to validate the derived criteria in healthcare information systems context. The authors conclude that the system-related functional expertise should be the primary criterion employed to select healthcare personnel to participate in system design and development. Other criteria, such as users' communication skills, computing backgrounds, and personality traits, should be given secondary considerations. Ignoring these guidelines can render user participation superfluous, resulting in system failures.

  1. Applying e-procurement system in the healthcare: the EPOS paradigm

    NASA Astrophysics Data System (ADS)

    Ketikidis, Panayiotis H.; Kontogeorgis, Apostolos; Stalidis, George; Kaggelides, Kostis

    2010-03-01

    One of the goals of procurement is to establish a competitive price, while e-procurement utilises electronic commerce to identify potential sources of supply, to purchase goods and services, to exchange contractual information and to interact with suppliers. Extensive academic work has been extensively devoted to e-procurement in diverse industries. However, applying e-procurement in the healthcare sector remains unexplored. It lacks an efficient e-procurement mechanism that will enable hospitals and healthcare suppliers to electronically exchange contractual information, aided by the technologies of optimisation and business rules. The development and deployment of e-procurement requires a major effort in the coordination of complex interorganisational business process. This article presents an e-procurement optimised system (EPOS) for the healthcare marketplace, a complete methodological approach for deploying and operating such system, as piloted in public and private hospitals in three European countries (Greece, Spain and Belgium) and suppliers of healthcare items in the fourth country (Italy). The efficient e-procurement mechanism that EPOS suggests enables hospitals and pharmaceutical and medical equipment suppliers to electronically exchange contractual information.

  2. Enhancing Health-Care Services with Mixed Reality Systems

    NASA Astrophysics Data System (ADS)

    Stantchev, Vladimir

    This work presents a development approach for mixed reality systems in health care. Although health-care service costs account for 5-15% of GDP in developed countries the sector has been remarkably resistant to the introduction of technology-supported optimizations. Digitalization of data storing and processing in the form of electronic patient records (EPR) and hospital information systems (HIS) is a first necessary step. Contrary to typical business functions (e.g., accounting or CRM) a health-care service is characterized by a knowledge intensive decision process and usage of specialized devices ranging from stethoscopes to complex surgical systems. Mixed reality systems can help fill the gap between highly patient-specific health-care services that need a variety of technical resources on the one side and the streamlined process flow that typical process supporting information systems expect on the other side. To achieve this task, we present a development approach that includes an evaluation of existing tasks and processes within the health-care service and the information systems that currently support the service, as well as identification of decision paths and actions that can benefit from mixed reality systems. The result is a mixed reality system that allows a clinician to monitor the elements of the physical world and to blend them with virtual information provided by the systems. He or she can also plan and schedule treatments and operations in the digital world depending on status information from this mixed reality.

  3. Enhancing security and improving interoperability in healthcare information systems.

    PubMed

    Gritzalis, D A

    1998-01-01

    Security is a key issue in healthcare information systems, since most aspects of security become of considerable or even critical importance when handling healthcare information. In addition, the intense need for information exchange has revealed interoperability of systems and applications as another key issue. Standardization can play an important role towards both these issues. In this paper, relevant standardization activities are briefly presented, and existing and emerging healthcare information security standards are identified and critically analysed. The analysis is based on a framework which has been developed for this reason. Therefore, the identification of gaps and inconsistencies in current standardization, the description of the conflicts of standards with legislation, and the analysis of implications of these standards to user organizations, are the main results of this paper.

  4. Polypathology, an emerging phenomenon and a challenge for healthcare systems.

    PubMed

    Román, P; Ruiz-Cantero, A

    2017-02-25

    Improvements in living conditions and scientific advances have led to an unprecedented demographic change. The curing of numerous acute diseases and the growing adoption of unhealthy lifestyles have caused a pandemic of cumulative chronic diseases that constitute the leading cause of death worldwide. Currently, the most common situation is the coexistence of multiple chronic diseases (or polypathology). This situation undermines socio-economic development and increases inequality. This results in an overriding need to change the way in which health and disease are addressed. Healthcare systems are not prepared to meet the needs of complex polypathological patients. In this article, we summarise the challenges facing healthcare systems and states, as well as the main recommendations from the organisations responsible for healthcare.

  5. Object technology: raising the standards for healthcare information systems.

    PubMed

    Pollard, D L; Hammond, W E

    1998-01-01

    Netscape and the public Internet have accelerated the acceptance of many different open "Internet standards". Through wide acceptance of its browser, Netscape gave a boost to the Java programming language helping it become truly platform independent. Objects written in Java are ideal building blocks for application components. CORBA gives such objects the ability to communicate and operate over networks. Applications built with these distributed objects become the services in an Internet-wide healthcare framework. The convergence of object technologies has raised the standards for modern healthcare information systems. To illustrate the relationship among such technologies, this paper presents an architecture for a Universal Healthcare Information System (UHIS) in terms of its web, Java and CORBA components.

  6. Web-based healthcare hand drawing management system.

    PubMed

    Hsieh, Sheau-Ling; Weng, Yung-Ching; Chen, Chi-Huang; Hsu, Kai-Ping; Lin, Jeng-Wei; Lai, Feipei

    2010-01-01

    The paper addresses Medical Hand Drawing Management System architecture and implementation. In the system, we developed four modules: hand drawing management module; patient medical records query module; hand drawing editing and upload module; hand drawing query module. The system adapts windows-based applications and encompasses web pages by ASP.NET hosting mechanism under web services platforms. The hand drawings implemented as files are stored in a FTP server. The file names with associated data, e.g. patient identification, drawing physician, access rights, etc. are reposited in a database. The modules can be conveniently embedded, integrated into any system. Therefore, the system possesses the hand drawing features to support daily medical operations, effectively improve healthcare qualities as well. Moreover, the system includes the printing capability to achieve a complete, computerized medical document process. In summary, the system allows web-based applications to facilitate the graphic processes for healthcare operations.

  7. Modelling healthcare systems with phase-type distributions.

    PubMed

    Fackrell, Mark

    2009-03-01

    Phase-type distributions constitute a very versatile class of distributions. They have been used in a wide range of stochastic modelling applications in areas as diverse as telecommunications, finance, biostatistics, queueing theory, drug kinetics, and survival analysis. Their use in modelling systems in the healthcare industry, however, has so far been limited. In this paper we introduce phase-type distributions, give a survey of where they have been used in the healthcare industry, and propose some ideas on how they could be further utilized.

  8. [Restructuring the healthcare system: redesigning based on needs].

    PubMed

    Szentes, Tamás; Vályi-Nagy, István

    2015-01-18

    The main task of a healthcare system is the provision of the healthcare services demanded by the population. These needs are mostly defined by the epidemiological status, which has been significantly changed during the last century. Due to development of medical science and technology, the main health problems in modern industrial societies are related to chronic diseases rather than infectious diseases occurring at the beginning of the 20th century. However, healthcare services provided by health institutions are still reactive, formed as reactions to current conditions, and they are hardly suited to requirements related to chronic diseases. This paper outlines international and national healthcare models and their shortcomings, and it traces novel paths of a future solution. The structure of the optimal model is suited to systematically produce the services which are needed by the population, decisively in the case of chronic, non communicable diseases. This can significantly relieve the expensive, technology-based reactive care system, nevertheless, it can provide efficient services in case of tertiary prevention. The configuration of this system is cheap, there is no need of significant infrastructure, but needs massive human resource, so that it can be rationally designed in parallel with the constriction of the reactive care system.

  9. Implementing the incident command system in the healthcare setting.

    PubMed

    Huser, T J

    The author discusses a new requirement in NFPA 99 for healthcare facilities--the implementation of an Incident Command System in the event of a disaster. He offers suggestions on how facilities can change their disaster plans to meet this new standard.

  10. Understanding healthcare innovation systems: the Stockholm region case.

    PubMed

    Larisch, Lisa-Marie; Amer-Wåhlin, Isis; Hidefjäll, Patrik

    2016-11-21

    Purpose There is an increasing interest in understanding how innovation processes can address current challenges in healthcare. The purpose of this paper is to analyze the wider socio-economic context and conditions for such innovation processes in the Stockholm region, using the functional dynamics approach to innovation systems (ISs). Design/methodology/approach The analysis is based on triangulation using data from 16 in-depth interviews, two workshops, and additional documents. Using the functional dynamics approach, critical structural and functional components of the healthcare IS were analyzed. Findings The analysis revealed several mechanisms blocking innovation processes such as fragmentation, lack of clear leadership, as well as insufficient involvement of patients and healthcare professionals. Furthermore, innovation is expected to occur linearly as a result of research. Restrictive rules for collaboration with industry, reimbursement, and procurement mechanisms limit entrepreneurial experimentation, commercialization, and spread of innovations. Research limitations/implications In this study, the authors analyzed how certain functions of the functional dynamics approach to ISs related to each other. The authors grouped knowledge creation, resource mobilization, and legitimacy as they jointly constitute conditions for needs articulation and entrepreneurial experimentation. The economic effects of entrepreneurial experimentation and needs articulation are mainly determined by the stage of market formation and existence of positive externalities. Social implications Stronger user involvement; a joint innovation strategy for healthcare, academia, and industry; and institutional reform are necessary to remove blocking mechanisms that today prevent innovation from occurring. Originality/value This study is the first to provide an analysis of the system of innovation in healthcare using a functional dynamics approach, which has evolved as a tool for public

  11. Automatic Data Processing System and Procedures, Computerized Academic Counseling System.

    ERIC Educational Resources Information Center

    Zagorski, Henry J.; And Others

    The Computerized Academic Counseling System (CACS) designed by the System Development Corporation is reviewed. Aspects of the system, constructed to assist counselors in guiding undergraduates in the selection of academic majors, which are discussed include: problem definition, system analysis, design rationale, methodology, measurement…

  12. Development of security guidelines for existing healthcare systems.

    PubMed

    Furnell, S M; Sanders, P W; Warren, M J

    1995-01-01

    As modern healthcare establishments become increasingly dependent upon information systems it is vital to ensure that adequate security is present to safeguard the confidentiality and integrity of data and the availability of systems. Whilst this is now generally recognized in the design of new systems, many existing operational systems have been implemented without security in mind. This paper describes the need for a standardized approach in the protection of existing healthcare systems within Europe and presents an overview of a new set of information security guidelines that have been developed specifically for the medical community. The guidelines discussed have been produced as a deliverable of the Commission of European Communities (CEC) SEISMED (Secure Environment for Information Systems in Medicine) project, under the Advanced Informatics in Medicine (AIM) programme.

  13. Academic Support Systems: A Networked Approach.

    ERIC Educational Resources Information Center

    Klingenstein, Kenneth

    1984-01-01

    Academic support systems are characterized as those activities that center around a dean's office--office automation/information systems, institutional research and electronic communication. The basic and design and implementation issues that are encountered in providing these support systems are examined. (Author/MLW)

  14. Primary healthcare information system--the cornerstone for the next generation healthcare sector in Republic of Croatia.

    PubMed

    Koncar, Miroslav; Gvozdanović, Darko

    2006-01-01

    At no time in the history of medicine has the growth in knowledge and technologies been so profound [Crossing the Quality Chasm: A New Health System for the 21st Century, Institute of Medicine (IOM), 2001. ISBN 0-309-07280-8]. However, healthcare delivery systems today are not able to keep up with the pace. Studies have shown that it takes an average of about 17 years for new knowledge generated by randomized trials to be incorporated into practice [B. Andrew, S. Boren, Managing clinical knowledge for health care improvement, in: Yearbook of Medical Informatics, National Library of Medicine, Bethesda, MD, 2000, pp. 65-70]. It is safe to say that today healthcare systems "have the data, but not information". In order to provide highest quality patient care, Republic of Croatia has started the process of introducing enterprise information systems to support business processes in the healthcare domain. Two major requirements are in focus: to provide efficient healthcare related data management in support of decision-making processes; and to support continuous process of healthcare resources spending optimization. The first initiated project refers to Primary Healthcare Information System (PHCIS) that provides domain of primary care with state-of-the-art enterprise information system that connects General Practitioners, Pediatricians and Gynecologists offices with the Croatian Institute for Health Insurance and Public Health Institute. In the years to come, PHCIS will serve as the main integration platform for connecting all other stakeholders and levels of healthcare (e.g. hospitals, pharmacies, laboratories) into single enterprise healthcare network. This article gives an overview of PHCIS, explains challenges that were faced in designing and implementing the system, and elaborates PHCIS role as the cornerstone for the next generation healthcare provisioning in Republic of Croatia.

  15. A Connectivity Framework for Social Information Systems Design in Healthcare

    PubMed Central

    Kuziemsky, Craig E.; Andreev, Pavel; Benyoucef, Morad; O'Sullivan, Tracey; Jamaly, Syam

    2016-01-01

    Social information systems (SISs) will play a key role in healthcare systems’ transformation into collaborative patient-centered systems that support care delivery across the entire continuum of care. SISs enable the development of collaborative networks andfacilitate relationships to integrate people and processes across time and space. However, we believe that a “connectivity” issue, which refers to the scope and extent of system requirements for a SIS, is a significant challenge of SIS design. This paper’s contribution is the development of the Social Information System Connectivity Framework for supporting SIS design in healthcare. The framework has three parts. First, it defines the structure of a SIS as a set of social triads. Second, it identifies six dimensions that represent the behaviour of a SIS. Third, it proposes the Social Information System Connectivity Factor as our approximation of the extent of connectivity and degree of complexity in a SIS. PMID:28269869

  16. 34 CFR 200.3 - Designing State Academic Assessment Systems.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 1 2010-07-01 2010-07-01 false Designing State Academic Assessment Systems. 200.3... State Academic Assessment Systems. (a)(1) For each grade and subject assessed, a State's academic assessment system must— (i) Address the depth and breadth of the State's academic content standards...

  17. An Informatics Blueprint for Healthcare Quality Information Systems

    PubMed Central

    Niland, Joyce C.; Rouse, Layla; Stahl, Douglas C.

    2006-01-01

    There is a critical gap in our nation's ability to accurately measure and manage the quality of medical care. A robust healthcare quality information system (HQIS) has the potential to address this deficiency through the capture, codification, and analysis of information about patient treatments and related outcomes. Because non-technical issues often present the greatest challenges, this paper provides an overview of these socio-technical issues in building a successful HQIS, including the human, organizational, and knowledge management (KM) perspectives. Through an extensive literature review and direct experience in building a practical HQIS (the National Comprehensive Cancer Network Outcomes Research Database system), we have formulated an “informatics blueprint” to guide the development of such systems. While the blueprint was developed to facilitate healthcare quality information collection, management, analysis, and reporting, the concepts and advice provided may be extensible to the development of other types of clinical research information systems. PMID:16622161

  18. Academic Information Systems: From Segregation to Integration.

    ERIC Educational Resources Information Center

    Bernbom, Gerald; And Others

    1992-01-01

    Through integration of administrative information systems across diverse technology platforms and opening access to institutional data, Indiana University has begun to expand the concept of academic information systems. The university's experience has resulted in conclusions and guidelines for other institutions to use in AIS planning and…

  19. Systems modelling approaches to the design of safe healthcare delivery: ease of use and usefulness perceived by healthcare workers.

    PubMed

    Jun, Gyuchan Thomas; Ward, James; Clarkson, P John

    2010-07-01

    The UK health service, which had been diagnosed to be seriously out of step with good design practice, has been recommended to obtain knowledge of design and risk management practice from other safety-critical industries. While these other industries have benefited from a broad range of systems modelling approaches, healthcare remains a long way behind. In order to investigate the healthcare-specific applicability of systems modelling approaches, this study identified 10 distinct methods through meta-model analysis. Healthcare workers' perception on 'ease of use' and 'usefulness' was then evaluated. The characterisation of the systems modelling methods showed that each method had particular capabilities to describe specific aspects of a complex system. However, the healthcare workers found that some of the methods, although potentially very useful, would be difficult to understand, particularly without prior experience. This study provides valuable insights into a better use of the systems modelling methods in healthcare. STATEMENT OF RELEVANCE: The findings in this study provide insights into how to make a better use of various systems modelling approaches to the design and risk management of healthcare delivery systems, which have been a growing research interest among ergonomists and human factor professionals.

  20. A secure steganography for privacy protection in healthcare system.

    PubMed

    Liu, Jing; Tang, Guangming; Sun, Yifeng

    2013-04-01

    Private data in healthcare system require confidentiality protection while transmitting. Steganography is the art of concealing data into a cover media for conveying messages confidentially. In this paper, we propose a steganographic method which can provide private data in medical system with very secure protection. In our method, a cover image is first mapped into a 1D pixels sequence by Hilbert filling curve and then divided into non-overlapping embedding units with three consecutive pixels. We use adaptive pixel pair match (APPM) method to embed digits in the pixel value differences (PVD) of the three pixels and the base of embedded digits is dependent on the differences among the three pixels. By solving an optimization problem, minimal distortion of the pixel ternaries caused by data embedding can be obtained. The experimental results show our method is more suitable to privacy protection of healthcare system than prior steganographic works.

  1. An academic hospitalist model to improve healthcare worker communication and learner education: Results from a quasi-experimental study at a veterans affairs medical center

    PubMed Central

    Saint, Sanjay; Fowler, Karen E; Krein, Sarah L; Flanders, Scott A; Bodnar, Timothy W; Young, Eric; Moseley, Richard H

    2013-01-01

    BACKGROUND Although hospitalists may improve efficiency and quality of inpatient care, their effect on healthcare-worker communication and education has been less well-studied. OBJECTIVE To test various approaches to improving healthcare-worker communication and learner education within the context of a newly designed academic hospital medicine program. DESIGN Before-and-after design with concurrent control group. SETTING A Midwestern Veterans Affairs medical center. INTERVENTION Multimodal systems redesign of 1 of 4 medical teams (Gold team) that included clinical modifications (change in rounding structure, with inclusion of nurses, a Clinical Care Coordinator, and a pharmacist) and educational interventions (providing explicit expectations of learners and providing a reading list for both learners and attending physicians). MEASUREMENTS Number of admissions, length of stay, readmissions, house officer and medical student ratings of attendings' teaching, medical student internal medicine National Board of Medical Examiners Subject Examination (“shelf” exam) scores, and clinical staff surveys. RESULTS Length of stay was reduced by about 0.3 days on all teams after the initiative began (P = 0.004), with no significant differences between Gold and non-Gold teams. The majority of physicians (83%) and nurses (68%) felt that including nurses during rounds improved healthcare-worker communication; significantly more nurses were satisfied with communication with the Gold team than with the other teams (71% vs 53%; P = 0.02). Gold attendings generally received higher teaching scores compared with non-Gold attendings, and third-year medical students on the Gold team scored significantly higher on the shelf exam compared with non–Gold team students (84 vs 82; P = 0.006). CONCLUSIONS Academic hospitalists working within a systems redesign intervention were able to improve healthcare-worker communication and enhance learner education without increasing

  2. An integrated healthcare enterprise information portal and healthcare information system framework.

    PubMed

    Hsieh, S L; Lai, Feipei; Cheng, P H; Chen, J L; Lee, H H; Tsai, W N; Weng, Y C; Hsieh, S H; Hsu, K P; Ko, L F; Yang, T H; Chen, C H

    2006-01-01

    The paper presents an integrated, distributed Healthcare Enterprise Information Portal (HEIP) and Hospital Information Systems (HIS) framework over wireless/wired infrastructure at National Taiwan University Hospital (NTUH). A single sign-on solution for the hospital customer relationship management (CRM) in HEIP has been established. The outcomes of the newly developed Outpatient Information Systems (OIS) in HIS are discussed. The future HEIP blueprints with CRM oriented features: e-Learning, Remote Consultation and Diagnosis (RCD), as well as on-Line Vaccination Services are addressed. Finally, the integrated HEIP and HIS architectures based on the middleware technologies are proposed along with the feasible approaches. The preliminary performance of multi-media, time-based data exchanges over the wireless HEIP side is collected to evaluate the efficiency of the architecture.

  3. Healthcare information system architecture (HISA) and its middleware models.

    PubMed

    Scherrer, J R; Spahni, S

    1999-01-01

    The use of middleware to develop widely distributed healthcare information systems (HIS) has become inevitable. However, the fact that many different platforms, even sometimes heterogeneous to each other, are hooked into the same network makes the integration of various middleware components more difficult than some might believe. This paper discusses the HISA standard and proposes extensions to the model that, in turn, could be compliant with other various existing distributed platforms and their middleware components.

  4. Decision Support Systems for Academic Administration.

    ERIC Educational Resources Information Center

    Moore, Laurence J.; Greenwood, Allen G.

    1984-01-01

    The history and features of Decision Support Systems (DSS) and use of the approach by academic administrators are discussed. The objective of DSS is to involve the manager/decision maker in the decision-analysis process while simultaneously relieving that person of the burden of developing and performing detailed analysis. DSS represents a…

  5. Designing an architectural style for Pervasive Healthcare systems.

    PubMed

    Rafe, Vahid; Hajvali, Masoumeh

    2013-04-01

    Nowadays, the Pervasive Healthcare (PH) systems are considered as an important research area. These systems have a dynamic structure and configuration. Therefore, an appropriate method for designing such systems is necessary. The Publish/Subscribe Architecture (pub/sub) is one of the convenient architectures to support such systems. PH systems are safety critical; hence, errors can bring disastrous results. To prevent such problems, a powerful analytical tool is required. So using a proper formal language like graph transformation systems for developing of these systems seems necessary. But even if software engineers use such high level methodologies, errors may occur in the system under design. Hence, it should be investigated automatically and formally that whether this model of system satisfies all their requirements or not. In this paper, a dynamic architectural style for developing PH systems is presented. Then, the behavior of these systems is modeled and evaluated using GROOVE toolset. The results of the analysis show its high reliability.

  6. Healthcare Analytics: Creating a Prioritized Improvement System with Performance Benchmarking.

    PubMed

    Kolker, Eugene; Kolker, Evelyne

    2014-03-01

    The importance of healthcare improvement is difficult to overstate. This article describes our collaborative work with experts at Seattle Children's to create a prioritized improvement system using performance benchmarking. We applied analytics and modeling approaches to compare and assess performance metrics derived from U.S. News and World Report benchmarking data. We then compared a wide range of departmental performance metrics, including patient outcomes, structural and process metrics, survival rates, clinical practices, and subspecialist quality. By applying empirically simulated transformations and imputation methods, we built a predictive model that achieves departments' average rank correlation of 0.98 and average score correlation of 0.99. The results are then translated into prioritized departmental and enterprise-wide improvements, following a data to knowledge to outcomes paradigm. These approaches, which translate data into sustainable outcomes, are essential to solving a wide array of healthcare issues, improving patient care, and reducing costs.

  7. High level security policies for Healthcare Information Systems.

    PubMed

    Katsikas, Sokratis; Kokolakis, Spyros

    2003-01-01

    Healthcare Establishments (HCE) have are today highly dependent upon Information and Communications Technologies (ICT). This increasing reliance upon ICT has stressed the need to foster security in Healthcare Information Systems (HIS). Security policies may have a significant contribution to this effort, but they could become the cause of portability and interoperability problems. Moreover, policies that fail to take into account all the aspects of HIS security, the legal and regulatory requirements, and the existence of several stakeholders may lead to ineffective or inefficient security measures. Policies of a special category, named Generic Security Policies (GSPs), should be developed to provide policy-level harmonisation and guidance to policy-makers within HCEs. Five such policies are comparatively reviewed herein.

  8. Healthcare information system approaches based on middleware concepts.

    PubMed

    Holena, M; Blobel, B

    1997-01-01

    To meet the challenges for efficient and high-level quality, health care systems must implement the "Shared Care" paradigm of distributed co-operating systems. To this end, both the newly developed and legacy applications must be fully integrated into the care process. These requirements can be fulfilled by information systems based on middleware concepts. In the paper, the middleware approaches HL7, DHE, and CORBA are described. The relevance of those approaches to the healthcare domain is documented. The description presented here is complemented through two other papers in this volume, concentrating on the evaluation of the approaches, and on their security threats and solutions.

  9. Principles for Health System Capacity Planning: Insights for Healthcare Leaders.

    PubMed

    Shaw, James; Wong, Ivy; Griffin, Bailey; Robertson, Michael; Bhatia, R Sacha

    2017-01-01

    Jurisdictions across Canada and around the world face the challenge of planning high-performing and sustainable health systems in response to growing healthcare demands. In this paper, we report on the process of developing principles for health system capacity planning by the Ministry of Health and Long-Term Care in Ontario. Integrating the results of a literature review on health system planning and a symposium with representatives from local health integration networks, we describe the following six principles in detail: (1) develop an aspirational vision, (2) establish clear leadership, (3) commit to stakeholder engagement, (4) engage patients and the public, (5) build analytics infrastructure and (6) revise policy when necessary.

  10. The role of research in integrated healthcare systems: the HMO Research Network.

    PubMed

    Vogt, Thomas M; Elston-Lafata, Jennifer; Tolsma, Dennis; Greene, Sarah M

    2004-09-01

    Science is the basis of medicine. Good science leads to better decisions and more effective systems to support those decisions. Most individuals associate science primarily with academic institutions. However, top-quality research relevant to managing the health of populations and the care of specific clinical conditions is increasingly being carried out by investigators working in integrated healthcare systems. This introduction outlines the activities of the HMO Research Network, whose researchers have made and continue to make important contributions to the field of health research. Its objective is to inform readers of the activities and value of systems-based health research. We describe the importance and extent of the research conducted by HMO Research Network members, as well as the advantages of conducting research in such settings.

  11. Healthcare delivery systems: designing quality into health information systems.

    PubMed

    Joyce, Phil; Green, Rosamund; Winch, Graham

    2007-01-01

    To ensure that quality is 'engineered in' a holistic, integrated and quality approach is required, and Total Quality Management (TQM) principles are the obvious foundations for this. This paper describes a novel approach to viewing the operations of a healthcare provider where electronic means could be used to distribute information (including electronic fund settlements), building around the Full Service Provider core. Specifically, an approach called the "triple pair flow" model is used to provide a view of healthcare delivery that is integrated, yet detailed, and that combines the strategic enterprise view with a business process view.

  12. The holistic architectural approach to integrating the healthcare record in the overall information system.

    PubMed

    Ferrara, F M; Sottile, P A; Grimson, W

    1999-01-01

    The integration and evolution of existing systems represents one of the most urgent problems facing those responsible for healthcare information systems so that the needs of the whole organisation are addressed. The management of the healthcare record represents one of the major requirements in the overall process, however it is also necessary to ensure that the healthcare record and other healthcare information is integrated within the context of an overall healthcare information system. The CEN ENV 12967-1 'Healthcare Information Systems Architecture' standard defines a holistic architectural approach where the various, organisational, clinical, administrative and managerial requirements co-exist and cooperate, relying on a common heritage of information and services. This paper reviews the middleware-based approach adopted by CEN ENV 12967-1 and the specialisation necessary for the healthcare record based on CEN ENV 12265 'Electronic Healthcare Record Architecture'.

  13. What indicates competency in systems based practice? An analysis of perspective consistency among healthcare team members.

    PubMed

    Graham, Mark J; Naqvi, Zoon; Encandela, John A; Bylund, Carma L; Dean, Randa; Calero-Breckheimer, Ayxa; Schmidt, Hilary J

    2009-05-01

    In many parts of the world the practice of medicine and medical education increasingly focus on providing patient care within context of the larger healthcare system. Our purpose is to solicit perceptions of all professional stakeholders (e.g. nurses) of the system regarding the U.S. ACGME competency Systems Based Practice to uncover the extent to which there is agreement or discrepancy among key system stakeholders. Eighty-eight multidisciplinary personnel (n = 88) from two academic medical centers were invited to participate in one of 14 nominal group process sessions. Participants generated and prioritized resident characteristics that they believed were important for effective System Based Practices. Through content analysis the prioritized attribute statements were coded to identify embedded themes of resident roles and behavior. From the themes, three major resident roles emerged: resident as Self-Manager, Team Collaborator, and Patient Advocate. No one professional group (e.g., nurses, attending physicians, social workers) emphasized all of these roles. Some concepts that are emphasized in the ACGME definition like using cost-benefit analysis were conspicuously absent from the healthcare team generated list. We showed that there are gaps between the key stakeholders prioritizations about the ACGME definition of SBP and, more generally, the behaviors and roles identified by healthcare team stakeholders beyond the U.S. This suggests that within the process of developing a comprehensive working understanding of the Systems Based Practice competency (or other similar competencies, such as in CanMEDS), it is necessary to use multiple stakeholders in the system (perhaps including patients) to more accurately identify key resident roles and observable behaviors.

  14. Reforming healthcare systems on a locally integrated basis: is there a potential for increasing collaborations in primary healthcare?

    PubMed Central

    2013-01-01

    . This is with the exception of private medical clinics, where collaborations decreased both outside and within LHNs. Conclusion Health system reforms aimed at creating geographically based networks influenced primary healthcare practices’ both among themselves (horizontal collaborations) and with hospitals (vertical collaborations). There is evidence of increased collaborations within defined geographic areas, particularly among new type of primary healthcare. PMID:23835105

  15. Inequality and the health-care system in the USA.

    PubMed

    Dickman, Samuel L; Himmelstein, David U; Woolhandler, Steffie

    2017-04-08

    Widening economic inequality in the USA has been accompanied by increasing disparities in health outcomes. The life expectancy of the wealthiest Americans now exceeds that of the poorest by 10-15 years. This report, part of a Series on health and inequality in the USA, focuses on how the health-care system, which could reduce income-based disparities in health, instead often exacerbates them. Other articles in this Series address population health inequalities, and the health effects of racism, mass incarceration, and the Affordable Care Act (ACA). Poor Americans have worse access to care than do wealthy Americans, partly because many remain uninsured despite coverage expansions since 2010 due to the ACA. For individuals with private insurance, rising premiums and cost sharing have undermined wage gains and driven many households into debt and even bankruptcy. Meanwhile, the share of health-care resources devoted to care of the wealthy has risen. Additional reforms that move forward, rather than backward, from the ACA are sorely needed to mitigate health and health-care inequalities and reduce the financial burdens of medical care borne by non-wealthy Americans.

  16. Wireless Network of Collaborative Physiological Signal Devices in a U-Healthcare System

    NASA Astrophysics Data System (ADS)

    Jung, Joonyoung; Kim, Daeyoung

    We designed and implemented collaborative physiological signal devices in a u-healthcare(ubiquitous healthcare) system. In this system, wireless body area network (WBAN) such as ZigBee is used to communicate between physiological signal devices and the mobile system. WBAN device needs a specific function for ubiquitous healthcare application. We show several collaborative physiological devices and propose WBAN mechanism such as a fast scanning algorithm, a dynamic discovery and installation mechanism, a reliable data transmission, a device access control for security, and a healthcare profile for u-healthcare system.

  17. The opinions and attitudes of dental school academic staff towards oral healthcare education for older adults.

    PubMed

    Haresaku, S; Mariño, R; Naito, T; Morgan, M V

    2016-08-01

    The term 'oral health care for older adults' has various interpretations, and its meaning is not clear among dental school academic staff. Additionally, there are no theoretical or practical stand-alone courses on oral health care for older adults in Japanese dental schools. To improve oral health care education, we investigated the opinions and attitudes toward oral health care education for older adults among academic staff in dental schools. Data were collected in seven dental schools from May to September 2013 via an online questionnaire survey. Five-hundred-fifty-eight academics (428 male, 130 female) participated (response rate 57%). The average number of years since they had completed a university degree was 20.2 (SD 10.2) years. The majority (Over 90%) of participants perceived that oral health care should be provided in nursing facilities, hospitals, and at home. Its treatments and instructions should include, not only methods of keeping good oral hygiene, but also improvement of oral function such as swallowing training and salivary glands massage. The majority (84.2%) suggested oral health care education should be combined as a one-credit, stand-alone course. Findings indicate that dental academics have an understanding the need for a course in oral health care for older adults. Participants supported the need for further development of education in oral health care for older adults' in Japan, as a separate course on its own right. However there were some different views about content by teaching field. The need for a national core program for teaching oral health care education was suggested.

  18. China's public health-care system: facing the challenges.

    PubMed Central

    Liu, Yuanli

    2004-01-01

    The severe acute respiratory syndrome (SARS) crisis in China revealed not only the failures of the Chinese health-care system but also some fundamental structural deficiencies. A decentralized and fragmented health system, such as the one found in China, is not well-suited to making a rapid and coordinated response to public health emergencies. The commercial orientation of the health sector on the supply-side and lack of health insurance coverage on the demand-side further exacerbate the problems of the under-provision of public services, such as health surveillance and preventive care. For the past 25 years, the Chinese Government has kept economic development at the top of the policy agenda at the expense of public health, especially in terms of access to health care for the 800 million people living in rural areas. A significant increase in government investment in the public health infrastructure, though long overdue, is not sufficient to solve the problems of the health-care system. China needs to reorganize its public health system by strengthening both the vertical and horizontal connections between its various public health organizations. China's recent policy of establishing a matching-fund financed rural health insurance system presents an exciting opportunity to improve people's access to health care. PMID:15500285

  19. IT management and governance systems and their emergence in healthcare.

    PubMed

    Mohrmann, Gregg; Kropf, Roger

    2007-01-01

    Today's healthcare IT departments are challenged with understanding the total service demand imposed by their user communities and how much of their limited resources are available to meet that demand. This challenge is being addressed through the use of new IT management and governance (IT-MG) systems. This software supports IT governance and project and portfolio management. IT-MG is a relatively new term to healthcare; it entails reviewing and managing demand for IT services from inception to completion through the application of IT resources. These systems help save time through automated reporting and quicker delivery of services; they save money by more effectively addressing resource needs on time and on budget. The systems also reduce the number of administrative tasks through process automation; increase customer satisfaction by communicating services and deliverables more quickly and accurately; and help executives make better and more informed decisions about priorities and expectations through reporting that was previously nonexistent. This article will explore IT-MG systems and present a case study of a hospital that rapidly implemented this type of system.

  20. Increasing the safety of healthcare information systems through improved procurement: toward a framework for selection of safe healthcare systems.

    PubMed

    Kushniruk, Andre; Beuscart-Zéphir, Marie-Catherine; Grzes, Alexis; Borycki, Elizabeth; Watbled, Ludivine; Kannry, Joseph

    2010-01-01

    In this article, we describe a framework that we have developed for improving the effectiveness of critical decision-making in selecting information systems. In our framework, we consider system selection in terms of strength of evidence obtained from the testing of candidate systems in order to reduce risk and increase the likelihood of selection and implementation of an effective and safe system. Two case studies, one from a major North American hospital and one from a major European hospital, are presented to illustrate how methods such as usability testing can be applied to improve system selection as well as customization (through early identification of system-organization mismatches and error-prone system features). It is argued that technology-organization fit and consideration of the potential for technology-induced error should be important selection criteria in the procurement process. Here, implications are discussed for the development of improved procurement processes to lead to safer healthcare systems.

  1. The Indiana University Center for Healthcare Innovation and Implementation Science: Bridging healthcare research and delivery to build a learning healthcare system.

    PubMed

    Azar, Jose; Adams, Nadia; Boustani, Malaz

    2015-01-01

    In the United States, it is estimated that 75,000 deaths every year could be averted if the healthcare system implemented high quality care more effectively and efficiently. Patient harm in the hospital occurs as a consequence of inadequate procedures, medications and other therapies, nosocomial infections, diagnostic evaluations and patient falls. Implementation science, a new emerging field in healthcare, is the development and study of methods and tools aimed at enhancing the implementation of new discoveries and evidence into daily healthcare delivery. The Indiana University Center for Healthcare Innovation and Implementation Science (IU-CHIIS) was launched in September 2013 with the mission to use implementation science and innovation to produce great-quality, patient-centered and cost-efficient healthcare delivery solutions for the United States of America. Within the first 24 months of its initiation, the IU-CHIIS successfully scaled up an evidence-based collaborative care model for people with dementia and/or depression, successfully expanded the Accountable Care Unit model positively impacting the efficiency and quality of care, created the first Certificate in Innovation and Implementation Science in the US and secured funding from National Institutes of Health to investigate innovations in dementia care. This article summarizes the establishment of the IU-CHIIS, its impact and outcomes and the lessons learned during the journey.

  2. Policy Capacity in the Learning Healthcare System Comment on "Health Reform Requires Policy Capacity".

    PubMed

    Gardner, William

    2015-08-07

    Pierre-Gerlier Forest and his colleagues make a strong argument for the need to expand policy capacity among healthcare actors. In this commentary, I develop an additional argument in support of Forest et al view. Forest et al rightly point to the need to have embedded policy experts to successfully translate healthcare reform policy into healthcare change. Translation of externally generated innovation policy into local solutions is only one source of healthcare system change. We also need to build learning healthcare systems that can discover new health solutions at the frontline of care. Enhanced policy capacity staffing in those organizations will be key to building continuously learning health systems.

  3. Security of healthcare information systems based on the CORBA middleware.

    PubMed

    Blobel, B; Holena, M

    1997-01-01

    The development of healthcare systems in accordance to the "Shared Care" paradigm results in co-operative health information systems across the boundaries of organisational, technological, and policy domains. Increasingly, these distributed and heterogeneous systems are based on middleware approaches, such as CORBA. Regarding the sensitivity of personal and medical data, such open, distributed, and heterogeneous health information systems demand a high level of data protection and data security, both with respect to patient information and with respect to users. The security concepts and measures available and additionally needed in health information systems based on CORBA architecture are described in this paper. The proposed security solution is also open to other middleware approaches, such as DHE or HL7.

  4. Utah healthcare system watches over Olympians and spectators.

    PubMed

    Rees, Tom

    2002-01-01

    For the first time in Olympic history, a single organization was tapped to provide medical services when Intermountain Health Care (IHC), Salt Lake City, was named for the 2002 Olympic and Paralympic Games in Utah. IHC, a charitable, community owned, integrated, not-for-profit healthcare system serving patients in Utah and Idaho, spent four years developing and implementing a plan to deliver medical services to both Olympians and spectators. Nearly 350 IHC doctors, nurses, physical therapists and other professionals donated their services for the Olympics without compensation as part of their not-for-profit mission. In addition, about 1,000 IHC employees applied to be general volunteers during the games.

  5. Instrumentation system upgrade supports mobile personalized healthcare delivery.

    PubMed

    Ellingson, Roger M; Helt, Wendy J; Kelt, Patrick V; Fausti, Stephen A

    2006-01-01

    Clinicians and patients need mobile tools to detect ototoxic change early and prevent hearing loss. We report on the development of an upgrade of our existing desktop-based clinical-audiological instrumentation into a mobile instrument platform which efficiently supports personalized ototoxicity monitoring on the hospital wards as well as clinic by a trained clinician. Our new wireless-enabled system also serves as the instrumentation platform for the next phase of our work which is remote healthcare delivery with patient-guided at-home ototoxicity monitoring using an evidence-based individualized SRO protocol.

  6. The role of privacy protection in healthcare information systems adoption.

    PubMed

    Hsu, Chien-Lung; Lee, Ming-Ren; Su, Chien-Hui

    2013-10-01

    Privacy protection is an important issue and challenge in healthcare information systems (HISs). Recently, some privacy-enhanced HISs are proposed. Users' privacy perception, intention, and attitude might affect the adoption of such systems. This paper aims to propose a privacy-enhanced HIS framework and investigate the role of privacy protection in HISs adoption. In the proposed framework, privacy protection, access control, and secure transmission modules are designed to enhance the privacy protection of a HIS. An experimental privacy-enhanced HIS is also implemented. Furthermore, we proposed a research model extending the unified theory of acceptance and use of technology by considering perceived security and information security literacy and then investigate user adoption of a privacy-enhanced HIS. The experimental results and analyses showed that user adoption of a privacy-enhanced HIS is directly affected by social influence, performance expectancy, facilitating conditions, and perceived security. Perceived security has a mediating effect between information security literacy and user adoption. This study proposes several implications for research and practice to improve designing, development, and promotion of a good healthcare information system with privacy protection.

  7. The chief nurse executive role in large healthcare systems.

    PubMed

    Englebright, Jane; Perlin, Jonathan

    2008-01-01

    Community hospitals are most frequently led by nonclinicians. Although some may have employed physician leaders, most often clinical leadership is provided by a chief nurse executive (CNE) or chief nursing officer. Clinical leadership of community hospital and health systems may similarly be provided by a system-level nursing executive or, often, by a council of facility CNEs. The increasingly competitive healthcare environment in which value-based purchasing of healthcare and pay-for-performance programs demand improved clinical performance for financial success has led to reconsideration of whether a council model can provide either the leadership or adequate attention to clinical (and operational) improvement. In turn, community hospitals and health systems look to CNE or chief nursing officer roles at the highest level of the organization as resources that are able to segue between the clinical and operational domains, translating clinical performance demands into operating strategies and tactics. This article explores CNE characteristics required for success in these increasingly responsible and visible roles.

  8. Achieving Equity in an Evolving Healthcare System: Opportunities and Challenges.

    PubMed

    Williams, Joni Strom; Walker, Rebekah J; Egede, Leonard E

    2016-01-01

    For decades, disparities in health have been well documented in the United States and regrettably, remain prevalent despite evidence and appeals for their elimination. Compared with the majority, racial and ethnic minorities continue to have poorer health status and health outcomes for most chronic conditions, including diabetes mellitus, cardiovascular disease, cancer and end-stage renal disease. Many factors, such as affordability, access and diversity in the healthcare system, influence care and outcomes, creating challenges that make the task of eliminating health disparities and achieving health equity daunting and elusive. Novel strategies are needed to bring about much needed change in the complex and evolving United States healthcare system. Although not exhaustive, opportunities such as (1) developing standardized race measurements across health systems, (2) implementing effective interventions, (3) improving workforce diversity, (4) using technological advances and (5) adopting practices such as personalized medicine may serve as appropriate starting points for moving toward health equity. Over the past several decades, diversity in the U.S. population has increased significantly and is expected to increase exponentially in the near future. As the population becomes more diverse, it is important to recognize the possibilities of new and emerging disparities. It is imperative that steps are taken to eliminate the current gap in care and prevent new disparities from developing. Therefore, we present challenges and offer recommendations for facilitating the process of eliminating health disparities and achieving health equity across diverse populations.

  9. MEDICARE PAYMENTS AND SYSTEM-LEVEL HEALTH-CARE USE

    PubMed Central

    ROBBINS, JACOB A.

    2015-01-01

    The rapid growth of Medicare managed care over the past decade has the potential to increase the efficiency of health-care delivery. Improvements in care management for some may improve efficiency system-wide, with implications for optimal payment policy in public insurance programs. These system-level effects may depend on local health-care market structure and vary based on patient characteristics. We use exogenous variation in the Medicare payment schedule to isolate the effects of market-level managed care enrollment on the quantity and quality of care delivered. We find that in areas with greater enrollment of Medicare beneficiaries in managed care, the non–managed care beneficiaries have fewer days in the hospital but more outpatient visits, consistent with a substitution of less expensive outpatient care for more expensive inpatient care, particularly at high levels of managed care. We find no evidence that care is of lower quality. Optimal payment policies for Medicare managed care enrollees that account for system-level spillovers may thus be higher than those that do not. PMID:27042687

  10. Wireless health data exchange for home healthcare monitoring systems.

    PubMed

    Lee, Malrey; Gatton, Thomas M

    2010-01-01

    Ubiquitous home healthcare systems have been playing an increasingly significant role in the treatment and management of chronic diseases, such as diabetes and hypertension, but progress has been hampered by the lack of standardization in the exchange of medical health care information. In an effort to establish standardization, this paper proposes a home healthcare monitoring system data exchange scheme between the HL7 standard and the IEEE1451 standard. IEEE1451 is a standard for special sensor networks, such as industrial control and smart homes, and defines a suite of interfaces that communicate among heterogeneous networks. HL7 is the standard for medical information exchange among medical organizations and medical personnel. While it provides a flexible data exchange in health care domains, it does not provide for data exchange with sensors. Thus, it is necessary to develop a data exchange schema to convert data between the HL7 and the IEEE1451 standard. This paper proposes a schema that can exchange data between HL7 devices and the monitoring device, and conforms to the IEEE 1451 standard. The experimental results and conclusions of this approach are presented and show the feasibility of the proposed exchange schema.

  11. Systems Medicine: The Future of Medical Genomics, Healthcare, and Wellness.

    PubMed

    Saqi, Mansoor; Pellet, Johann; Roznovat, Irina; Mazein, Alexander; Ballereau, Stéphane; De Meulder, Bertrand; Auffray, Charles

    2016-01-01

    Recent advances in genomics have led to the rapid and relatively inexpensive collection of patient molecular data including multiple types of omics data. The integration of these data with clinical measurements has the potential to impact on our understanding of the molecular basis of disease and on disease management. Systems medicine is an approach to understanding disease through an integration of large patient datasets. It offers the possibility for personalized strategies for healthcare through the development of a new taxonomy of disease. Advanced computing will be an important component in effectively implementing systems medicine. In this chapter we describe three computational challenges associated with systems medicine: disease subtype discovery using integrated datasets, obtaining a mechanistic understanding of disease, and the development of an informatics platform for the mining, analysis, and visualization of data emerging from translational medicine studies.

  12. Distributed Agent Based Interoperable Virtual EMR System for Healthcare System Integration.

    PubMed

    Yang, Xuebing; Miao, Yuan

    2011-06-01

    One of the major problems in health care system integration is the formidable cost of mediating between myriad vendors and policy makers for updating existing heterogeneous systems to support a great variety of standards or interfaces. To provide cost-effective healthcare system integration solution, this paper presents a Graphical User Interface state model (GUISM) for automatically exchanging information with existing healthcare software through their GUIs with no modifications needed to them. This can save the huge cost of upgrading, testing and redeploying the existing systems. By using the GUISM model, distributed agents are deployed to the client computers interacting with the local electronic medical system (EMR) for communicating with other EMR systems. The whole system is called virtual EMR system and each client in this system can request needed patient healthcare information without knowing the actual location of the data.

  13. Lean healthcare.

    PubMed

    Weinstock, Donna

    2008-01-01

    As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.

  14. The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association.

    PubMed

    Maddox, Thomas M; Albert, Nancy M; Borden, William B; Curtis, Lesley H; Ferguson, T Bruce; Kao, David P; Marcus, Gregory M; Peterson, Eric D; Redberg, Rita; Rumsfeld, John S; Shah, Nilay D; Tcheng, James E

    2017-03-02

    The learning healthcare system uses health information technology and the health data infrastructure to apply scientific evidence at the point of clinical care while simultaneously collecting insights from that care to promote innovation in optimal healthcare delivery and to fuel new scientific discovery. To achieve these goals, the learning healthcare system requires systematic redesign of the current healthcare system, focusing on 4 major domains: science and informatics, patient-clinician partnerships, incentives, and development of a continuous learning culture. This scientific statement provides an overview of how these learning healthcare system domains can be realized in cardiovascular disease care. Current cardiovascular disease care innovations in informatics, data uses, patient engagement, continuous learning culture, and incentives are profiled. In addition, recommendations for next steps for the development of a learning healthcare system in cardiovascular care are presented.

  15. Primary care training and the evolving healthcare system.

    PubMed

    Peccoralo, Lauren A; Callahan, Kathryn; Stark, Rachel; DeCherrie, Linda V

    2012-01-01

    With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. Recruitment methods for medical students include early preclinical exposure to patients in the primary-care setting, enhanced longitudinal patient experiences in clinical clerkships, and primary-care tracks. Recruitment methods for residents include enhanced ambulatory-care training and primary-care programs. Financial-incentive programs such as loan forgiveness may encourage trainees to enter primary care. Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians.

  16. The Pharma Summit 2010: competing in the future healthcare system.

    PubMed

    Kibble, Alexandra

    2010-04-01

    The Pharma Summit 2010, held in London, included topics covering the future changes and developments that are expected in the pharmaceutical industry. This conference report highlights selected presentations on various visions for the future of the pharma industry, the expected revolution in healthcare, changes with patients driving healthcare innovation, the future of healthcare technology, and the outlook for the global economy and emerging markets in the pharma industry.

  17. Identifying healthcare activities using a real-time location system.

    PubMed

    Cagle, Rick; Darling, Erika; Kim, Bo

    2014-01-01

    This article discusses human resource allocation in a Veterans Health Administration audiology clinic as a model for clinics facing similar challenges in maximizing quality, safety, and effectiveness of care. A framework is proposed combining automatic identification technology with simulation and visualization software, asserting a relationship between location of staff within the facility and clinical activity, focusing healthcare staff on high-value activities to deliver safe, quality care. This enables "what-if" analyses of potential resource allocation scenarios, correlating location information from radiofrequency identification tags worn by clinicians and technicians in the clinic as part of a real-time location system, then inferring probable activity from the data. Once the baseline "as-is" can be established, the model will be refined to supply predictive analyses of resource allocation and management. Simulations of activities in specialized spaces saves time managing resources, which means more time can be spent on patient safety and increased satisfaction.

  18. A reliable architectural style for designing pervasive healthcare systems.

    PubMed

    Rafe, Vahid; Hajvali, Masoumeh

    2014-09-01

    The evolution of wireless communication technologies opened the way to the definition of innovative e-Health systems aimed at providing a continuous and remote support to patients and new instruments to improve the workflow of the medical personnel. Nowadays, pervasive healthcare systems are a major step in this regard. The safety-critical systems on one hand and their failure in communication (i.e. sending and receiving messages) in other hand may lead to disaster results in the systems. Moreover, the need for high quality services in such systems, and the access to various types of Quality of Services such as reliability in software development has been increasing in the past years. In this paper, firstly we extend the core meta-model of the previously designed style for designing the structures of such systems in order to reach a high level of reliability in messaging. Secondly, their configuration mechanisms in controlling the communicative errors will be modeled using graph transformation rules. Finally, the correctness of the model is analyzed by model checking techniques. The results of the analysis show its high reliability.

  19. Modeling virtual healthcare systems: methods for qualitative case analysis and sociometry of institutional infrastructures.

    PubMed

    Séror, Ann

    2003-01-01

    The objective of this paper is to present a strategy for the qualitative analysis of virtual institutional infrastructures serving complex healthcare systems. Methodologies considered include case analysis, grounded theory, and sociometry. The discussion is illustrated with references to case analyses of diverse healthcare systems. Particular attention is focused on ideological values expressed in market dynamics and system control structures.

  20. Healthcare chains - enabling application and data privacy controls for healthcare information systems.

    PubMed

    Omran, Esraa; Grandison, Tyrone; Abu Almaati, Shereef

    2010-01-01

    Healthcare applications that have access control, disclosure management and or privacy enforcement requirements may implement the respective solutions to these issues at the application level or at the database level or in both. Unfortunately, there are technical and non-technical factors that influence what can be done. In this paper we present a flexible, simple and novel approach to seamlessly imbuing current healthcare applications and their supporting infrastructure with security and privacy functionality, while being cognizant of these factors. This approach is called the Chain method. This paper will highlight the smaller design footprint, the increased ease of implementation and use of the Chain method, while demonstrating that it is as powerful and effective as traditional methods.

  1. Patient Relationship Management: What the U.S. Healthcare System Can Learn from Other Industries.

    PubMed

    Poku, Michael K; Behkami, Nima A; Bates, David W

    2017-01-01

    As the U.S. healthcare system moves to value-based care, the importance of engaging patients and families continues to intensify. However, simply engaging patients and families to improve their subjective satisfaction will not be enough for providers who want to maximize value. True optimization entails developing deep and long-term relationships with patients. We suggest that healthcare organizations must build such a discipline of "patient relationship management" (PRM) just as companies in non-healthcare industries have done with the concept of customer relationship management (CRM). Some providers have already made strides in this area, but overall it has been underemphasized or ignored by most healthcare systems to date. As healthcare providers work to develop their dedicated PRM systems, tools, and processes, we suggest they may benefit from emulating companies in other industries who have been able to engage their customers in innovative ways while acknowledging the differences between healthcare and other industries.

  2. Patient Education as an Information System, Healthcare Tool and Interaction

    ERIC Educational Resources Information Center

    Pirhonen, Antti; Silvennoinen, Minna; Sillence, Elizabeth

    2014-01-01

    Patient education (PE) has a crucial role in the function of a healthcare organisation. For the care process of a patient, it is essential to get the right information at the right moment and in the right form. This paper analyses PE as the primary mode of interaction between a patient and a healthcare organisation. The approach is illustrated…

  3. China Academic Library and Information System: An Academic Library Consortium in China.

    ERIC Educational Resources Information Center

    Dai, Longji; Chen, Ling; Zhang, Hongyang

    2000-01-01

    Describes CALIS (China Academic Library and Information System), a nationwide academic library consortium funded primarily by the Chinese government to serve multiple resource-sharing functions among the participating libraries, including online searching, interlibrary loan, document delivery, and coordinated purchasing and cataloging, by…

  4. Improving oral healthcare delivery systems through workforce innovations: an introduction.

    PubMed

    Mertz, Elizabeth A; Finocchio, Len

    2010-06-01

    The objective of this paper is to describe the purpose, rationale and key elements of the special issue, Improving Oral Healthcare Delivery Systems through Workforce Innovations. The purpose of the special issue is to further develop ideas presented at the 2009 Institute of Medicine (IOM) workshop, Sufficiency of the U.S. Oral Health Workforce in the Coming Decade. Using the IOM discussions as their starting point, the authors evaluate oral health care delivery system performance for specific populations' needs and explore the roles that the workforce can play in improving the care delivery model. The contributing articles provide a broad framework for stimulating and evaluating innovation and change in the oral health care delivery system. The articles in this special issue point to many deficits in the current oral health care delivery system and provide compelling arguments and proposals for improvements. The issues presented and solutions recommended are not entirely new, but add to a growing body of work that is of critical importance given the context of wider health care reform.

  5. Healthcare systems, the State, and innovation in the pharmaceutical industry.

    PubMed

    Delgado, Ignacio José Godinho

    2016-11-03

    This article discusses the relations between healthcare systems and the pharmaceutical industry, focusing on state support for pharmaceutical innovation. The study highlights the experiences of the United States, United Kingdom, and Germany, developed countries and paradigms of modern health systems (liberal, universal, and corporatist), in addition to Japan, a case of successful catching up. The study also emphasizes the experiences of China, India, and Brazil, large developing countries that have tried different catching up strategies, with diverse histories and profiles in their healthcare systems and pharmaceutical industries. Finally, with a focus on state forms of support for health research, the article addresses the mechanisms for linkage between health systems and the pharmaceutical industry, evaluating the possibilities of Brazil strengthening a virtuous interaction, favoring the expansion and consolidation of the Brazilian health system - universal but segmented ‒ and the affirmation of the innovative national pharmaceutical industry. Resumo: O artigo discute as relações entre os sistemas de saúde e a indústria farmacêutica, concentrando-se no apoio do Estado à inovação farmacêutica. Salienta as trajetórias dos Estados Unidos, Reino Unido e Alemanha, países desenvolvidos, paradigmáticos dos modernos sistemas de saúde (liberais, universais e corporativos), além do Japão, um caso de emparelhamento bem-sucedido. Também enfatiza as trajetórias de China, Índia e Brasil, países em desenvolvimento, extensos, que experimentaram diferentes estratégias de emparelhamento, dispondo de sistemas de saúde e indústrias farmacêuticas com trajetórias e perfis diversos. Finalmente, com foco nas formas estatais de apoio à pesquisa em saúde, considera os mecanismos de conexão entre os sistemas de saúde e a indústria farmacêutica, avaliando as possibilidades, no Brasil, de fortalecer uma interação virtuosa que favoreça a expansão e

  6. Intelligent diagnosis and prescription for a customized physical fitness and healthcare system.

    PubMed

    Huang, Chung-Chi; Liu, Hsiao-Man; Huang, Chung-Lin

    2015-01-01

    With the advent of the era of global high-tech industry and commerce and its associated sedentary lifestyle, opportunities for physical activity are reduced. People's physical fitness and health is deteriorating. Therefore, it is necessary to develop a system that can enhance people's physical fitness and health. However, it is difficult for general physical fitness and healthcare systems to meet individualized needs. The main purpose of this research is to develop a method of intelligent diagnosis and prescription for a customized physical fitness and healthcare system. The proposed system records all processes of the physical fitness and healthcare system via a wireless sensor network and the results of the diagnosis and prescription will be generated by fuzzy logic inference. It will improve individualized physical fitness and healthcare. Finally, we demonstrate the advantages of intelligent diagnosis and prescription for a customized physical fitness and healthcare system.

  7. "Academic Freedom" or "Bottom Line": Public College Healthcare Professionals Teaching in a Global Economy

    ERIC Educational Resources Information Center

    McKnight, Kelly; Muzzin, Linda

    2014-01-01

    College faculty teaching in the health professions work within a unionized, neoliberal system designed to produce competent graduates trained to work in the health care hierarchy. The workers trained include community care assistants, two levels of nurses (practical nurses and baccalaureate nurses, the latter in collaboration with university…

  8. Achieving Equity in an Evolving Healthcare System: Opportunities and Challenges

    PubMed Central

    Williams, Joni Strom; Walker, Rebekah J.; Egede, Leonard E.

    2015-01-01

    For decades, disparities in health have been well documented in the United States and regrettably, remain prevalent despite evidence and appeals for their elimination. Compared to the majority, racial and ethnic minorities continue to have poorer health status and health outcomes for most chronic conditions including diabetes, cardiovascular disease, cancer, and end-stage renal disease. Many factors, such as affordability, access, and diversity in the healthcare system, influence care and outcomes, creating challenges that make the task of eliminating health disparities and achieving health equity daunting and elusive. Novel strategies are needed to bring about much needed change in the complex and evolving United States health care system. Although not exhaustive, opportunities such as 1) developing standardized race measurements across health systems, 2) implementing effective interventions, 3) improving workforce diversity, 4) utilizing technological advances, and 5) adopting practices such as personalized medicine may serve as appropriate starting points for moving towards health equity. Over the past several decades, diversity in the U.S. population has increased significantly and is expected to increase exponentially in the near future. As the population becomes more diverse, it is important to recognize the possibilities of new and emerging disparities. It is imperative that steps are taken to eliminate the current gap in care and prevent new disparities from developing. Therefore, we present challenges and offer recommendations for facilitating the process of eliminating health disparities and achieving health equity across diverse populations. PMID:26802756

  9. The healthcare system and the provision of oral healthcare in European Union member states. Part 7: Republic of Ireland.

    PubMed

    Woods, N; Ahern, S; Burke, F; Eaton, K A; Widström, E

    2017-04-07

    The Irish oral healthcare system is a hybrid model with a public/private mix of service provision, predominantly organised on the basis of fee-per-item remuneration. The system is structured around three long standing publicly funded schemes: the Public Dental Service (PDS) for all children and adults with special needs and provided by salaried dentists, the Dental Treatment Services Scheme (DTSS) for low income adults, and the Dental Treatment Benefit Scheme (DTBS) for insured persons, the latter two both provided by private independent dental practitioners. Ireland introduced systemic water fluoridation in 1963 and currently 73% of the population has access to fluoridated water. Ireland currently has a dentist density ratio of 6.1 dentists per 10,000 inhabitants and on average, 43% of the population (30% for those aged 70+ years) visit a dentist annually. In 2014, 83% of expenditure on oral healthcare was from out-of-pocket payments by patients, with less than 1% of overall government expenditure on healthcare allotted to oral healthcare. After the economic downturn of 2008 and the severe recession that followed in Ireland, substantial cutbacks in government expenditure resulted in extensive cuts to the public sector supply of dental services and to the extent of cover provided by the publicly funded schemes. The Department of Health has recognised the major post recessionary challenges facing the Irish health system, not least, significantly reduced budgets and capacity deficits, and acknowledges the need for change in Ireland's health service. In 2014, a three-year project commenced at the Department of Health, to develop a new national oral health policy for Ireland.

  10. Source characterization of nervous system active pharmaceutical ingredients in healthcare wastewaters

    EPA Science Inventory

    Nervous system active pharmaceutical ingredients (APIs), including anti-depressants and opioids, are important clinically administered pharmaceuticals within healthcare facilities. Concentrations and mass loadings of ten nervous system APIs and three nervous system API metaboli...

  11. Do reviews of healthcare interventions teach us how to improve healthcare systems?

    PubMed

    Pawson, Ray; Greenhalgh, Joanne; Brennan, Cathy; Glidewell, Elizabeth

    2014-08-01

    Planners, managers and policy makers in modern health services are not without ingenuity - they will always try, try and try again. They face deep-seated or 'wicked' problems, which have complex roots in the labyrinthine structures though which healthcare is delivered. Accordingly, the interventions devised to deal with such stubborn problems usually come in the plural. Many different reforms are devised to deal with a particular stumbling block, which may be implemented sequentially, simultaneously or whenever policy fashion or funding dictates. This paper examines this predicament from the perspective of evidence based policy. How might researchers go about reviewing the evidence when they are faced with multiple or indeed competing interventions addressing the same problem? In the face of this plight a rather unheralded form of research synthesis has emerged, namely the 'typological review'. We critically review the fortunes of this strategy. Separating the putative reforms into series of subtypes and producing a scorecard of their outcomes has the unintended effect of divorcing them all from an understanding of how organisations change. A more fruitful approach may lie in a 'theory-driven review' underpinned by an understanding of dynamics of social change in complex organisations. We test this thesis by examining the primary and secondary research on the many interventions designed to tackle a particularly wicked problem, namely the inexorable rise in demand for healthcare.

  12. Quality improvement in healthcare in New Zealand. Part 1: what would a high-quality healthcare system look like?

    PubMed

    Seddon, Mary

    2006-07-07

    This Special Series attempts to define what a high-quality healthcare system would look like for New Zealand. The Series focuses on the dimensions of a quality service - safety, access, equity, effectiveness, efficiency, and patient centeredness - not only elucidating in plain language what these dimensions are, but how they might be measured and improved. The central premise is that clinicians need to become involved in measuring and improving the quality of healthcare provided. To assist clinicians, the Series will cover ways to measure the effectiveness of care they provide with articles on clinical audit and clinical indicators, and also to examine the pros and cons of the measures of efficiency used by the funders - organisational performance indicators, and benchmarking. The Series will wrap up with a vision of how we might continue to improve quality through embedding clinical governance into District Health Boards, so that their performance is measured in both quality and fiscal terms.

  13. How to co-develop services, work, and information systems in healthcare: the daisy approach.

    PubMed

    Korpela, Mikko; Ikävalko, Pauliina; Luukkonen, Irmeli; Martikainen, Susanna; Palmén, Marilla; Tiihonen, Tuija; Toivanen, Marika; Vainikainen, Vilma

    2013-01-01

    Information systems in healthcare need to be designed and developed in a collaborative way. However, existing collaborative methodologies for the parallel development of healthcare work and information systems are vague and fragmented. Furthermore, they neither address people-centred healthcare nor limited-resource contexts. In this paper we introduce an emerging holistic approach, based on a unifying theoretical basis, for co-developing the services, work and information systems in healthcare. The approach intends to (a) be collaborative in nature; (b) address the domains of both healthcare professionals and ordinary people / communities; (c) span the main analysis and design tasks of socio-technical information systems development from needs assessment through requirements setting to functional-architectural solutions; (d) be contextually sensitive; and (e) be practicable in "real life" beyond research settings.

  14. Corruption in health-care systems and its effect on cancer care in Africa.

    PubMed

    Mostert, Saskia; Njuguna, Festus; Olbara, Gilbert; Sindano, Solomon; Sitaresmi, Mei Neni; Supriyadi, Eddy; Kaspers, Gertjan

    2015-08-01

    At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients.

  15. A privacy-strengthened scheme for E-Healthcare monitoring system.

    PubMed

    Huang, Chanying; Lee, Hwaseong; Lee, Dong Hoon

    2012-10-01

    Recent Advances in Wireless Body Area Networks (WBANs) offer unprecedented opportunities and challenges to the development of pervasive electronic healthcare (E-Healthcare) monitoring system. In E-Healthcare system, the processed data are patients' sensitive health data that are directly related to individuals' privacy. For this reason, privacy concern is of great importance for E-Healthcare system. Current existing systems for E-Healthcare services, however, have not yet provided sufficient privacy protection for patients. In order to offer adequate security and privacy, in this paper, we propose a privacy-enhanced scheme for patients' physical condition monitoring, which achieves dual effects: (1) providing unlinkability of health records and individual identity, and (2) supporting anonymous authentication and authorized data access. We also conduct a simulation experiment to evaluate the performance of the proposed scheme. The experimental results demonstrate that the proposed scheme achieves better performance in terms of computational complexity, communication overheads and querying efficiency compared with previous results.

  16. Healthcare is primary.

    PubMed

    Kumar, Raman

    2015-01-01

    India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2(nd) National Conference on Family Medicine and Primary Care 2015 (FMPC) brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care), the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

  17. Mobile healthcare.

    PubMed

    Morgan, Stephen A; Agee, Nancy Howell

    2012-01-01

    Mobile technology's presence in healthcare has exploded over the past five years. The increased use of mobile devices by all segments of the US population has driven healthcare systems, providers, and payers to accept this new form of communication and to develop strategies to implement and leverage the use of mobile healthcare (mHealth) within their organizations and practices. As healthcare systems move toward a more value-driven model of care, patient centeredness and engagement are the keys to success. Mobile healthcare will provide the medium to allow patients to participate more in their care. Financially, mHealth brings to providers the ability to improve efficiency and deliver savings to both them and the healthcare consumer. However, mHealth is not without challenges. Healthcare IT departments have been reluctant to embrace this shift in technology without fully addressing security and privacy concerns. Providers have been hesitant to adopt mHealth as a form of communication with patients because it breaks with traditional models. Our healthcare system has just started the journey toward the development of mHealth. We offer an overview of the mobile healthcare environment and our approach to solving the challenges it brings to healthcare organizations.

  18. Determining research knowledge infrastructure for healthcare systems: a qualitative study

    PubMed Central

    2011-01-01

    Background This study examines research knowledge infrastructures (RKIs) found in health systems. An RKI is defined as any instrument (i.e., programs, interventions, tools) implemented in order to facilitate access, dissemination, exchange, and/or use of evidence in healthcare organisations. Based on an environmental scan (17 key informant interviews) and scoping review (26 studies), we found support for a framework that we developed that outlines components that a health system can have in its RKI. The broad domains are climate for research use, research production, activities used to link research to action, and evaluation. The objective of the current study is to profile the RKI of three types of health system organisations--regional health authorities, primary care practices, and hospitals--in two Canadian provinces to determine the current mix of components these organisations have in their RKI, their experience with these components, and their views about future RKI initiatives. Methods This study will include semistructured telephone interviews with a purposive sample region of a senior management team member, library/resource centre manager, and a 'knowledge broker' in three regional health authorities, five or six purposively sampled hospitals, and five or six primary care practices in Ontario and Quebec, for a maximum of 71 interviewees. The interviews will explore (a) which RKI components have proven helpful, (b) barriers and facilitators in implementing RKI components, and (c) views about next steps in further development of RKIs. Discussion This is the first qualitative examination of potential RKI efforts that can increase the use of research evidence in health system decision making. We anticipate being able to identify broadly applicable insights about important next steps in building effective RKIs. Some of the identified RKI components may increase the use of research evidence by decision makers, which may then lead to more informed decisions

  19. Primary healthcare system and practice characteristics in Singapore.

    PubMed

    Khoo, Hwee Sing; Lim, Yee Wei; Vrijhoef, Hubertus Jm

    2014-01-01

    It is crucial to adapt and improve the (primary) health care systems of countries to prepare for future patient profiles and their related needs. The main aim of this study was to acquire a comprehensive overview of the perceptions of primary care experts in Singapore about the state of primary care in Singapore, and to compare this with the state of primary care in other countries. Notwithstanding ranked 2(nd) in terms of efficiency of health care, Singapore is facing significant health care challenges. Emails were sent to 85 experts, where they were asked to rate Singapore's primary care system based on nine internationally adopted health system characteristics and six practice characteristics (response rate = 29%). The primary care system in Singapore received an average of 10.9 out of 30 possible points. Lowest ratings were given to: earnings of primary care physicians compared to specialists, requirement for 24 hr accessibility of primary care services, standard of family medicine in academic departments, reflection of community served by practices in patient lists, and the access to specialists without needing to be referred by primary care physicians. Singapore was categorized as a 'low' primary care country according to the experts.

  20. A novel web-enabled healthcare solution on health vault system.

    PubMed

    Liao, Lingxia; Chen, Min; Rodrigues, Joel J P C; Lai, Xiaorong; Vuong, Son

    2012-06-01

    Complicated Electronic Medical Records (EMR) systems have created problems in systems regarding an easy implementation and interoperability for a Web-enabled Healthcare Solution, which is normally provided by an independent healthcare giver with limited IT knowledge and interests. An EMR system with well-designed and user-friendly interface, such as Microsoft HealthVault System used as the back-end platform of a Web-enabled healthcare application will be an approach to deal with these problems. This paper analyzes the patient oriented Web-enabled healthcare service application as the new trend to delivery healthcare from hospital/clinic-centric to patient-centric, the current e-healthcare applications, and the main backend EMR systems. Then, we present a novel web-enabled healthcare solution based on Microsoft HealthVault EMR system to meet customers' needs, such as, low total cost, easily development and maintenance, and good interoperability. A sample system is given to show how the solution can be fulfilled, evaluated, and validated. We expect that this paper will provide a deep understanding of the available EMR systems, leading to insights for new solutions and approaches driven to next generation EMR systems.

  1. The role of pharmacoeconomics in current Indian healthcare system.

    PubMed

    Ahmad, Akram; Patel, Isha; Parimilakrishnan, Sundararajan; Mohanta, Guru Prasad; Chung, HaeChung; Chang, Jongwha

    2013-01-01

    Phamacoeconomics can aid the policy makers and the healthcare providers in decision making in evaluating the affordability of and access to rational drug use. Efficiency is a key concept of pharmacoeconomics, and various strategies are suggested for buying the greatest amount of benefits for a given resource use. Phamacoeconomic evaluation techniques such as cost minimization analysis, cost effectiveness analysis, cost benefit analysis, and cost utilization analysis, which support identification and quantification of cost of drugs, are conducted in a similar way, but vary in measurement of value of health benefits and outcomes. This article provides a brief overview about pharmacoeconomics, its utility with respect to the Indian pharmaceutical industry, and the expanding insurance system in India. Pharmacoeconomic evidences can be utilized to support decisions on licensing, pricing, reimbursement, and maintenance of formulary procedure of pharmaceuticals. For the insurance companies to give better facility at minimum cost, India must develop the platform for pharmacoeconomics with a validating methodology and appropriate training. The role of clinical pharmacists including PharmD graduates are expected to be more beneficial than the conventional pharmacists, as they will be able to apply the principles of economics in daily basis practice in community and hospital pharmacy.

  2. Women's wellness club a trusted communications vehicle. Methodist Healthcare system, San Antonio, TX.

    PubMed

    Moore, P

    1997-01-01

    Methodist Healthcare System's long-standing WomanPlus program came in handy when the system announced its new partnership with Columbia/HCA. Already faithful consumers got the news through already established mediums.

  3. It is time to talk about people: a human-centered healthcare system.

    PubMed

    Searl, Meghan M; Borgi, Lea; Chemali, Zeina

    2010-11-26

    Examining vulnerabilities within our current healthcare system we propose borrowing two tools from the fields of engineering and design: a) Reason's system approach 1 and b) User-centered design 23. Both approaches are human-centered in that they consider common patterns of human behavior when analyzing systems to identify problems and generate solutions. This paper examines these two human-centered approaches in the context of healthcare. We argue that maintaining a human-centered orientation in clinical care, research, training, and governance is critical to the evolution of an effective and sustainable healthcare system.

  4. It is time to talk about people: a human-centered healthcare system

    PubMed Central

    2010-01-01

    Examining vulnerabilities within our current healthcare system we propose borrowing two tools from the fields of engineering and design: a) Reason's system approach [1] and b) User-centered design [2,3]. Both approaches are human-centered in that they consider common patterns of human behavior when analyzing systems to identify problems and generate solutions. This paper examines these two human-centered approaches in the context of healthcare. We argue that maintaining a human-centered orientation in clinical care, research, training, and governance is critical to the evolution of an effective and sustainable healthcare system. PMID:21110859

  5. Distrust in the healthcare system and organ donation intentions among African Americans.

    PubMed

    Russell, Emily; Robinson, Dana H Z; Thompson, Nancy J; Perryman, Jennie P; Arriola, Kimberly R Jacob

    2012-02-01

    The purpose of this study is to further understanding of the association between distrust in the healthcare system and written and verbal expressions of donation intentions among African Americans. We hypothesize that distrust in the healthcare system will be significantly, positively associated with both verbal and written donation intentions. Five hundred and eighty five participants completed a 98-item survey that included scales on distrust in the healthcare system and donation intentions. Bivariate analyses (t-tests, ANOVA, chi-square tests and odds ratios) were used to explore the extent to which donation intentions and distrust in the healthcare system varied by demographic characteristics and the association between the distrust in the healthcare system scale and verbal and written donation intentions. Separate logistic regressions were performed with each of the dependent variables to see if significant associations remained while controlling for confounders. Findings based on the multiple regression indicate that when controlling the participant's education level, distrust in the healthcare system was not significantly related to written donation intentions (OR = 1.04; P = .12). When controlling for education level, health insurance status, Community Health Advocates group and marital status, distrust in the healthcare system was significantly associated with verbal donation intentions (OR = 1.08; P < 0.05). Our results suggest that distrust in the healthcare system varies in the way that it is associated with donation intentions. Future organ donation studies should be conducted to determine the pathways through which distrust in the healthcare system impacts different types of organ donation intentions.

  6. Intelligent scheduling of execution for customized physical fitness and healthcare system.

    PubMed

    Huang, Chung-Chi; Liu, Hsiao-Man; Huang, Chung-Lin

    2015-01-01

    Physical fitness and health of white collar business person is getting worse and worse in recent years. Therefore, it is necessary to develop a system which can enhance physical fitness and health for people. Although the exercise prescription can be generated after diagnosing for customized physical fitness and healthcare. It is hard to meet individual execution needs for general scheduling of physical fitness and healthcare system. So the main purpose of this research is to develop an intelligent scheduling of execution for customized physical fitness and healthcare system. The results of diagnosis and prescription for customized physical fitness and healthcare system will be generated by fuzzy logic Inference. Then the results of diagnosis and prescription for customized physical fitness and healthcare system will be scheduled and executed by intelligent computing. The scheduling of execution is generated by using genetic algorithm method. It will improve traditional scheduling of exercise prescription for physical fitness and healthcare. Finally, we will demonstrate the advantages of the intelligent scheduling of execution for customized physical fitness and healthcare system.

  7. A healthcare management system for Turkey based on a service-oriented architecture.

    PubMed

    Herand, Deniz; Gürder, Filiz; Taşkin, Harun; Yuksel, Emre Nuri

    2013-09-01

    The current Turkish healthcare management system has a structure that is extremely inordinate, cumbersome and inflexible. Furthermore, this structure has no common point of view and thus has no interoperability and responds slowly to innovations. The purpose of this study is to show that using which methods can the Turkish healthcare management system provide a structure that could be more modern, more flexible and more quick to respond to innovations and changes taking advantage of the benefits given by a service-oriented architecture (SOA). In this paper, the Turkish healthcare management system is chosen to be examined since Turkey is considered as one of the Third World countries and the information architecture of the existing healthcare management system of Turkey has not yet been configured with SOA, which is a contemporary innovative approach and should provide the base architecture of the new solution. The innovation of this study is the symbiosis of two main integration approaches, SOA and Health Level 7 (HL7), for integrating divergent healthcare information systems. A model is developed which is based on SOA and enables obtaining a healthcare management system having the SSF standards (HSSP Service Specification Framework) developed by the framework of the HSSP (Healthcare Services Specification Project) under the leadership of HL7 and the Object Management Group.

  8. Views of the United States healthcare system: Findings from documentary analysis of an interprofessional education course.

    PubMed

    Bultas, Margaret W; Ruebling, Irma; Breitbach, Anthony; Carlson, Judy

    2016-11-01

    As the healthcare system of the United States becomes more complex, collaboration among health professionals is becoming an essential aspect in improving the health of individuals and populations. An interprofessional education course entitled "Health Care System and Health Promotion" was developed to allow health profession students to work and learn together about issues related to healthcare delivery, health promotion, and the effect of policy issues on key stakeholders in the system. A qualitative document analysis research design was used to evaluate the effect of this interprofessional course on students' views of the current healthcare system of the United States. Fifty-nine student articles were analysed using document analysis. Health professions represented in the sample included occupational therapy, physical therapy, athletic training, nursing, and radiation therapy, nuclear medicine technology, and magnetic resonance imaging. Eight themes were identified including: increased personal awareness, the need for a system change, concern for access, affordability of healthcare, vision for future practice role, need for quality care, the value of interprofessional collaboration (IPC), and the importance of disease prevention. The results of the study suggest that healthcare education can benefit from the integration of Interprofessional Education (IPE) courses into their curriculum especially when teaching content common to all healthcare professions such as healthcare systems and health promotion.

  9. Printable low-cost sensor systems for healthcare smart textiles

    NASA Astrophysics Data System (ADS)

    Rai, Pratyush; Kumar, Prashanth S.; Oh, Sechang; Kwon, Hyeokjun; Mathur, Gyanesh N.; Varadan, Vijay K.

    2011-04-01

    Smart textiles-based wearable health monitoring systems (ST-HMS) have been presented as elegant solutions to the requirements of individuals across a wide range of ages. They can be used to monitor young or elderly recuperating /convalescent patients either in hospital or at home, or they can be used by young athletes to monitor important physiological parameters to better design their training or fitness program. Business and academic interests, all over the world, have fueled a great deal of work in the development of this technology since 1990. However, two important impediments to the development of ST-HMS are:-integration of flexible electrodes, flexible sensors, signal conditioning circuits and data logging or wireless transmission devices into a seamless garment and a means to mass manufacture the same, while keeping the costs low. Roll-to-roll printing and screen printing are two low cost methods for large scale manufacturing on flexible substrates and can be extended to textiles as well. These two methods are, currently, best suited for planar structures. The sensors, integrated with wireless telemetry, facilitate development of a ST-HMS that allows for unobtrusive health monitoring. In this paper, we present our results with planar screen printable sensors based on conductive inks which can be used to monitor EKG, abdominal respiration effort, blood pressure, pulse rate and body temperature. The sensor systems were calibrated, and tested for sensitivity, reliability and robustness to ensure reuse after washing cycles.

  10. Understanding Safety in Healthcare: The System Evolution, Erosion and Enhancement Model

    PubMed Central

    Carthey, Jane

    2013-01-01

    The paper summarises previous theories of accident causation, human error, foresight, resilience and system migration. Five lessons from these theories are used as the foundation for a new model which describes how patient safety emerges in complex systems like healthcare: the System Evolution Erosion and Enhancement model. It is concluded that to improve patient safety, healthcare organisations need to understand how system evolution both enhances and erodes patient safety. Significance for public health The article identifies lessons from previous theories of human error and accident causation, foresight, resilience engineering and system migration and introduces a new framework for understanding patient safety in healthcare; the System Evolution, Erosion and Enhancement (SEEE) model. The article is significant for public health because healthcare organizations around the world need to understand how safety evolves and erodes to develop and implement interventions to reduce patient harm. PMID:25170496

  11. Bringing Big Data to the Forefront of Healthcare Delivery: The Experience of Carolinas HealthCare System.

    PubMed

    Dulin, Michael F; Lovin, Carol A; Wright, Jean A

    2016-01-01

    The use of big data to transform care delivery is rapidly becoming a reality. To deliver on the promise of value-based care, providers must know the key drivers of wellness at the patient and community levels, as well as understand resource constraints and opportunities to improve efficiency in the healthcare system itself. Data are the linchpin. By gathering the right data and finding innovative ways to glean knowledge, we can improve clinical care, advance the health of our communities, improve the lives of our patients, and operate more efficiently. At Carolinas HealthCare System-one of the nation's largest healthcare systems, with nearly 12 million patient encounters annually at more than 900 care locations-we have made substantial investments to establish a centralized data and analytics infrastructure that is transforming the way we deliver care across the continuum. Although the impetus and vision for our program have evolved over the past decade, our efforts coalesced into a strategic, centralized initiative with the launch of the Dickson Advanced Analytics (DA2) group in 2012. DA2 has yielded significant gains in our ability to use data, not only for reporting purposes and understanding our business but also for predicting outcomes and informing action.While these efforts have been successful, the path has not been easy. Effectively harnessing big data requires navigating myriad technological, cultural, operational, and other hurdles. Building a program that is feasible, effective, and sustainable takes concerted effort and a rigorous process of continuous self-evaluation and strategic adaptation.

  12. Bringing Big Data to the Forefront of Healthcare Delivery: The Experience of Carolinas HealthCare System.

    PubMed

    Dulin, Michael F; Lovin, Carol A; Wright, Jean A

    2017-01-01

    The use of big data to transform care delivery is rapidly becoming a reality. To deliver on the promise of value-based care, providers must know the key drivers of wellness at the patient and community levels, as well as understand resource constraints and opportunities to improve efficiency in the health-care system itself. Data are the linchpin. By gathering the right data and finding innovative ways to glean knowledge, we can improve clinical care, advance the health of our communities, improve the lives of our patients, and operate more efficiently. At Carolinas HealthCare System-one of the nation's largest health-care systems, with nearly 12 million patient encounters annually at more than 900 care locations-we have made substantial investments to establish a centralized data and analytics infrastructure that is transforming the way we deliver care across the continuum. Although the impetus and vision for our program have evolved over the past decade, our efforts coalesced into a strategic, centralized initiative with the launch of the Dickson Advanced Analytics (DA) group in 2012. DA has yielded significant gains in our ability to use data, not only for reporting purposes and understanding our business but also for predicting outcomes and informing action.While these efforts have been successful, the path has not been easy. Effectively harnessing big data requires navigating myriad technological, cultural, operational, and other hurdles. Building a program that is feasible, effective, and sustainable takes concerted effort and a rigorous process of continuous self-evaluation and strategic adaptation.

  13. Data Privacy in Cloud-assisted Healthcare Systems: State of the Art and Future Challenges.

    PubMed

    Sajid, Anam; Abbas, Haider

    2016-06-01

    The widespread deployment and utility of Wireless Body Area Networks (WBAN's) in healthcare systems required new technologies like Internet of Things (IoT) and cloud computing, that are able to deal with the storage and processing limitations of WBAN's. This amalgamation of WBAN-based healthcare systems to cloud-based healthcare systems gave rise to serious privacy concerns to the sensitive healthcare data. Hence, there is a need for the proactive identification and effective mitigation mechanisms for these patient's data privacy concerns that pose continuous threats to the integrity and stability of the healthcare environment. For this purpose, a systematic literature review has been conducted that presents a clear picture of the privacy concerns of patient's data in cloud-assisted healthcare systems and analyzed the mechanisms that are recently proposed by the research community. The methodology used for conducting the review was based on Kitchenham guidelines. Results from the review show that most of the patient's data privacy techniques do not fully address the privacy concerns and therefore require more efforts. The summary presented in this paper would help in setting research directions for the techniques and mechanisms that are needed to address the patient's data privacy concerns in a balanced and light-weight manner by considering all the aspects and limitations of the cloud-assisted healthcare systems.

  14. Academic Literacies and Systemic Functional Linguistics: How Do They Relate?

    ERIC Educational Resources Information Center

    Coffin, Caroline; Donohue, James P.

    2012-01-01

    Two approaches to English for Academic Purposes (EAP) research and teaching which have arisen in recent years are systemic functional linguistics (SFL) approaches in Australia and elsewhere (e.g. Hood, 2006; Lee, 2010; Woodward-Kron, 2009) and Academic Literacies approaches in the UK and elsewhere (e.g. Lillis & Scott, 2008; Thesen &…

  15. Software engineering principles applied to large healthcare information systems--a case report.

    PubMed

    Nardon, Fabiane Bizinella; de A Moura, Lincoln

    2007-01-01

    São Paulo is the largest city in Brazil and one of the largest cities in the world. In 2004, São Paulo City Department of Health decided to implement a Healthcare Information System to support managing healthcare services and provide an ambulatory health record. The resulting information system is one of the largest public healthcare information systems ever built, with more than 2 million lines of code. Although statistics shows that most software projects fail, and the risks for the São Paulo initiative were enormous, the information system was completed on-time and on-budget. In this paper, we discuss the software engineering principles adopted that allowed to accomplish that project's goals, hoping that sharing the experience of this project will help other healthcare information systems initiatives to succeed.

  16. Applying analytic hierarchy process to assess healthcare-oriented cloud computing service systems.

    PubMed

    Liao, Wen-Hwa; Qiu, Wan-Li

    2016-01-01

    Numerous differences exist between the healthcare industry and other industries. Difficulties in the business operation of the healthcare industry have continually increased because of the volatility and importance of health care, changes to and requirements of health insurance policies, and the statuses of healthcare providers, which are typically considered not-for-profit organizations. Moreover, because of the financial risks associated with constant changes in healthcare payment methods and constantly evolving information technology, healthcare organizations must continually adjust their business operation objectives; therefore, cloud computing presents both a challenge and an opportunity. As a response to aging populations and the prevalence of the Internet in fast-paced contemporary societies, cloud computing can be used to facilitate the task of balancing the quality and costs of health care. To evaluate cloud computing service systems for use in health care, providing decision makers with a comprehensive assessment method for prioritizing decision-making factors is highly beneficial. Hence, this study applied the analytic hierarchy process, compared items related to cloud computing and health care, executed a questionnaire survey, and then classified the critical factors influencing healthcare cloud computing service systems on the basis of statistical analyses of the questionnaire results. The results indicate that the primary factor affecting the design or implementation of optimal cloud computing healthcare service systems is cost effectiveness, with the secondary factors being practical considerations such as software design and system architecture.

  17. Integrating Social impacts on Health and Health-Care Systems in Systemic Seismic Vulnerability Analysis

    NASA Astrophysics Data System (ADS)

    Kunz-Plapp, T.; Khazai, B.; Daniell, J. E.

    2012-04-01

    This paper presents a new method for modeling health impacts caused by earthquake damage which allows for integrating key social impacts on individual health and health-care systems and for implementing these impacts in quantitative systemic seismic vulnerability analysis. In current earthquake casualty estimation models, demand on health-care systems is estimated by quantifying the number of fatalities and severity of injuries based on empirical data correlating building damage with casualties. The expected number of injured people (sorted by priorities of emergency treatment) is combined together with post-earthquake reduction of functionality of health-care facilities such as hospitals to estimate the impact on healthcare systems. The aim here is to extend these models by developing a combined engineering and social science approach. Although social vulnerability is recognized as a key component for the consequences of disasters, social vulnerability as such, is seldom linked to common formal and quantitative seismic loss estimates of injured people which provide direct impact on emergency health care services. Yet, there is a consensus that factors which affect vulnerability and post-earthquake health of at-risk populations include demographic characteristics such as age, education, occupation and employment and that these factors can aggravate health impacts further. Similarly, there are different social influences on the performance of health care systems after an earthquake both on an individual as well as on an institutional level. To link social impacts of health and health-care services to a systemic seismic vulnerability analysis, a conceptual model of social impacts of earthquakes on health and the health care systems has been developed. We identified and tested appropriate social indicators for individual health impacts and for health care impacts based on literature research, using available European statistical data. The results will be used to

  18. Potentiality of Big Data in the Medical Sector: Focus on How to Reshape the Healthcare System

    PubMed Central

    Jee, Kyoungyoung

    2013-01-01

    Objectives The main purpose of this study was to explore whether the use of big data can effectively reduce healthcare concerns, such as the selection of appropriate treatment paths, improvement of healthcare systems, and so on. Methods By providing an overview of the current state of big data applications in the healthcare environment, this study has explored the current challenges that governments and healthcare stakeholders are facing as well as the opportunities presented by big data. Results Insightful consideration of the current state of big data applications could help follower countries or healthcare stakeholders in their plans for deploying big data to resolve healthcare issues. The advantage for such follower countries and healthcare stakeholders is that they can possibly leapfrog the leaders' big data applications by conducting a careful analysis of the leaders' successes and failures and exploiting the expected future opportunities in mobile services. Conclusions First, all big data projects undertaken by leading countries' governments and healthcare industries have similar general common goals. Second, for medical data that cuts across departmental boundaries, a top-down approach is needed to effectively manage and integrate big data. Third, real-time analysis of in-motion big data should be carried out, while protecting privacy and security. PMID:23882412

  19. Seeking perfection in healthcare. A case study in adopting Toyota Production System methods.

    PubMed

    Kaplan, Gary S; Patterson, Sarah H

    2008-01-01

    Virginia Mason Health System's vision to be the quality leader in healthcare means continually adopting new ways of thinking. One change has been shifting from believing defects are to be expected to believing zero defects in healthcare is not only possible, but also necessary. Generally, healthcare has advanced in technology and understanding of disease, but its business and management systems have changed little since the 1950s. Virginia Mason realized it needed a management method to help make real and measurable improvements in safety, quality, service and staff satisfaction.

  20. [The origins of the basic healthcare system in Brazil: the District System of Sanitation Administration].

    PubMed

    Campos, Carlos Eduardo Aguilera

    2007-01-01

    There exists an interaction between multiple issues involving policy making, the building of knowledge and the implementation of practices in the health sector, which results in the particular way health services are provided in different historical contexts. The emergence and consolidation of sanitation organization was the result of a political process based on an idea of meeting the needs perceived in a given historical context. The historical course taken by the basic healthcare system in Brazil is analyzed from the perspective of its organizational and welfare principles, its expansion in physical terms, and its function within the public health system between 1918 and 1942. The article seeks to describe in detail the antecedents and initiatives taken in the establishment of a district system of sanitation administration, first in Rio de Janeiro and later across Brazil, which was a precursor of the basic healthcare system in Brazil.

  1. Building a sustainable clinical academic workforce to meet the future healthcare needs of Australia and New Zealand: report from the first summit meeting.

    PubMed

    Windsor, J; Searle, J; Hanney, R; Chapman, A; Grigg, M; Choong, P; Mackay, A; Smithers, B M; Churchill, J A; Carney, S; Smith, J A; Wainer, Z; Talley, N J; Gladman, M A

    2015-09-01

    The delivery of healthcare that meets the requirements for quality, safety and cost-effectiveness relies on a well-trained medical workforce, including clinical academics whose career includes a specific commitment to research, education and/or leadership. In 2011, the Medical Deans of Australia and New Zealand published a review on the clinical academic workforce and recommended the development of an integrated training pathway for clinical academics. A bi-national Summit on Clinical Academic Training was recently convened to bring together all relevant stakeholders to determine how best to do this. An important part understood the lessons learnt from the UK experience after 10 years since the introduction of an integrated training pathway. The outcome of the summit was to endorse strongly the recommendations of the medical deans. A steering committee has been established to identify further stakeholders, solicit more information from stakeholder organisations, convene a follow-up summit meeting in late 2015, recruit pilot host institutions and engage the government and future funders.

  2. 2006 Foster G. McGaw Prize winner: memorial healthcare system, Hollywood, Fla.

    PubMed

    Thrall, Terese Hudson

    2007-04-01

    Memorial Healthcare System in Hollywood, Fla., is receiving well-deserved national recognition for its myriad community benefit programs, from public housing improvements to prenatal care for uninsured mothers-to-be.

  3. Bosnia and Herzegovina Healthcare System Preparedness for Pandemic Influenza as of 2010

    PubMed Central

    Begic, Almir; Pilav, Aida; Dzananovic, Lejla; Cavaljuga, Semra

    2013-01-01

    Objectives: To determine if Bosnia and Herzegovina healthcare system is prepared for influenza pandemic; and to indicate strengths and weaknesses in planed resolution of pandemic influenza in Bosnia and Herzegovina healthcare system. Methodology: Qualitative systematic review, comparing established elements of healthcare systems with WHO’s guidelines on pandemic preparedness. Critical evaluations of available findings on preparedness of healthcare system of Bosnia and Herzegovina (B&H) compared in details to preparedness of healthcare system of United Kingdom (UK) but in certain elements with some other European countries. Results and Discussion: Analysis of preparedness plans of B&H and UK are presented in details, with comparison of B&H with eight other countries by WHO guidelines categories and phases of pandemic preparedness and contingency plans. Conclusions: Disregarding the obstacles in B&H health care system policy Bosnia and Herzegovina has preparedness plans, that are made based on WHO’s guidelines but unlike all other analyzed countries does not have contingency plan. This can be seen as strength while weaknesses of B&H’s healthcare system are: late forming of preparedness plan with poor implementation of set activities, and lack of contingency plan. PMID:24511267

  4. Healthcare information exchange system based on a hybrid central/federated model.

    PubMed

    Ghane, Kamran

    2014-01-01

    The quality of care can be significantly enhanced and healthcare cost can be substantially reduced if healthcare providers can have access to patient records that are scattered among several paper and electronic based systems. Major challenges of Healthcare Information Exchange result from patient's medical records being kept in several healthcare provider offices, clinics and hospitals in different formats. There are two major problems with healthcare information retrieval. The first problem is lack of visibility and knowledge as to where patient's medical records reside. The second problem is lack of access to information and also incompatibility of data formats. A considerable coverage of Electronic Information Exchange among Electronic Health Record (EHR) systems remains to be implemented despite extensive standardization efforts toward providing solutions. The adoption pace of available standards and solutions has been slow with the exception of some public/government entities. This paper describes a comprehensive and practical solution based on a distributed system with independent subsystems that control and manage processes and data flow of information exchange. The Registrar Subsystem creates a directory of healthcare providers and patients. The Security Subsystem provides authentication and authorization services across all subsystems. The Locators address patient and medical location lookup. The Agents act on behalf of healthcare providers to communicate with other subsystems. The Mediators facilitate information retrieval. The Solution comprises of three levels of participation that allows healthcare providers to join the system easily by starting from basic semi-manual information exchange level and then migrating to a fully electronic and automated information exchange. The Solution is modeled based on variety of standards and protocols used in Internet and other application fields as well as healthcare specific standards and proposals.

  5. Interoperability of a mobile health care solution with electronic healthcare record systems.

    PubMed

    De Toledo, P; Lalinde, W; Del Pozo, F; Thurber, D; Jimenez-Fernandez, S

    2006-01-01

    Mobile health care solutions involving patient monitoring are an increasingly accepted element in chronic disease management strategies. When used in healthcare systems with different providers, it is essential that the information gathered from the patient is available at each of these providers information repositories. This paper describes the design of a connectivity interface based on the HL7 standard that allows the MOTOHEALTH mobile health care solution to communicate with external electronic healthcare record systems supporting HL7.

  6. Specific factors influencing information system/information and communication technology sourcing strategies in healthcare facilities.

    PubMed

    Potančok, Martin; Voříšek, Jiří

    2016-09-01

    Healthcare facilities use a number of information system/information and communication technologies. Each healthcare facility faces a need to choose sourcing strategies most suitable to ensure provision of information system/information and communication technology services, processes and resources. Currently, it is possible to observe an expansion of sourcing possibilities in healthcare informatics, which creates new requirements for sourcing strategies. Thus, the aim of this article is to identify factors influencing information system/information and communication technology sourcing strategies in healthcare facilities. The identification was based on qualitative research, namely, a case study. This study provides a set of internal and external factors with their impact levels. The findings also show that not enough attention is paid to these factors during decision-making.

  7. The application of the unified modeling language in object-oriented analysis of healthcare information systems.

    PubMed

    Aggarwal, Vinod

    2002-10-01

    This paper concerns itself with the beneficial effects of the Unified Modeling Language (UML), a nonproprietary object modeling standard, in specifying, visualizing, constructing, documenting, and communicating the model of a healthcare information system from the user's perspective. The author outlines the process of object-oriented analysis (OOA) using the UML and illustrates this with healthcare examples to demonstrate the practicality of application of the UML by healthcare personnel to real-world information system problems. The UML will accelerate advanced uses of object-orientation such as reuse technology, resulting in significantly higher software productivity. The UML is also applicable in the context of a component paradigm that promises to enhance the capabilities of healthcare information systems and simplify their management and maintenance.

  8. Promoting patient-centred fundamental care in acute healthcare systems.

    PubMed

    Feo, Rebecca; Kitson, Alison

    2016-05-01

    Meeting patients' fundamental care needs is essential for optimal safety and recovery and positive experiences within any healthcare setting. There is growing international evidence, however, that these fundamentals are often poorly executed in acute care settings, resulting in patient safety threats, poorer and costly care outcomes, and dehumanising experiences for patients and families. Whilst care standards and policy initiatives are attempting to address these issues, their impact has been limited. This discussion paper explores, through a series of propositions, why fundamental care can be overlooked in sophisticated, high technology acute care settings. We argue that the central problem lies in the invisibility and subsequent devaluing of fundamental care. Such care is perceived to involve simple tasks that require little skill to execute and have minimal impact on patient outcomes. The propositions explore the potential origins of this prevailing perception, focusing upon the impact of the biomedical model, the consequences of managerial approaches that drive healthcare cultures, and the devaluing of fundamental care by nurses themselves. These multiple sources of invisibility and devaluing surrounding fundamental care have rendered the concept underdeveloped and misunderstood both conceptually and theoretically. Likewise, there remains minimal role clarification around who should be responsible for and deliver such care, and a dearth of empirical evidence and evidence-based metrics. In explicating these propositions, we argue that key to transforming the delivery of acute healthcare is a substantial shift in the conceptualisation of fundamental care. The propositions present a cogent argument that counters the prevailing perception that fundamental care is basic and does not require systematic investigation. We conclude by calling for the explicit valuing and embedding of fundamental care in healthcare education, research, practice and policy. Without this

  9. Vaccination: the cornerstone of an efficient healthcare system

    PubMed Central

    Rémy, Vanessa; Zöllner, York; Heckmann, Ulrike

    2015-01-01

    Vaccination has made an important contribution to the decreased incidence of numerous infectious diseases and associated mortality. In 2013, it was estimated that 103 million cases of childhood diseases in the United States had been prevented by the use of vaccines since 1924. These health effects translate into positive economic results, as vaccination can provide significant savings by avoiding the direct and indirect costs associated with treating the disease and possible long-term disability. A recent US study estimated that every dollar spent on childhood vaccination could save US$3 from a payer perspective and US$10 from a societal perspective. The first vaccines set a high standard from a public health ‘return on investment’ perspective, because they are highly cost-saving. Today, however, where only a few healthcare interventions are considered to be cost-saving, the challenge that decision-makers typically face is to identify such healthcare interventions that are deemed cost-effective, that is, provide extra benefit at a reasonable extra cost. Some of the newer vaccines provide a solution to some of today's important health issues, such as cervical cancers with human papillomavirus vaccines, or debilitating diseases with herpes zoster vaccines. These recent, more expensive vaccines have been shown to be cost-effective in several economic analyses. Overall, vaccination can still be regarded as one of the most cost-effective healthcare interventions. PMID:27123189

  10. ICT use for information management in healthcare system for chronic disease patient

    NASA Astrophysics Data System (ADS)

    Wawrzyniak, Zbigniew M.; Lisiecka-Biełanowicz, Mira

    2013-10-01

    Modern healthcare systems are designed to fulfill needs of the patient, his system environment and other determinants of the treatment with proper support of technical aids. A whole system of care is compatible to the technical solutions and organizational framework based on legal rules. The purpose of this study is to present how can we use Information and Communication Technology (ICT) systemic tools in a new model of patient-oriented care, improving the effectiveness of healthcare for patients with chronic diseases. The study material is the long-term process of healthcare for patients with chronic illness. Basing on the knowledge of the whole circumstances of patient's ecosystem and his needs allow us to build a new ICT model of long term care. The method used is construction, modeling and constant improvement the efficient ICT layer for the patient-centered healthcare model. We present a new constructive approach to systemic process how to use ICT for information management in healthcare system for chronic disease patient. The use of ICT tools in the model for chronic disease can improve all aspects of data management and communication, and the effectiveness of long-term complex healthcare. In conclusion: ICT based model of healthcare can be constructed basing on the interactions of ecosystem's functional parts through information feedback and the provision of services and models as well as the knowledge of the patient itself. Systematic approach to the model of long term healthcare assisted functionally by ICT tools and data management methods will increase the effectiveness of patient care and organizational efficiency.

  11. How secure is your information system? An investigation into actual healthcare worker password practices.

    PubMed

    Cazier, Joseph A; Medlin, B Dawn

    2006-09-27

    For most healthcare information systems, passwords are the first line of defense in keeping patient and administrative records private and secure. However, this defense is only as strong as the passwords employees chose to use. A weak or easily guessed password is like an open door to the medical records room, allowing unauthorized access to sensitive information. In this paper, we present the results of a study of actual healthcare workers' password practices. In general, the vast majority of these passwords have significant security problems on several dimensions. Implications for healthcare professionals are discussed.

  12. How Secure Is Your Information System? An Investigation into Actual Healthcare Worker Password Practices

    PubMed Central

    Cazier, Joseph A; Medlin, B. Dawn

    2006-01-01

    For most healthcare information systems, passwords are the first line of defense in keeping patient and administrative records private and secure. However, this defense is only as strong as the passwords employees chose to use. A weak or easily guessed password is like an open door to the medical records room, allowing unauthorized access to sensitive information. In this paper, we present the results of a study of actual healthcare workers' password practices. In general, the vast majority of these passwords have significant security problems on several dimensions. Implications for healthcare professionals are discussed. PMID:18066366

  13. THE DESIGN OF PERFORMANCE MONITORING SYSTEMS IN HEALTHCARE ORGANIZATIONS: A STAKEHOLDER PERSPECTIVE.

    PubMed

    Rouhana, Rima E; Van Caillie, Didier

    2016-01-01

    Monitoring hospitals performance is evolving over time in search of more efficiency by integrating additional levels of care, reducing costs and keeping staff up-to-date. To fulfill these three potentially divergent aspects and to monitor performance, healthcare administrators are using dissimilar management control tools. To explain why, we suggest to go beyond traditional contingent factors to assess the role of the different stakeholders that are at the heart of any healthcare organization. We rely first on seminal studies to appraise the role of the main healthcare players and their influence on some organizational attributes. We then consider the managerial awareness and the perception of a suitable management system to promote a strategy-focused organization. Our methodology is based on a qualitative approach of twenty-two case studies, led in two heterogeneous environments (Belgium and Lebanon), comparing the managerial choice of a management system within three different healthcare organizational structures. Our findings allow us to illustrate, for each healthcare player, his positioning within the healthcare systems. Thus, we define how his role, perception and responsiveness manipulate the organization's internal climate and shape the design of the performance monitoring systems. In particular, we highlight the managerial role and influence on the choice of an adequate management system.

  14. Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil.

    PubMed

    Vargas, Ingrid; Mogollón-Pérez, Amparo Susana; De Paepe, Pierre; Ferreira da Silva, Maria Rejane; Unger, Jean-Pierre; Vázquez, María-Luisa

    2016-07-01

    Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen

  15. Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil

    PubMed Central

    Vargas, Ingrid; Mogollón-Pérez, Amparo Susana; De Paepe, Pierre; Ferreira da Silva, Maria Rejane; Unger, Jean-Pierre; Vázquez, María-Luisa

    2016-01-01

    Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel’ perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive–interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives

  16. System-Level Reform in Healthcare Delivery for Patients and Populations Living with Chronic Disease.

    PubMed

    Wedge, Richard; Currie, Douglas W

    2016-01-01

    Healthcare in Canada has generally not kept pace with the evolving needs of patients since the creation of medicare in the 1960s. Budgets for hospitals, physicians and prescription drugs make up the bulk of spending in health, despite the need for better prevention and management of chronic disease, the needed expansion of home-based care services and the call for reform of front-line primary care. Over the past decade, a number of Canadian health authorities have adopted the US-based Institute for Healthcare Improvement Triple Aim philosophy (better population health, better patient experience and better per capita cost of care) in order to build system-level change. The Atlantic Healthcare Collaboration was one attempt to initiate system-level reform in healthcare delivery for patients living with chronic disease.

  17. The healthcare system and the provision of oral healthcare in EU Member States: France.

    PubMed

    Pegon-Machat, E; Faulks, D; Eaton, K A; Widström, E; Hugues, P; Tubert-Jeannin, S

    2016-02-26

    The French oral health system is based on the provision of dental treatment and is organised around a fee-per-item model. The system is funded by a complex mix of public and complementary health insurance schemes. The system is successful in that it provides access to affordable dental treatment to the majority of the French population. However, France had the highest health expenditure as a share of gross domestic product (GDP) of all European Union countries in 2008 and rising oral health inequalities may be exacerbated by the manner in which oral health care is provided and funded. In addition, there is no organised national strategy for the prevention of oral diseases or for oral health promotion.

  18. X-PAT: a multiplatform patient referral data management system for small healthcare institution requirements.

    PubMed

    Masseroli, Marco; Marchente, Mario

    2008-07-01

    We present X-PAT, a platform-independent software prototype that is able to manage patient referral multimedia data in an intranet network scenario according to the specific control procedures of a healthcare institution. It is a self-developed storage framework based on a file system, implemented in eXtensible Markup Language (XML) and PHP Hypertext Preprocessor Language, and addressed to the requirements of limited-dimension healthcare entities (small hospitals, private medical centers, outpatient clinics, and laboratories). In X-PAT, healthcare data descriptions, stored in a novel Referral Base Management System (RBMS) according to Health Level 7 Clinical Document Architecture Release 2 (CDA R2) standard, can be easily applied to the specific data and organizational procedures of a particular healthcare working environment thanks also to the use of standard clinical terminology. Managed data, centralized on a server, are structured in the RBMS schema using a flexible patient record and CDA healthcare referral document structures based on XML technology. A novel search engine allows defining and performing queries on stored data, whose rapid execution is ensured by expandable RBMS indexing structures. Healthcare personnel can interface the X-PAT system, according to applied state-of-the-art privacy and security measures, through friendly and intuitive Web pages that facilitate user acceptance.

  19. Careers in Academe: The Academic Labour Market as an Eco-System

    ERIC Educational Resources Information Center

    Baruch, Yehuda

    2013-01-01

    Purpose: This paper aims to explore the contrast between stable and dynamic labour markets in academe in light of career theories that were originally developed for business environments. Design/methodology/approach: A conceptual design, offering the eco-system as a framework. Findings: It evaluates their relevance and applicability to dynamic and…

  20. Academic Counselling in ODL: Information System for Capacity Building of Academic Counselors' in IGNOU

    ERIC Educational Resources Information Center

    Kishore, S.

    2014-01-01

    Indira Gandhi national Open University (IGNOU) is an apex body for open and distance learning (ODL) system in India. The university has nation-wide operation and pioneer in distance education. IGNOU has an hqrs, 67 Regional Centres and about 3400 Study Centres throughout India. The study centres are the academic contact point for distance learners…

  1. Healthcare IT system in the midst of and after Great East Japan Earthquake Disaster : Grand design for reconstruction of Tohoku-region healthcare IT system

    NASA Astrophysics Data System (ADS)

    Tanaka, Hiroshi

    In this article, we described what was really going in the disaster medical care at the Great East Japan Earthquake, mainly in Ishinomaki and Kesen-numa areas. As for exchange tools of the disaster information, in contrast to the breakdown of fixed-line and mobile phone, MCA radio system, satellite mobiles and internet, especially SNS, were greatly helpful. Learned from the disaster experiences, we are making the grand design for “disaster-robust” regional healthcare IT systems, which are composed of (1) cloud center storing whole-prefecture medical records, (2) SS-MIX based regional healthcare information systems of “the second medical care zones”, (3) ASP/SaaS typed electronic medical record system for all clinics located at Pacific coastal areas, and (4) wireless communication environment supporting comprehensive care of elderly for daily living activities.

  2. Return Migrants’ Experience of Access to Care in Corrupt Healthcare Systems: The Bosnian Example

    PubMed Central

    Neerup Handlos, Line; Fog Olwig, Karen; Bygbjerg, Ib Christian; Norredam, Marie

    2016-01-01

    Equal and universal access to healthcare services is a core priority for a just health system. A key societal determinant seen to create inequality in access to healthcare is corruption in the healthcare system. How return migrants’ access to healthcare is affected by corruption is largely unstudied, even though return migrants may be particularly vulnerable to problems related to corruption due to their period of absence from their country of origin. This article investigates how corruption in the healthcare sector affects access to healthcare for refugees who repatriated to Bosnia, a country with a high level of corruption, from Denmark, a country with a low level of corruption. The study is based on 18 semi-structured interviews with 33 refugees who returned after long-term residence in Denmark. We found that the returned refugees faced greater problems with corruption than was the case for those who had not left the country, as doctors considered them to be better endowed financially and therefore demanded larger bribes from them than they did from those who had remained in Bosnia. Moreover, during their stay abroad the returnees had lost the connections that could have helped them sidestep the corruption. Returned refugees are thus particularly vulnerable to the effects of corruption. PMID:27657096

  3. Web-Based Integrated Public Healthcare Information System of Korea: Development and Performance

    PubMed Central

    Park, Minsu; Lee, Jaegook; Kim, Sung-Soo; Han, Bum Soo; Mo, Kyoung Chun; Lee, Hyung Seok

    2013-01-01

    Objectives The Web-based integrated public healthcare information system (PHIS) of Korea was planned and developed from 2005 to 2010, and it is being used in 3,501 regional health organizations. This paper introduces and discusses development and performance of the system. Methods We reviewed and examined documents about the development process and performance of the newly integrated PHIS. The resources we analyzed the national plan for public healthcare, information strategy for PHIS, usage and performance reports of the system. Results The integrated PHIS included 19 functional business areas, 47 detailed health programs, and 48 inter-organizational tasks. The new PHIS improved the efficiency and effectiveness of the business process and inter-organizational business, and enhanced user satisfaction. Economic benefits were obtained from five categories: labor, health education and monitoring, clinical information management, administration and civil service, and system maintenance. The system was certified by a patent from the Korean Intellectual Property Office and accredited as an ISO 9001. It was also reviewed and received preliminary comments about its originality, advancement, and business applicability from the Patent Cooperation Treaty. It has been found to enhance the quality of policy decision-making about regional healthcare at the self-governing local government level. Conclusions PHIS, a Web-based integrated system, has contributed to the improvement of regional healthcare services of Korea. However, when it comes to an appropriate evolution, the needs and changing environments of community-level healthcare service and IT infrastructure should be analyzed properly in advance. PMID:24523997

  4. [Utilization of healthcare services by groups in the Israeli population as a measurement reflecting equity in the healthcare system].

    PubMed

    Afek, Arnon

    2008-04-01

    The Israeli health care system bases itself on the principles of justice, equality, and social solidarity. In 1994 a Health Insurance Act was passed, based upon these principles, which helped to reduce the differences between Israeli population groups. People from lower socio-economic status suffer from more illnesses and have shorter life spans than their more fortunate countrymen. These differences in well-being, as well as being unnecessary and avoidable, are also unfair and unjust - and define the inequities in our health care system. Therefore, the goal of the health care system should be to reduce or eliminate these disparities, especially when they are avoidable and unjust. A study by Orna Apel Brown describes the results of a health care survey among new immigrants to Israel from the former U.S.S.R. She shows that there has been an increase in their utilization of healthcare services, excluding preventive measures such as mammography, along with a reduction in the differences in their self perception of health care status and well-being - now placing them on the same par as their fellow Israeli-born citizens. The results, although encouraging, stress the importance of the health care system's need to direct its efforts to decreasing the disparity and making the system more equitable to the underprivileged populations in Israel.

  5. An enhanced mobile-healthcare emergency system based on extended chaotic maps.

    PubMed

    Lee, Cheng-Chi; Hsu, Che-Wei; Lai, Yan-Ming; Vasilakos, Athanasios

    2013-10-01

    Mobile Healthcare (m-Healthcare) systems, namely smartphone applications of pervasive computing that utilize wireless body sensor networks (BSNs), have recently been proposed to provide smartphone users with health monitoring services and received great attentions. An m-Healthcare system with flaws, however, may leak out the smartphone user's personal information and cause security, privacy preservation, or user anonymity problems. In 2012, Lu et al. proposed a secure and privacy-preserving opportunistic computing (SPOC) framework for mobile-Healthcare emergency. The brilliant SPOC framework can opportunistically gather resources on the smartphone such as computing power and energy to process the computing-intensive personal health information (PHI) in case of an m-Healthcare emergency with minimal privacy disclosure. To balance between the hazard of PHI privacy disclosure and the necessity of PHI processing and transmission in m-Healthcare emergency, in their SPOC framework, Lu et al. introduced an efficient user-centric privacy access control system which they built on the basis of an attribute-based access control mechanism and a new privacy-preserving scalar product computation (PPSPC) technique. However, we found out that Lu et al.'s protocol still has some secure flaws such as user anonymity and mutual authentication. To fix those problems and further enhance the computation efficiency of Lu et al.'s protocol, in this article, the authors will present an improved mobile-Healthcare emergency system based on extended chaotic maps. The new system is capable of not only providing flawless user anonymity and mutual authentication but also reducing the computation cost.

  6. What Indicates Competency in Systems Based Practice? An Analysis of Perspective Consistency among Healthcare Team Members

    ERIC Educational Resources Information Center

    Graham, Mark J.; Naqvi, Zoon; Encandela, John A.; Bylund, Carma L.; Dean, Randa; Calero-Breckheimer, Ayxa; Schmidt, Hilary J.

    2009-01-01

    In many parts of the world the practice of medicine and medical education increasingly focus on providing patient care within context of the larger healthcare system. Our purpose is to solicit perceptions of all professional stakeholders (e.g. nurses) of the system regarding the U.S. ACGME competency Systems Based Practice to uncover the extent to…

  7. Methods to evaluate health information systems in healthcare settings: a literature review.

    PubMed

    Rahimi, Bahlol; Vimarlund, Vivian

    2007-10-01

    Although information technology (IT)-based applications in healthcare have existed for more than three decades, methods to evaluate outputs and outcomes of the use of IT-based systems in medical informatics is still a challenge for decision makers, as well as to those who want to measure the effects of ICT in healthcare settings. The aim of this paper is to review published articles in the area evaluations of IT-based systems in order to gain knowledge about methodologies used and findings obtained from the evaluation of IT-based systems applied in healthcare settings. The literature review includes studies of IT-based systems between 2003 and 2005. The findings show that economic and organizational aspects dominate evaluation studies in this area. However, the results focus mostly on positive outputs such as user satisfaction, financial benefits and improved organizational work. This review shows that there is no standard framework for evaluation effects and outputs of implementation and use of IT in the healthcare setting and that until today no studies explore the impact of IT on the healthcare system' productivity and effectiveness.

  8. Injustice to transsexual women in a hetero-normative healthcare system

    PubMed Central

    Duma, Sinegugu

    2014-01-01

    Abstract Background Transsexual women who are on the journey of sexual re-alignment will experience various health problems. These problems are related directly to the treatment regime that they are following in order to attain and maintain their physical embodiment as a woman. They are forced to negotiate a hetero-normative healthcare system in order to receive assistance and care for their health problems related to their sexual re-alignment process. Aim The questions posed were: What are the unique health problems that transsexual women experience whilst on the journey of sexual re-alignment? What is the current context of the South African healthcare system in which transsexual women should negotiate healthcare? These questions were asked in order to explore the health problems with which transsexual women are faced and to describe the hetero-normative healthcare system in South Africa. Method An electronic literature search was executed via the EBSCO host with specific inclusion and exclusion criteria. The search words that were used were: Transsexual/s and Health/Healthcare. All studies had to be peer reviewed and published in the English language, from January 1972 up until February 2013. Literature on transsexual children was excluded. Results Transsexual women have the potential to suffer significant side-effects from their sexual re-alignment treatment, including cardio-vascular problems, endocrine problems and mental ill-health. They are also vulnerable to HIV infection. They have poor access to quality holistic healthcare and this may lead an increase in the mortality and morbidity figures of women. Conclusion A hetero-normative healthcare system has a negative impact on the health of transsexual women and will cause them to be marginalised. This could contribute to both homo- and trans-phobia that will in turn strengthen the belief that transsexual women are un-African. PMID:26245442

  9. Payment source and provider type in the US healthcare system.

    PubMed

    Benitez, Joseph; Coplan, Bettie; Dehn, Richard W; Hooker, Roderick S

    2015-03-01

    Greater use of physician assistants (PAs) and nurse practitioners (NPs) to meet growing demand for healthcare in the United States is an increasingly common strategy to improve access to care and control costs. Evidence suggests that payment for services differs depending on the type of provider. This study sought to determine if the source of payment for a medical visit varies based on whether care is provided by a physician, PA, or NP. Data from the National Hospital Ambulatory Medical Care Survey (2006 through 2010) were analyzed. Physicians were proportionally more likely than NPs or PAs to provide care for medical visits compensated by private insurance or Medicare. Conversely, PAs and NPs were more likely to serve as providers of care for services with other payment sources such as Medicaid and out-of-pocket.

  10. Patient State Recognition System for Healthcare Using Speech and Facial Expressions.

    PubMed

    Hossain, M Shamim

    2016-12-01

    Smart, interactive healthcare is necessary in the modern age. Several issues, such as accurate diagnosis, low-cost modeling, low-complexity design, seamless transmission, and sufficient storage, should be addressed while developing a complete healthcare framework. In this paper, we propose a patient state recognition system for the healthcare framework. We design the system in such a way that it provides good recognition accuracy, provides low-cost modeling, and is scalable. The system takes two main types of input, video and audio, which are captured in a multi-sensory environment. Speech and video input are processed separately during feature extraction and modeling; these two input modalities are merged at score level, where the scores are obtained from the models of different patients' states. For the experiments, 100 people were recruited to mimic a patient's states of normal, pain, and tensed. The experimental results show that the proposed system can achieve an average 98.2 % recognition accuracy.

  11. [China is poised to build a better healthcare delivery system using the integrative health paradigm].

    PubMed

    Hui, Ka Kit; Zhang, Wei-jun

    2011-01-01

    China and the United States share similar goals regarding their health care reform: expanding coverage, bending the curve of healthcare expenditure, and ensuring quality improvement and effectiveness of healthcare. Though many differences in the two health care systems exist, there are still many innovative strategies both countries can learn from each other. This paper first discusses two major problems in the America's health care system: an increasing aging population coupled with ineffective chronic disease management; and a failing primary care system. Next it discusses the role of integrative medicine in the United States health care reform. We also review some key strategies in China's health care reform, which we believe if these policies are implemented fully and effectively, China is poised to build a better healthcare delivery system using the integrative health paradigm.

  12. A Modified No-fault Malpractice System Can Resolve Multiple Healthcare System Deficiencies

    PubMed Central

    Sacopulos, Michael

    2008-01-01

    Medical professional liability in the United States, as measured by total premiums paid by physicians and healthcare facilities, costs approximately $30 billion a year in direct expenses, less than 2% of the entire annual healthcare expenditures. Only a fraction of those dollars reach patients who are negligently injured. Nonetheless, the tort system has far-reaching effects that create substantial indirect costs. Medical malpractice litigation is pervasive and physicians practice defensively to avoid being named in a suit. Those extra expenditures provide little value to patients. Despite an elaborate existing tort system, patient safety remains a vexing problem. Many injured patients are denied access to timely, reasonable remedies. We propose a no-fault system supplemented by a variation of the traditional tort system whereby physicians are incentivized to follow evidence-based guidelines. The proposed system would guarantee a substantial decrease in, but not elimination of, litigation. The system would lower professional liability premiums. Injured patients would ordinarily be compensated with no-fault disability and life insurance proceeds. To the extent individual physicians pose a recurrent danger, their care would be reviewed on an administrative level. Savings would be invested in health information technology and purchase of insurance coverage for the uninsured. We propose a financial model based on publicly accessible sources. Electronic supplementary material The online version of this article (doi:10.1007/s11999-008-0577-9) contains supplementary material, which is available to authorized users. PMID:18979149

  13. [Data coding in the Israeli healthcare system - do choices provide the answers to our system's needs?].

    PubMed

    Zelingher, Julian; Ash, Nachman

    2013-05-01

    The IsraeLi healthcare system has undergone major processes for the adoption of health information technologies (HIT), and enjoys high Levels of utilization in hospital and ambulatory care. Coding is an essential infrastructure component of HIT, and ts purpose is to represent data in a simplified and common format, enhancing its manipulation by digital systems. Proper coding of data enables efficient identification, storage, retrieval and communication of data. UtiLization of uniform coding systems by different organizations enables data interoperability between them, facilitating communication and integrating data elements originating in different information systems from various organizations. Current needs in Israel for heaLth data coding include recording and reporting of diagnoses for hospitalized patients, outpatients and visitors of the Emergency Department, coding of procedures and operations, coding of pathology findings, reporting of discharge diagnoses and causes of death, billing codes, organizational data warehouses and national registries. New national projects for cLinicaL data integration, obligatory reporting of quality indicators and new Ministry of Health (MOH) requirements for HIT necessitate a high Level of interoperability that can be achieved only through the adoption of uniform coding. Additional pressures were introduced by the USA decision to stop the maintenance of the ICD-9-CM codes that are also used by Israeli healthcare, and the adoption of ICD-10-C and ICD-10-PCS as the main coding system for billing purpose. The USA has also mandated utilization of SNOMED-CT as the coding terminology for the ELectronic Health Record problem list, and for reporting quality indicators to the CMS. Hence, the Israeli MOH has recently decided that discharge diagnoses will be reported using ICD-10-CM codes, and SNOMED-CT will be used to code the cLinical information in the EHR. We reviewed the characteristics, strengths and weaknesses of these two coding

  14. Community-, Healthcare- and Hospital-Acquired Severe Sepsis Hospitalizations in the University HealthSystem Consortium

    PubMed Central

    Page, David B.; Donnelly, John P.; Wang, Henry E.

    2015-01-01

    Objectives Severe sepsis poses a major burden on the U.S. healthcare system. Previous epidemiologic studies have not differentiated community-acquired severe sepsis from healthcare-associated severe sepsis or hospital-acquired severe sepsis hospitalizations. We sought to compare and contrast community-acquired severe sepsis, healthcare-associated severe sepsis, and hospital-acquired severe sepsis hospitalizations in a national hospital sample. Setting United States Interventions None Measurements & Main Results Prevalence of community-acquired severe sepsis, healthcare-associated severe sepsis, and hospital-acquired severe sepsis, adjusted hospital mortality, length of hospitalization, length of stay in an ICU, and hospital costs. Among 3,355,753 hospital discharges, there were 307,491 with severe sepsis, including 193,081 (62.8%) community-acquired severe sepsis, 79,581 (25.9%) healthcare-associated severe sepsis, and 34,829 (11.3%) hospital-acquired severe sepsis. Hospital-acquired severe sepsis and healthcare-associated severe sepsis exhibited higher in-hospital mortality than community-acquired severe sepsis (hospital-acquired [19.2%] vs healthcare-associated [12.8%] vs community-acquired [8.6%]). Hospital-acquired severe sepsis had greater resource utilization than both healthcare-associated severe sepsis and community-acquired severe sepsis, with higher median length of hospital stay (hospital acquired [17 d] vs healthcare associated [7 d] vs community-acquired [6 d]), median length of ICU stay (hospital-acquired [8 d] vs healthcare-associated [3 d] vs community-acquired [3 d]), and median hospital costs (hospital-acquired [$38,369] vs healthcare-associated [$8,796] vs community-acquired [$7,024]). Conclusions In this series, severe sepsis hospitalizations included CA-SS (62.8%), HCA-SS (25.9%) and HA-SS (11.3%) cases. HA-SS was associated with both higher mortality and resource utilization than CA-SS and HCA-SS. PMID:26110490

  15. Future of the US healthcare system and the effects on the practice of hand surgery.

    PubMed

    Pushman, Allison G; Chung, Kevin C

    2009-06-01

    The multitier healthcare system of the USA has several major flaws. High costs and uncertain quality of care indicate that this system is no longer practical. Several improvement initiatives, such as the Oregon Health Plan, Leapfrog, Lean Manufacturing, and Pay-for-Performance have been implemented into the current system. All of these quality improvement models are being experimented in a limited fashion and do not address the biggest problem in the US healthcare, inequality of care. There is now increasing support for a universal health coverage model as an ethically sound and just way to decrease health disparities in the USA. The current quality initiatives as well as an adoption of universal coverage appear to be the best way to improve quality of care, reduce cost, and increase equality in healthcare. These initiatives may have considerable effects on the practice of hand surgery in the near future, and thus, it is important for the field of hand surgery to become more engaged in advocacy and public policy arena. The purpose of this paper is to examine the current problems in the US healthcare system and to evaluate potential solutions that will enhance quality while simultaneously curbing the unchecked increase in healthcare expenditure.

  16. Healthcare information systems: data mining methods in the creation of a clinical recommender system

    NASA Astrophysics Data System (ADS)

    Duan, L.; Street, W. N.; Xu, E.

    2011-05-01

    Recommender systems have been extensively studied to present items, such as movies, music and books that are likely of interest to the user. Researchers have indicated that integrated medical information systems are becoming an essential part of the modern healthcare systems. Such systems have evolved to an integrated enterprise-wide system. In particular, such systems are considered as a type of enterprise information systems or ERP system addressing healthcare industry sector needs. As part of efforts, nursing care plan recommender systems can provide clinical decision support, nursing education, clinical quality control, and serve as a complement to existing practice guidelines. We propose to use correlations among nursing diagnoses, outcomes and interventions to create a recommender system for constructing nursing care plans. In the current study, we used nursing diagnosis data to develop the methodology. Our system utilises a prefix-tree structure common in itemset mining to construct a ranked list of suggested care plan items based on previously-entered items. Unlike common commercial systems, our system makes sequential recommendations based on user interaction, modifying a ranked list of suggested items at each step in care plan construction. We rank items based on traditional association-rule measures such as support and confidence, as well as a novel measure that anticipates which selections might improve the quality of future rankings. Since the multi-step nature of our recommendations presents problems for traditional evaluation measures, we also present a new evaluation method based on average ranking position and use it to test the effectiveness of different recommendation strategies.

  17. Designing a Safer Interactive Healthcare System - The Impact of Authentic User Participation

    NASA Astrophysics Data System (ADS)

    Went, Kathryn L.; Gregor, Peter; Ricketts, Ian W.

    Information technology has been widely promoted in the healthcare sector to improve current practice and patient safety. However, end users are seldom involved extensively in the design and development of healthcare systems, with lip service often paid to the idea of true user involvement. In this case study the impact of sustained authentic user participation was explored using an interdisciplinary team, consisting of experts both in interaction and healthcare design and consultant anaesthetists, nurses, and pharmacists, to create an electronic prescribing and administration system. This paper details the interface that was created and provides examples of the way in which the design evolved in response to the sustained authentic user participation methods. The working prototype both reduced the opportunity for user error and was preferred by its users to the existing manual system.

  18. An Efficient and Secure Certificateless Authentication Protocol for Healthcare System on Wireless Medical Sensor Networks

    PubMed Central

    Guo, Rui; Wen, Qiaoyan; Jin, Zhengping; Zhang, Hua

    2013-01-01

    Sensor networks have opened up new opportunities in healthcare systems, which can transmit patient's condition to health professional's hand-held devices in time. The patient's physiological signals are very sensitive and the networks are extremely vulnerable to many attacks. It must be ensured that patient's privacy is not exposed to unauthorized entities. Therefore, the control of access to healthcare systems has become a crucial challenge. An efficient and secure authentication protocol will thus be needed in wireless medical sensor networks. In this paper, we propose a certificateless authentication scheme without bilinear pairing while providing patient anonymity. Compared with other related protocols, the proposed scheme needs less computation and communication cost and preserves stronger security. Our performance evaluations show that this protocol is more practical for healthcare system in wireless medical sensor networks. PMID:23710147

  19. Clinical pharmacists: The major support to Indian healthcare system in near future

    PubMed Central

    Deshpande, Prasanna R.; Vantipalli, Raghuram; Chaitanya Lakshmi, C. H.; Rao, E. Jagadeswara; Regmi, Bishnu; Ahad, Abdul; Nirojini, P. Sharmila

    2015-01-01

    Pharmacy practice is still in the initial stages of development in India, but launching of Doctor of Pharmacy (PharmD) study program has brought serious discussions about clinical pharmacy in the country. As the profession is in budding stage in the country, the patients, physicians, nurses, other healthcare providers, recruiters in pharmaceutical industries, prospective students, and their parents have numerous questions about this profession and study course. The objective of this article is to create awareness about clinical pharmacy services (CPS) and to introduce the role of clinical pharmacists (CPs). After reading this article, one will know about the usefulness of CPs in the Indian healthcare system against the current flaws in the system. The article describes the role of CPs in the hospitals, in research, in pharmaceutical/contract research companies, in community service and it also tells about the related myths and facts. Prospective job opportunities for CPs, present challenges and the possible solutions are elaborated as well. In conclusion, CPs are going to be the major support to the Indian healthcare system in near future; the reasons being (1) CPS are beneficial in many ways to improve healthcare; CPS have already proved their importance in western countries (2) India was never officially and efficiently exposed to CPS; so launching of CPS shall revolutionize the country's healthcare scenario. PMID:26229349

  20. Intelligent Counseling System: A 24 x 7 Academic Advisor

    ERIC Educational Resources Information Center

    Leung, Chun Ming; Tsang, Eva Y. M.; Lam, S. S.; Pang, Dominic C. W.

    2010-01-01

    Universities are increasingly looking into self-service systems with intelligent digital agents to supplement or replace labor-intensive services, such as academic counseling. The Open University of Hong Kong has developed an intelligent online system that instantly responds to enquiries about career development, learning modes, program/course…

  1. [Development method of healthcare information system integration based on business collaboration model].

    PubMed

    Li, Shasha; Nie, Hongchao; Lu, Xudong; Duan, Huilong

    2015-02-01

    Integration of heterogeneous systems is the key to hospital information construction due to complexity of the healthcare environment. Currently, during the process of healthcare information system integration, people participating in integration project usually communicate by free-format document, which impairs the efficiency and adaptability of integration. A method utilizing business process model and notation (BPMN) to model integration requirement and automatically transforming it to executable integration configuration was proposed in this paper. Based on the method, a tool was developed to model integration requirement and transform it to integration configuration. In addition, an integration case in radiology scenario was used to verify the method.

  2. Productivity changes in OECD healthcare systems: bias-corrected Malmquist productivity approach.

    PubMed

    Kim, Younhee; Oh, Dong-Hyun; Kang, Minah

    2016-10-01

    This study evaluates productivity changes in the healthcare systems of 30 Organization for Economic Co-operation and Development (OECD) countries over the 2002-2012 periods. The bootstrapped Malmquist approach is used to estimate bias-corrected indices of healthcare performance in productivity, efficiency and technology by modifying the original distance functions. Two inputs (health expenditure and school life expectancy) and two outputs (life expectancy at birth and infant mortality rate) are used to calculate productivity growth. There are no perceptible trends in productivity changes over the 2002-2012 periods, but positive productivity improvement has been noticed for most OECD countries. The result also informs considerable variations in annual productivity scores across the countries. Average annual productivity growth is evenly yielded by efficiency and technical changes, but both changes run somewhat differently across the years. The results of this study assert that policy reforms in OECD countries have improved productivity growth in healthcare systems over the past decade. Countries that lag behind in productivity growth should benchmark peer countries' practices to increase performance by prioritizing an achievable trajectory based on socioeconomic conditions. For example, relatively inefficient countries in this study indicate higher income inequality, corresponding to inequality and health outcomes studies. Although income inequality and globalization are not direct measures to estimate healthcare productivity in this study, these issues could be latent factors to explain cross-country healthcare productivity for future research. Copyright © 2016 John Wiley & Sons, Ltd.

  3. Impact of new water systems on healthcare-associated colonization or infection with Pseudomonas aeruginosa

    PubMed Central

    Lefebvre, Annick; Quantin, Catherine; Vanhems, Philippe; Lucet, Jean-Christophe; Bertrand, Xavier; Astruc, Karine; Chavanet, Pascal; Aho-Glélé, Ludwig S.

    2016-01-01

    Aim: We aimed to study the impact of new water systems, which were less contaminated with P. aeruginosa, on the incidence of healthcare-associated P. aeruginosa cases (colonizations or infections) in care units that moved to a different building between 2005 and 2014. Methods: Generalized Estimated Equations were used to compare the incidence of P. aeruginosa healthcare-associated cases according to the building. Results: Twenty-nine units moved during the study period and 2,759 cases occurred in these units. No difference was observed when the new building was compared with older buildings overall. Conclusion: Our results did not support our hypothesis of a positive association between water system contamination and the incidence of healthcare-associated P. aeruginosa cases. These results must be confirmed by linking results of water samples and patients’ data. PMID:27274443

  4. [Healthcare expenditure].

    PubMed

    Huguier, Michel

    2012-10-01

    Healthcare expenditure is divided between medical infrastructure and individual patient management. Total healthcare costs in France amount to roughly 175 billion euros, financed through public health insurance (77%), private insurance (14%), and individual expenditure (9%). The principal expenditures are for hospitalization (44%), community medical, dental and paramedical care (28%), drugs (20%) and miscellaneous resources (8%). The main factors of rising costs are medical progress and aging. More controllable costs include healthcare provision, the level of reimbursement, public education and information, and physician training. France devotes 9.2% of its gross national product to healthcare, compared to 7-8% in Sweden, Germany and the United Kingdom, representing a diference of about 18 billion euros. In France there is a chronic imbalance between resources and expenditure, creating a cumulative budget deficit of about 100 billlion euros. Major efforts must be made to improve efficiency, and it will be necessary to choose between preserving our healthcare system or our financial system. If the latter is prioritized, healthcare will inevitably deteriorate.

  5. Primary healthcare in transition – a qualitative study of how managers perceived a system change

    PubMed Central

    2013-01-01

    Background Primary healthcare in Sweden has undergone widespread reforms in recent years, including freedom of choice regarding provider, freedom of establishment and increased privatisation. The key aims of the reforms were to strengthen the role of the patient and improve performance in terms of access and responsiveness. The aim of this study was to explore how managers at publicly owned primary healthcare centres perceived the transition of the primary healthcare system and the impact it has had on their work. Methods In this qualitative study, 24 managers of publicly owned primary healthcare centres in the metropolitan region of Gothenburg were recruited. Semi-structured interviews were conducted and data were analysed using content analysis inspired by Silverman. Results The analysis revealed two core themes: The transition is perceived as a rapid change, enforced mainly through financial incentives and Prioritisation conflicts arise between patient groups with different needs, demands and levels of empowerment. The transition has produced powerful and rapid effects that were considered to be both positive and negative. While the new financial incentives were seen as a driving force and a tool for change, they also became a stress factor due to uncertainty, competition with other primary healthcare centres and negative feelings associated with staff cutbacks. The shift in power towards the patient improved access and service but also led to more patients with unreasonable demands. Managers found it difficult to prioritise correctly between patient groups with different needs, demands and levels of empowerment and they were concerned about potentially negative effects on less empowered patients, e.g. multi-morbid patients. Managers also experienced shortcomings in their change management skills. Conclusions This qualitative study shows the complexity of the system change and describes the different effects and perceptions of the transition from a manager

  6. Fool-proofing design and crisis management for customized intelligent physical fitness and healthcare system.

    PubMed

    Huang, Chung-Chi; Huang, Chung-Lin; Liu, Hsiao-Man

    2015-01-01

    In recent years, it is quite important to develop a customized system which can enhance physical fitness and health for people. And the system reliability is more important. In the paper, a fool-proofing design and crisis management for customized physical fitness and healthcare system is proposed. It is designed to prevent the failure of the various mechanisms of customized physical fitness and healthcare system, including records, surveillance, assessments, predictions, diagnosis, prescription, and scheduling. It is separated into (1) fool-proofing design module (2) crisis management module. The fool-proofing indexes are set to prevent the failure of the various mechanisms. The states of the various mechanisms are managed by the auto-checked fool-proofing indexes. If mistakes prevention was fail, we have to execute the crisis management for stopping harmful results. The crisis management will find the error level and response the solution by using fuzzy method. By the experiments, we can find the advantages of the fool-proofing design and crisis management for customized physical fitness and healthcare system. And it is effective to prevent the failure of the various mechanisms of intelligent customized physical fitness and healthcare system.

  7. How might healthcare systems influence speed of cancer diagnosis: A narrative review

    PubMed Central

    Brown, Sally; Castelli, Michele; Hunter, David J.; Erskine, Jonathan; Vedsted, Peter; Foot, Catherine; Rubin, Greg

    2014-01-01

    Striking differences exist in outcomes for cancer between developed countries with comparable healthcare systems. We compare the healthcare systems of 3 countries (Denmark, Norway, Sweden), 3 UK jurisdictions (England, Wales and Northern Ireland), 3 Canadian provinces (British Columbia, Manitoba, Ontario) and 2 Australian states (New South Wales, Victoria) using a framework which assesses the possible contribution of primary care systems to a range of health outcomes, drawing on key characteristics influencing population health. For many of the characteristics we investigated there are no significant differences between those countries with poorer cancer outcomes (England and Denmark) and the rest. In particular, regulation, financing, the existence of patient lists, the GP gatekeeping role, direct access to secondary care, the degree of comprehensiveness of primary care services, the level of cost sharing and the type of primary care providers within healthcare systems were not specifically and consistently associated with differences between countries. Factors that could have an influence on patient and professional behaviour, and consequently contribute to delays in cancer diagnosis and poorer cancer outcomes in some countries, include centralisation of services, free movement of patients between primary care providers, access to secondary care, and the existence of patient list systems. It was not possible to establish a causal correlation between healthcare system characteristics and cancer outcomes. Further studies should explore in greater depth the associations between single health system factors and cancer outcomes, recognising that in complex systems where context is all-important, it will be difficult to establish causal relationships. Better understanding of the interaction between healthcare system variables and patient and professional behaviour may generate new hypotheses for further research. PMID:24980792

  8. Patient Tobacco Use, Quit Attempts, and Perceptions of Healthcare Provider Practices in a Safety-Net Healthcare System

    PubMed Central

    Moody-Thomas, Sarah; Celestin, Michael D.; Tseng, Tung-Sung; Horswell, Ronald

    2013-01-01

    Background Although smoking rates in the United States (US) are high, healthcare systems and clinicians can increase cessation rates through application of the US Public Health Service tobacco treatment guideline (2000, 2008). In primary care settings, however, guideline implementation remains low. This report presents the results from an assessment of patient tobacco use, quit attempts, and perceptions of provider treatment before (2004) and after (2010) guideline implementation. Methods By use of a systems approach, the Louisiana Tobacco Control Initiative integrated evidence-based treatment of tobacco use into patient care practices in Louisiana's public hospital system. This prospective study, designed to collect data at 2 time points for the purpose of evaluating the effect of the 5A protocol (ask, advise, assess, assist, and arrange), included 571 and 889 adult patients selected from primary care clinics in 2004 and 2010, respectively. Chi-square analyses determined differences between survey administrations, along with direct standardization of weighted rates to control for confounding factors. Results Patient reports indicated that provider adherence to the 5A clinical protocol increased from 2004 to 2010. Significant (P<0.001) improvements were observed for the assess (39% vs 72%), assist (24% vs 76%), and arrange (8% vs 31%) treatment variables. Patient-reported quit attempts increased, along with awareness of cessation services (from 19% to 70%, P<0.001), while use of cessation medications decreased (from 23% to 5%, P<0.002). Conclusion Following implementation of the guideline, significant improvements were noted in patient reports of provider treatment and awareness of cessation services. PMID:24052766

  9. Factors associated with hospitalisations in chronic conditions deemed avoidable: ecological study in the Spanish healthcare system

    PubMed Central

    Angulo-Pueyo, Ester; Ridao-López, Manuel; Martínez-Lizaga, Natalia; García-Armesto, Sandra; Peiró, Salvador; Bernal-Delgado, Enrique

    2017-01-01

    Objectives Potentially avoidable hospitalisations have been used as a proxy for primary care quality. We aimed to analyse the ecological association between contextual and systemic factors featured in the Spanish healthcare system and the variation in potentially avoidable hospitalisations for a number of chronic conditions. Methods A cross-section ecological study based on the linkage of administrative data sources from virtually all healthcare areas (n=202) and autonomous communities (n=16) composing the Spanish National Health System was performed. Potentially avoidable hospitalisations in chronic conditions were defined using the Spanish validation of the Agency for Health Research and Quality (AHRQ) preventable quality indicators. Using 2012 data, the ecological association between potentially avoidable hospitalisations and factors featuring healthcare areas and autonomous communities was tested using multilevel negative binomial regression. Results In 2012, 151 468 admissions were flagged as potentially avoidable in Spain. After adjusting for differences in age, sex and burden of disease, the only variable associated with the outcome was hospitalisation intensity for any cause in previous years (incidence risk ratio 1.19 (95% CI 1.13 to 1.26)). The autonomous community of residence explained a negligible part of the residual unexplained variation (variance 0.01 (SE 0.008)). Primary care supply and activity did not show any association. Conclusions The findings suggest that the variation in potentially avoidable hospitalisations in chronic conditions at the healthcare area level is a reflection of how intensively hospitals are used in a healthcare area for any cause, rather than of primary care characteristics. Whether other non-studied features at the healthcare area level or primary care level could explain the observed variation remains uncertain. PMID:28237952

  10. The diffusion of decision support systems in healthcare: are we there yet?

    PubMed

    Wong, H J; Legnini, M W; Whitmore, H H

    2000-01-01

    Clinical decision support (CDS) systems, with the potential to minimize practice variation and improve patient care, have begun to surface throughout the healthcare industry. This study reviews historic patterns of information technology (IT) in healthcare, analyzes barriers and enabling factors, and draws three lessons. First, the widespread adoption of clinical IT, including CDS systems, depends on having the right organizational and individual financial incentives in place. Second, although CDS systems and clinical IT in general are powerful tools that can be used to support the practice of medicine, they alone cannot redefine the workflow or processes within the profession. Healthcare managers counting on technology to restructure or monitor clinicians' work patterns are likely to encounter substantial resistance to CDS systems, even those that generate valuable information. Third, while the pace of implementing IT systems in healthcare has lagged behind that of other industries, many of the obstacles are gradually diminishing. However, several factors continue to inhibit their widespread diffusion, including the organizational turmoil created by large numbers of mergers and acquisitions, and the lack of uniform data standards.

  11. Setting up a Wireless Local Area Network (WLAN) for a healthcare system.

    PubMed

    Wang, Jin; Du, Hongwei

    2005-01-01

    WLAN can help the medical professionals to improve their working efficiency and reduce medical errors. In this paper, the important issues of deploying WLAN in hospitals are discussed. It gives a comprehensive overview of how to set up the mobility, Quality of Service (QoS) and security of the WLAN for a healthcare system. IEEE 802.11e standard and the Health Insurance Portability and Accountability ACT (HIPAA) regulations are discussed and some suggestions are given to meet the specific requirements of a healthcare environment.

  12. An effectiveness analysis of healthcare systems using a systems theoretic approach

    PubMed Central

    Chuang, Sheuwen; Inder, Kerry

    2009-01-01

    Background The use of accreditation and quality measurement and reporting to improve healthcare quality and patient safety has been widespread across many countries. A review of the literature reveals no association between the accreditation system and the quality measurement and reporting systems, even when hospital compliance with these systems is satisfactory. Improvement of health care outcomes needs to be based on an appreciation of the whole system that contributes to those outcomes. The research literature currently lacks an appropriate analysis and is fragmented among activities. This paper aims to propose an integrated research model of these two systems and to demonstrate the usefulness of the resulting model for strategic research planning. Methods/design To achieve these aims, a systematic integration of the healthcare accreditation and quality measurement/reporting systems is structured hierarchically. A holistic systems relationship model of the administration segment is developed to act as an investigation framework. A literature-based empirical study is used to validate the proposed relationships derived from the model. Australian experiences are used as evidence for the system effectiveness analysis and design base for an adaptive-control study proposal to show the usefulness of the system model for guiding strategic research. Results Three basic relationships were revealed and validated from the research literature. The systemic weaknesses of the accreditation system and quality measurement/reporting system from a system flow perspective were examined. The approach provides a system thinking structure to assist the design of quality improvement strategies. The proposed model discovers a fourth implicit relationship, a feedback between quality performance reporting components and choice of accreditation components that is likely to play an important role in health care outcomes. An example involving accreditation surveyors is developed that

  13. Developing a marketing function in public healthcare systems: a framework for action.

    PubMed

    Lega, Federico

    2006-10-01

    The scope of this paper is to analyse the contribution that a marketing function can bring to the wide variety of healthcare organizations operating in public health systems (PHSs). While extensive research on marketing applied to healthcare services has been elaborated in competitive and managed care contexts, marketing is a rather new issue in PHSs and little research has been conducted to assess its relevance and benefits in these environments. This study tackles that gap and is based on a review of the current literature in order to provide answers to the following points: - definition of the scopes of marketing and of the elements that affect its incorporation in the healthcare sector; - conceptualization of the possible approaches to marketing by health organizations operating in PHSs; - discussion of the resulting framework for action.

  14. [Nursing and the humanization of the end- of-life care within healthcare systems].

    PubMed

    Gómez Arca, Marina

    2014-01-01

    The reflection upon the humanisation of the end-of-life process within healthcare systems and the implication of healthcare professionals is the main objective of this article. The evolution of the model of care and nurses leadership role at the end-of-life process is evaluated. This analysis starts from the first European references regarding advance wills, made in 1997 at the Oviedo Convention, until the introduction of the idea of advance directives incorporated into Spanish law in 2002. It sets the concept of advance planning in health-related decisions, which establishes a process of voluntary dialogue where every person can clarify values, preferences and wishes regarding the final moments of life, with the support of the healthcare professionals.

  15. Evolving Health Care System: Academic Implications for Content and Skill.

    ERIC Educational Resources Information Center

    Hartzema, Abraham G.

    1987-01-01

    The impact of changing health care systems on the content of pharmaceutical education is examined, including the relationship between basic and applied sciences and between the applied sciences and skill and attitude formation, in both academic and clinical education. The role of pharmacy administration in the curriculum is discussed. (MSE)

  16. Motivational Systems Theory and the Academic Performance of College Students

    ERIC Educational Resources Information Center

    Campbell, Michael M.

    2007-01-01

    This study explored the validity of the Motivational Systems Theory (MST) as a measure of performance of college students pursuing business degrees and the level of academic performance attained across gender and race lines. This goal is achieved by investigating the relationships between motivational strategies, biological factors, responsive…

  17. Building a Workable Academic Integrity System: Issues and Options.

    ERIC Educational Resources Information Center

    Sabloff, Paula L. W.; Yeager, John L.

    A survey was conducted of 55 American Association of Universities institutions regarding the guidelines, policies and procedures of their academic integrity systems. Forty-four universities responded, returning 42 questionnaires and 35 guidelines. Examination of the guidelines revealed very little overlap in procedures. Most institutions claimed…

  18. Online System Adoption and K-12 Academic Outcomes

    ERIC Educational Resources Information Center

    Kimmons, R.

    2015-01-01

    This study seeks to understand the relationship between K-12 online system adoption (e.g., Blackboard, Edmodo, WordPress) and school-level academic achievement ratings. Utilizing a novel approach to data collection via website data extraction and indexing of all school websites in a target state in the United States (n?=?732) and merging these…

  19. Develop security architecture for both in-house healthcare information systems and electronic patient record

    NASA Astrophysics Data System (ADS)

    Zhang, Jianguo; Chen, Xiaomeng; Zhuang, Jun; Jiang, Jianrong; Zhang, Xiaoyan; Wu, Dongqing; Huang, H. K.

    2003-05-01

    In this paper, we presented a new security approach to provide security measures and features in both healthcare information systems (PACS, RIS/HIS), and electronic patient record (EPR). We introduced two security components, certificate authoring (CA) system and patient record digital signature management (DSPR) system, as well as electronic envelope technology, into the current hospital healthcare information infrastructure to provide security measures and functions such as confidential or privacy, authenticity, integrity, reliability, non-repudiation, and authentication for in-house healthcare information systems daily operating, and EPR exchanging among the hospitals or healthcare administration levels, and the DSPR component manages the all the digital signatures of patient medical records signed through using an-symmetry key encryption technologies. The electronic envelopes used for EPR exchanging are created based on the information of signers, digital signatures, and identifications of patient records stored in CAS and DSMS, as well as the destinations and the remote users. The CAS and DSMS were developed and integrated into a RIS-integrated PACS, and the integration of these new security components is seamless and painless. The electronic envelopes designed for EPR were used successfully in multimedia data transmission.

  20. A Data Analytical Framework for Improving Real-Time, Decision Support Systems in Healthcare

    ERIC Educational Resources Information Center

    Yahav, Inbal

    2010-01-01

    In this dissertation we develop a framework that combines data mining, statistics and operations research methods for improving real-time decision support systems in healthcare. Our approach consists of three main concepts: data gathering and preprocessing, modeling, and deployment. We introduce the notion of offline and semi-offline modeling to…

  1. A Review on Methods of Risk Adjustment and their Use in Integrated Healthcare Systems

    PubMed Central

    Juhnke, Christin; Bethge, Susanne

    2016-01-01

    Introduction: Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The objective of this review was to obtain an overview of existing models of risk adjustment as well as on crucial weights in risk adjustment. Moreover, the predictive performance of selected methods in international healthcare systems should be analysed. Theory and methods: A comprehensive, systematic literature review on methods of risk adjustment was conducted in terms of an encompassing, interdisciplinary examination of the related disciplines. Results: In general, several distinctions can be made: in terms of risk horizons, in terms of risk factors or in terms of the combination of indicators included. Within these, another differentiation by three levels seems reasonable: methods based on mortality risks, methods based on morbidity risks as well as those based on information on (self-reported) health status. Conclusions and discussion: After the final examination of different methods of risk adjustment it was shown that the methodology used to adjust risks varies. The models differ greatly in terms of their included morbidity indicators. The findings of this review can be used in the evaluation of integrated healthcare delivery systems and can be integrated into quality- and patient-oriented reimbursement of care providers in the design of healthcare contracts. PMID:28316544

  2. Validation of Autism Spectrum Disorder Diagnoses in Large Healthcare Systems with Electronic Medical Records

    ERIC Educational Resources Information Center

    Coleman, Karen J.; Lutsky, Marta A.; Yau, Vincent; Qian, Yinge; Pomichowski, Magdalena E.; Crawford, Phillip M.; Lynch, Frances L.; Madden, Jeanne M.; Owen-Smith, Ashli; Pearson, John A.; Pearson, Kathryn A.; Rusinak, Donna; Quinn, Virginia P.; Croen, Lisa A.

    2015-01-01

    To identify factors associated with valid Autism Spectrum Disorder (ASD) diagnoses from electronic sources in large healthcare systems. We examined 1,272 charts from ASD diagnosed youth <18 years old. Expert reviewers classified diagnoses as confirmed, probable, possible, ruled out, or not enough information. A total of 845 were classified with…

  3. Time to colonoscopy after positive fecal blood test in four U.S. healthcare systems

    PubMed Central

    Chubak, Jessica; Garcia, Michael P.; Burnett-Hartman, Andrea N.; Zheng, Yingye; Corley, Douglas A.; Halm, Ethan A.; Singal, Amit G.; Klabunde, Carrie N.; Doubeni, Chyke A.; Kamineni, Aruna; Levin, Theodore R.; Schottinger, Joanne E.; Green, Beverly B.; Quinn, Virginia P.; Rutter, Carolyn M.

    2016-01-01

    Background To reduce colorectal cancer (CRC) mortality, positive fecal blood tests must be followed by colonoscopy. Methods We identified 62,384 individuals aged 50–89 years with a positive fecal blood test between 1/1/2011 and 12/31/2012 in four healthcare systems within the Population-Based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We estimated the probability of follow-up colonoscopy and 95% confidence intervals (CIs) using the Kaplan-Meier method. Overall differences in cumulative incidence of follow-up across health care systems were assessed with the log-rank test. Hazard ratios and 95% CIs were estimated from multivariate Cox proportional hazards models. Results Most patients who received a colonoscopy did so within six months of their positive fecal blood test, although follow-up rates varied across healthcare systems (p <0.001). Median days to colonoscopy ranged from 41 (95% CI, 40–41) to 174 (95% CI, 123–343); percent followed-up by 12-months ranged from 58.1% (95% CI, 51.6%–63.7%) to 83.8% (95% CI, 83.4%–84.3%) and differences across healthcare systems were also observed at 1, 2, 3, and 6 months. Increasing age and comorbidity score were associated with lower follow-up rates. Conclusion Individual characteristics and healthcare system were associated with colonoscopy after positive fecal blood tests. Patterns were consistent across healthcare systems, but proportions of patients receiving follow-up varied. These findings suggest there is room to improve follow-up of positive CRC screening tests. Impact Understanding the timing of colonoscopy after positive fecal blood tests and characteristics associated with lack of follow-up may inform future efforts to improve follow-up. PMID:26843520

  4. Writing by Academics: A Transactional and Systems Approach to Academic Writing Behaviours

    ERIC Educational Resources Information Center

    Kempenaar, Larissa Elisabeth; Murray, Rowena

    2016-01-01

    The literature on academic writing in higher education contains a wealth of research and theory on students' writing, but much less on academics' writing. In performative higher education cultures, discussions of academics' writing mainly concern outputs, rather than the process of producing them. This key component of academic work remains…

  5. Healthcare System Information at Language Schools for Newly Arrived Immigrants: A Pertinent Setting in Times of Austerity

    ERIC Educational Resources Information Center

    Tynell, Lena Lyngholt; Wimmelmann, Camilla Lawaetz; Jervelund, Signe Smith

    2017-01-01

    Objective: In most European countries, immigrants do not systematically learn about the host countries' healthcare system when arriving. This study investigated how newly arrived immigrants perceived the information they received about the Danish healthcare system. Methods: Immigrants attending a language school in Copenhagen in 2012 received…

  6. Socioeconomic profile of couples seeking the public healthcare system (SUS) for infertility treatment

    PubMed Central

    Tavares, Rachel; Cunha, Gisele; Aguiar, Lilian; Duarte, Shaytner Campos; Cardinot, Nilza; Bastos, Elizabeth; Coelho, Francisco

    2016-01-01

    Objective The number of couples seeking assisted reproduction services in pursuit of the dream of conceiving a child is growing. In developing countries 10 to 15% of couples of childbearing age cannot bear a child by natural means and the impossibility of conceiving a child has a significant impact on the health and well-being of the couple. The aim of this study was to evaluate the socioeconomic profile and the main causes of infertility of couples seeking assisted reproduction treatment through the public healthcare system. Methods We analyzed 600 medical records of couples who sought infertility treatment at the public healthcare system, and we divided them into three groups according to age: 35 years, 35 to 39, and 40 years or more. In each group we analyzed the cause of infertility, the number of children of the spouses, the education level and family income. Results The main cause of infertility was male-related in 34%, followed by tubal factor in 31.5%. We found that 56% of the women were less than 35 years old and 58% of the couples earned less than 3 minimum wages. Conclusion The profile of the couples was: low-income, low education and less than 35 years of age. The cost of assisted reproductive treatment is still high, being restricted to couples of higher socioeconomic statuses. An effective public healthcare policy could minimize this problem by improving the quality of care for couples seeking infertility treatment at the public healthcare system. PMID:27584602

  7. Healthcare system and the wealth-health gradient: a comparative study of older populations in six countries.

    PubMed

    Maskileyson, Dina

    2014-10-01

    The present study provides a comparative analysis of the association between wealth and health in six healthcare systems (Sweden, the United Kingdom, Germany, the Czech Republic, Israel, the United States). National samples of individuals fifty years and over reveal considerable cross-country variations in health outcomes. In all six countries wealth and health are positively associated. The findings also show that state-based healthcare systems produce better population health outcomes than private-based healthcare systems. The results indicate that in five out of the six countries studied, the wealth-health gradients were remarkably similar, despite significant variations in healthcare system type. Only in the United States was the association between wealth and health substantially different from, and much greater than that in the other five countries. The findings suggest that private-based healthcare system in the U.S. is likely to promote stronger positive associations between wealth and health.

  8. YUCSA: A CLIPS expert database system to monitor academic performance

    NASA Technical Reports Server (NTRS)

    Toptsis, Anestis A.; Ho, Frankie; Leindekar, Milton; Foon, Debra Low; Carbonaro, Mike

    1991-01-01

    The York University CLIPS Student Administrator (YUCSA), an expert database system implemented in C Language Integrated Processing System (CLIPS), for monitoring the academic performance of undergraduate students at York University, is discussed. The expert system component in the system has already been implemented for two major departments, and it is under testing and enhancement for more departments. Also, more elaborate user interfaces are under development. We describe the design and implementation of the system, problems encountered, and immediate future plans. The system has excellent maintainability and it is very efficient, taking less than one minute to complete an assessment of one student.

  9. Improving compliance in remote healthcare systems through smartphone battery optimization.

    PubMed

    Alshurafa, Nabil; Eastwood, Jo-Ann; Nyamathi, Suneil; Liu, Jason J; Xu, Wenyao; Ghasemzadeh, Hassan; Pourhomayoun, Mohammad; Sarrafzadeh, Majid

    2015-01-01

    Remote health monitoring (RHM) has emerged as a solution to help reduce the cost burden of unhealthy lifestyles and aging populations. Enhancing compliance to prescribed medical regimens is an essential challenge to many systems, even those using smartphone technology. In this paper, we provide a technique to improve smartphone battery consumption and examine the effects of smartphone battery lifetime on compliance, in an attempt to enhance users' adherence to remote monitoring systems. We deploy WANDA-CVD, an RHM system for patients at risk of cardiovascular disease (CVD), using a wearable smartphone for detection of physical activity. We tested the battery optimization technique in an in-lab pilot study and validated its effects on compliance in the Women's Heart Health Study. The battery optimization technique enhanced the battery lifetime by 192% on average, resulting in a 53% increase in compliance in the study. A system like WANDA-CVD can help increase smartphone battery lifetime for RHM systems monitoring physical activity.

  10. The standard 'Healthcare Information Systems Architecture' and the DHE middleware.

    PubMed

    Ferrara, F M

    1998-01-01

    The integration and evolution of existing systems represents one of the most urgent priorities of health care information systems in order to allow the whole organisation to meet the increasing clinical organisational and managerial needs. This paper discusses how an open architecture, based on the introduction of a middleware of common health care-specific services not only reduces the effort necessary for allowing existing systems to interwork, but also automatically establishes a functional and information basis common to the whole organisation, on top of which also new applications can be rapidly developed, natively integrated with the rest of the system. Such architecture has been already formalised through the European standard, defined by the CEN/TC251 prENV 12967-1 'Architecture for Health care Information Systems' (CEN prENV 12967-1 'Health care Information Systems Architecture'). Thanks to the availability of industrial products conforming to the standard, the effectiveness and the validity of this approach has been already demonstrated in practice. For example, through the Hansa collaboration hospitals and industries from countries of the Western and Eastern Europe, as well as of the Middle East use the same industrial middleware (i.e. 'The DHE middleware-Information view'-SPRI, 1998, 'The DHE middleware-Functional view'-SPRI, 1998) for integrating existing systems as well as for developing new applications.

  11. The Undermining of Academic Medicine.

    ERIC Educational Resources Information Center

    Andreoli, Thomas E.

    1999-01-01

    Discussion of trends in academic medicine focuses on declining support for research, pressures on medical schools to increase clinical revenues, public demands for cheaper care, and rising health-care costs in light of an aging population. Urges establishment of a system of universal health care equivalent to Medicare for all citizens. (DB)

  12. The enhancement of security in healthcare information systems.

    PubMed

    Liu, Chia-Hui; Chung, Yu-Fang; Chen, Tzer-Shyong; Wang, Sheng-De

    2012-06-01

    With the progress and the development of information technology, the internal data in medical organizations have become computerized and are further established the medical information system. Moreover, the use of the Internet enhances the information communication as well as affects the development of the medical information system that a lot of medical information is transmitted with the Internet. Since there is a network within another network, when all networks are connected together, they will form the "Internet". For this reason, the Internet is considered as a high-risk and public environment which is easily destroyed and invaded so that a relevant protection is acquired. Besides, the data in the medical network system are confidential that it is necessary to protect the personal privacy, such as electronic patient records, medical confidential information, and authorization-controlled data in the hospital. As a consequence, a medical network system is considered as a network requiring high security that excellent protections and managerial strategies are inevitable to prevent illegal events and external attacks from happening. This study proposes secure medical managerial strategies being applied to the network environment of the medical organization information system so as to avoid the external or internal information security events, allow the medical system to work smoothly and safely that not only benefits the patients, but also allows the doctors to use it more conveniently, and further promote the overall medical quality. The objectives could be achieved by preventing from illegal invasion or medical information being stolen, protecting the completeness and security of medical information, avoiding the managerial mistakes of the internal information system in medical organizations, and providing the highly-reliable medical information system.

  13. [The five commandments for preparing the Israeli healthcare system for emergencies].

    PubMed

    Adini, Bruria; Laor, Danny; Cohen, Robert; Lev, Boaz; Israeli, Avi

    2010-07-01

    In the last decade, the Israeli healthcare system dealt with many casualties that resulted from terrorist actions and at the same time maintained preparedness for other potential hazards such as natural disasters, toxicological, chemical, radiological and biological events. There are various models for emergency preparedness that are utilized in different countries. The aim of the article is to present the structure and the methodology of the Israeli healthcare system for emergencies. Assuring emergency preparedness for the different scenarios is based on 5 major components that include: comprehensive contingency planning; control and command of operations; central control of readiness; capacity building; coordination and collaboration among the numerous emergency agencies. CLose working relationships between the military and civilian systems characterize the operations of the emergency system. There is a mutual sharing of information, coordinated operations to achieve risk assessment and determine priorities, and consensual allocation of resources. The ability of the medical system to operate in optimal coordination with interface bodies, including the Israel Defense Forces, is derived from three main elements: the shortage of resources necessitate that all agencies work together to develop an effective response to emergencies; the Israeli society is characterized by transition of personnel from the military to the civilian system which promotes joint operations, whereas in most other countries these systems are completely separated; and also developing mechanisms for continuous and coordinated operation in routine and emergency times, such as the Supreme Health Authority. The Israeli healthcare system was put to the test several times in the Last decade, during the terror wave that occurred between 2001-2006, the 2nd Lebanon War and in operation "Cast Lead". An extensive process of learning lessons, conducted during and following each of these periods, and the

  14. A low-power RFID integrated circuits for intelligent healthcare systems.

    PubMed

    Lee, Shuenn-Yuh; Wang, Liang-Hung; Fang, Qiang

    2010-11-01

    This paper presents low-power radio-frequency identification (RFID) technology for intelligent healthcare systems. With attention to power-efficient communication in the body sensor network, RF power transfer was estimated and the required low-power ICs, which are important in the development of a healthcare system with miniaturization and system integration, are discussed based on the RFID platform. To analyze the power transformation, this paper adopts a 915-MHz industrial, scientific, and medical RF with a radiation power of 70 mW to estimate the power loss under the 1-m communication distance between an RFID reader (bioinformation node) and a transponder (biosignal acquisition nodes). The low-power ICs of the transponder will be implemented in the TSMC 0.18-μm CMOS process. The simulation result reveals that the transponder's IC can fit in with the link budget of the UHF RFID system.

  15. Integrating radiology information systems with healthcare delivery environments using DICOM and HL7 standards.

    PubMed

    Blazona, Bojan; Koncar, Miroslav

    2006-01-01

    Integration based on open standards, in order to achieve communication and information interoperability, is one of the key aspects of modern health care information systems. Interoperability presents data and communication layer interchange. In this context we identified the HL7 standard as the world's leading medical Information and communication technology (ICT) standard for the business layer in healthcare information systems and we tried to explore the ability to exchange clinical documents with minimal integrated healthcare information systems (IHCIS) change. We explored HL7 Clinical Document Architecture (CDA) abilities to achieve radiology information system integration (DICOM) to IHCIS (HL7). We introduced the use of WADO service interconnection to IHCIS and finally CDA rendering in widely used Internet explorers.

  16. [Colombian healthcare reform: a proposal for adjusting healthcare-related insurance and financing].

    PubMed

    García-Ubaque, Juan C; García-Ubaque, César A; Benítez, Luisa F C

    2012-10-01

    Colombian healthcare system reform (incorporated over fifteen years ago) has been the frequent object of analysis and the system currently seems to be facing one of its most serious crises. This has led to large-scale change being suggested from many social, professional and academic spaces, ranging from varied adjustments to the healthcare-related insurance model's total elimination. Research over the last ten years has suggested a balance of what may have been central to the current problem and has suggested that, although adjustment must be made from a wide national consensus, it is reasonable to maintain a healthcare-related insurance model as long as this reflects the learning achieved to date. Precautions and the necessary control measures must be taken to impede a fresh wave of frustration regarding the aim of ensuring a healthcare system which would be more equitable for all.

  17. [The Colombian healthcare system: 20 years of achievements and problems].

    PubMed

    Calderón, Carlos Alberto Agudelo; Botero, Jaime Cardona; Bolaños, Jesús Ortega; Martínez, Rocio Robledo

    2011-06-01

    An overview of some of the key processes and results of Colombia's National Health System is presented. A systematic review of the literature evaluating the quality of the evidence published in indexed journals and literature not published in journals was made. Health system financial resources have seen a sustained increase while spending on health has remained at around 8% of GNP. Coverage, measured by affiliation to contributory and subsidized regimes, is in the order of 92% of the total population. The Mandatory Health Plan, defining the benefits to which one has access, has been broadly maintained but has been hampered by mechanisms for making legal complaints, thereby leading to financial deficits. The health system has contributed towards improving the poorest sector's income, but inequalities persist due to the lack of universal coverage, differences in health plans and the system's expenditure according to the population's income. Advances made in the National Health System have been positive but universality has not been achieved and this has stagnated in matters regarding access to services and equality.

  18. Management of rheumatoid arthritis (Aamavata) using symbiohealth healthcare system

    PubMed Central

    Basisht, Gopal K.; Singh, Ram Harsh; Chandola, Harimohan

    2012-01-01

    Rheumatoid Arthritis (RA), according to modern medicine, and Aamavata according to Ayurveda, has an etiological and clinical relationship. Aamavata is a disease complex of which RA is a part. A comparative study of the pathophysiology of this disease by both systems reveals that modern medicine has investigated the mechanism of inflammation and has developed an offense strategy to control it. Ayurveda follows a defense strategy and it focuses its search on the etiological process, where disequilibrium at a higher level of physiology affects the gastrointestinal tract, causing an immune response that results in inflammation. Understanding the pathophysiology of both systems will help the treating physician to institute a dual treatment plan of modern medicine's offense strategy and Ayurvedic medicine's defense strategy at appropriate stages of the disease. Studying the pathophsiology of the two systems also gives insight into the genetic and epigenetic phenomenon in the treatment of disease and opens the doors for groundbreaking research. PMID:23723661

  19. Data-driven system to predict academic grades and dropout.

    PubMed

    Rovira, Sergi; Puertas, Eloi; Igual, Laura

    2017-01-01

    Nowadays, the role of a tutor is more important than ever to prevent students dropout and improve their academic performance. This work proposes a data-driven system to extract relevant information hidden in the student academic data and, thus, help tutors to offer their pupils a more proactive personal guidance. In particular, our system, based on machine learning techniques, makes predictions of dropout intention and courses grades of students, as well as personalized course recommendations. Moreover, we present different visualizations which help in the interpretation of the results. In the experimental validation, we show that the system obtains promising results with data from the degree studies in Law, Computer Science and Mathematics of the Universitat de Barcelona.

  20. Data-driven system to predict academic grades and dropout

    PubMed Central

    Rovira, Sergi; Puertas, Eloi

    2017-01-01

    Nowadays, the role of a tutor is more important than ever to prevent students dropout and improve their academic performance. This work proposes a data-driven system to extract relevant information hidden in the student academic data and, thus, help tutors to offer their pupils a more proactive personal guidance. In particular, our system, based on machine learning techniques, makes predictions of dropout intention and courses grades of students, as well as personalized course recommendations. Moreover, we present different visualizations which help in the interpretation of the results. In the experimental validation, we show that the system obtains promising results with data from the degree studies in Law, Computer Science and Mathematics of the Universitat de Barcelona. PMID:28196078

  1. Wearable healthcare systems, new frontiers of e-textile.

    PubMed

    Paradiso, Rita; Belloc, Carine; Loriga, Giannicola; Taccini, Nicola

    2005-01-01

    There is a growing need of renovation in our health care managing systems; people need to be more interactive and more conscious of their own health condition in a way to adjust incorrect lifestyles, to obtain a personalized therapy tuned to their own physiological reactions and on their own environmental condition. To gain knowledge of a citizen's health status and to monitor without harassing them (until they refuse any medical supervision), a comfortable remote monitoring of important physiological parameters is necessary. The approach is therefore to integrate system solutions into functional clothes with integrated textile sensors. The combination of functional clothes and integrated electronics and on-body processing, is defined as e-textile and gives rise to intelligent biomedical clothes. Systems, designed to be minimally invasive, are based on smart textile technologies, where conductive and piezoresistive materials in the form of fiber and yarn are used to realize clothes, in which knitted fabric sensors and electrodes are distributed and connected to an electronic portable unit. These systems are able to detect, acquire and transmit physiological signals. They are conformable to the human body, and move towards improving the patient's quality of life and their autonomy. These systems are also cost-effective in providing around-the-clock assistance, in helping physicians to monitor for example cardiac patients during periods of rehabilitation, and in addition result in decreased hospitalization time. Finally, by providing direct feedback to the users, they improve their awareness and potentially allow better control of their own condition, while the simultaneous recording of vital signs permits parameter extrapolation and inter-signal elaboration that contributes to produce alert messages and personalized synoptic tables of the patient's health.

  2. [The healthcare system and the complexity of social work].

    PubMed

    Kucharska, Ewa

    2012-01-01

    Due to ageing of populations, the number of persons older than 65 years will increase by 70% by 2050. At the same time the octogenarian group will grow by 170%. About half of people above 70 years develop a physical handicap of varied degree. Among the elderly, about 1.5 million have diminished mobility with the number of persons permanently bedridden and in need of an on-site care exceeds 120,000. The most important problems of old age include loneliness, disease, handicap, poverty and perceived lack usefulness. The situation of the elderly is complex and influenced by such factors as worse health, decay of intergenerational traditions, cultural change, bad living conditions and worsening of social status. Among the studied elderly, almost 30% suffer from an often unrecognised and untreated depression, and similar percentage from cognitive impairment which often implies constant care. Almost half of the elderly have poorly corrected visual problems. The apalling 1.3% of them had lost hearing. The basic citeria of effectiveness of a health care system are its availability, complexity of coverage, continuity of care, efficacy and quality, opportunity of adaptation of both caregiver and the client and the flexibility and adaptiveness of the system itself. Due to the peculiarities of ageing, older persons have special care-related needs. In the efect the system should be adapded to their needs and not vice-versa. The health care system in Poland has long-since been criticised for its inefficacy especially towards its elderly clients. It offers disintegrated, dispersed and incoherent services. The system does not fulfill the standards of geriatric approach such as universality, quality, availability and complexity of coverage of complex needs of the elderly person.

  3. What to do With Healthcare Incident Reporting Systems

    PubMed Central

    Pham, Julius Cuong; Girard, Thierry; Pronovost, Peter J.

    2013-01-01

    Incident Reporting Systems (IRS) are and will continue to be an important influence on improving patient safety. They can provide valuable insights into how and why patients can be harmed at the organizational level. However, they are not the panacea that many believe them to be. They have several limitations that should be considered. Most of these limitations stem from inherent biases of voluntary reporting systems. These limitations include: i) IRS can’t be used to measure safety (error rates); ii) IRS can’t be used to compare organizations; iii) IRS can’t be used to measure changes over time; iv) IRS generate too many reports; v) IRS often don’t generate in-depth analyses or result in strong interventions to reduce risk; vi) IRS are associated with costs. IRS do offer significant value; their value is found in the following: i) IRS can be used to identify local system hazards; ii) IRS can be used to aggregate experiences for uncommon conditions; iii) IRS can be used to share lessons within and across organizations; iv) IRS can be used to increase patient safety culture. Moving forward, several strategies are suggested to maximize their value: i) make reporting easier; ii) make reporting meaningful to the reporter; iii) make the measure of success system changes, rather than events reported; iv) prioritize which events to report and investigate, report and investigate them well; v) convene with diverse stakeholders to enhance the value of IRS. Significance for public health Incident Reporting Systems (IRS) are and will continue to be an important influence on improving patient safety. However, they are not the panacea that many believe them to be. They have several limitations that should be considered when utilizing them or interpreting their output: i) IRS can’t be used to measure safety (error rates); ii) IRS can’t be used to compare organizations; iii) IRS can’t be used to measure changes over time; iv) IRS generate too many reports; v) IRS

  4. Development of smart toothbrush monitoring system for ubiquitous healthcare.

    PubMed

    Lee, Jeong-Whan; Lee, Kang-Hwi; Kim, Kyeong-Seop; Kim, Dong-Jun; Kim, Kyungho

    2006-01-01

    The design of an intelligent toothbrush, capable of monitoring brushing motion, orientation through the grip axis, during toothbrushing is described. Inappropriate tooth-brushing styles, even in adults, sometimes cause dental problems, cavities, gingivitis, etc. This smart system provides user to monitor his or her brushing pattern using accelerometer and magnetic sensors for evaluation of toothbrushing style. Directional information of toothbrush with respect to the earth's magnetic field and activity data were measured by a miniaturized low-power micro-controller, MSP430 and transmitted to personal computer by 2.4 GHz radio transmitter, nRF2401. A personal computer provides an on-line display of activity and orientation measurements during toothbrushing. The signal trace is then analyzed to extract clinically relevant information. This preliminary study showed that the proposed monitoring system was conceived to aid dental care personnel in patient education and instruction in oral hygiene regarding brushing style.

  5. Testing the prospective evaluation of a new healthcare system

    PubMed Central

    Planitz, Birgit; Sanderson, Penelope; Freeman, Clinton; Xiao, Tania; Botea, Adi; Orihuela, Cristina Beltran

    2012-01-01

    Research into health ICT adoption suggests that the failure to understand the clinical workplace has been a major contributing factor to the failure of many computer-based clinical systems. We suggest that clinicians and administrators need methods for envisioning future use when adopting new ICT. This paper presents and evaluates a six-stage “prospective evaluation” model that clinicians can use when assessing the impact of a new electronic patient information system on a Specialist Outpatients Department (SOPD). The prospective evaluation model encompasses normative, descriptive, formative and projective approaches. We show that this combination helped health informaticians to make reasonably accurate predictions for technology adoption at the SOPD. We suggest some refinements, however, to improve the scope and accuracy of predictions. PMID:23304347

  6. Department of Defense Healthcare Management System Modernization (DHMSM)

    DTIC Science & Technology

    2016-03-01

    Acquisition Management Information Retrieval (DAMIR) UNCLASSIFIED DHMSM 2016 MAR UNCLASSIFIED 2 Table of Contents Common Acronyms and Abbreviations...Dollars MAIS - Major Automated Information System MAIS OE - MAIS Original Estimate MAR – MAIS Annual Report MDA - Milestone Decision Authority MDD...Determined TY - Then Year U.S.C- United States Code USD(AT&L) - Under Secretary of Defense for Acquisition, Technology, & Logistics DHMSM 2016 MAR

  7. Space Medicine Issues and Healthcare Systems for Space Exploration Medicine

    NASA Technical Reports Server (NTRS)

    Scheuring, Richard A.; Jones, Jeff

    2007-01-01

    This viewgraph presentation reviews issues of health care in space. Some of the issues reviewed are: (1) Physiological adaptation to microgravity, partial gravity, (2) Medical events during spaceflight, (3) Space Vehicle and Environmental and Surface Health Risks, (4) Medical Concept of Operations (CONOPS), (4a) Current CONOPS & Medical Hardware for Shuttle (STS) and ISS, (4b) Planned Exploration Medical CONOPS & Hardware needs, (5) Exploration Plans for Lunar Return Mission & Mars, and (6) Developing Medical Support Systems.

  8. Experiences of patients identifying with chronic Lyme disease in the healthcare system: a qualitative study

    PubMed Central

    2014-01-01

    Background Chronic Lyme disease is a term that describes a constellation of persistent symptoms in patients with or without evidence of previous Borrelia burgdorferi infection. Patients labeled as having chronic Lyme disease have a substantial clinical burden. Little is known about chronic Lyme disease patient experiences in the healthcare system and their relationships with healthcare providers. The purpose of this study was to gather insights about the experiences of patients who carry a diagnosis of chronic Lyme disease in the United States healthcare system. Methods Qualitative, phenomenological study in 12 adult participants who identified themselves as having chronic Lyme disease. Semi-structured face-to-face in-depth interviews were conducted, 60–90 minutes in length, focusing on perceptions of disease burden and of their healthcare providers, using the dimensions of the Health Belief Model. Transcribed interviews were analyzed for emergent topics and themes in the categories of beliefs/understanding, personal history/narrative, consequences/limitations, management, and influences on care. Results Enrollment continued until theoretical saturation was obtained. Four major themes emerged from participants’ descriptions of their experiences and perceptions: 1) changes in health status and the social impact of chronic Lyme disease, 2) doubts about recovery and the future, 3) contrasting doctor-patient relationships, 4) and the use of unconventional therapies to treat chronic Lyme disease. Conclusions Participants reported a significant decline in health status associated with chronic Lyme disease and were often unsatisfied with care in conventional settings. Negative experiences were associated with reports of dismissive, patronizing, and condescending attitudes. Positive experiences were associated with providers who were reported to be attentive, optimistic, and supportive. Consultations with CAM practitioners and use of CAM therapies were common. Actively

  9. Building a competitive insurance system: Switzerland's strategy for managed-care healthcare.

    PubMed

    Zweifel, Peter

    2006-12-01

    This paper applies the five standard criteria for assessing the performance of an economy to one of its sectors, namely, the provision of health care. They are (1) matching of consumer preferences, (2) technical efficiency, (3) adaptive capacity, (4) dynamic efficiency, and (5) a distribution of income that provides incentives for producers to attain criteria (1) through (4). Being insurance-based, the Swiss healthcare system comprises three contractual relationships that can be judged in the light of these criteria. First, the relationship between consumers and health insurers satisfies criterion (1) to a high degree, not least thanks to the managed-care (MC) options that were introduced with the new law on health insurance (effective 1996). However, it fails with regard to (2) because cost reductions achieved by MC cannot be passed on to consumers but to a very limited degree. The relationship between health insurers and service providers, by way of contrast, does not fully satisfy any of the five criteria, mainly because health insurers continue to operate under an any-willing-provider clause for conventional fee-for-service care. This makes it difficult for them to find MC providers. Finally, the relationship between consumers and healthcare providers match consumer preferences well (criterion 1) but do not result in an income distribution in the healthcare sector that is conducive to the attainment of criteria (2) through (4). The total score for the Swiss healthcare system amounts to 13 points out of a maximum of 30, to which the relationship between insurers and providers contributes only 3 points. Therefore, performance could be improved by granting health insurers freedom to contract not only with domestic but also foreign healthcare providers offering a favorable benefit cost ratio.

  10. Funding New Zealand's public healthcare system: time for an honest appraisal and public debate.

    PubMed

    Keene, Lyndon; Bagshaw, Philip; Nicholls, M Gary; Rosenberg, Bill; Frampton, Christopher M; Powell, Ian

    2016-05-27

    Successive New Zealand governments have claimed that the cost of funding the country's public healthcare services is excessive and unsustainable. We contest that these claims are based on a misrepresentation of healthcare spending. Using data from the New Zealand Treasury and the Organisation for Economic Cooperation and Development (OECD), we show how government spending as a whole is low compared with most other OECD countries and is falling as a proportion of GDP. New Zealand has a modest level of health spending overall, but government health spending is also falling as a proportion of GDP. Together, the data indicate the New Zealand Government can afford to spend more on healthcare. We identify compelling reasons why it should do so, including forecast growing health need, signs of increasing unmet need, and the fact that if health needs are not met the costs still have to be borne by the economy. The evidence further suggests it is economically and socially beneficial to meet health needs through a public health system. An honest appraisal and public debate is needed to determine more appropriate levels of healthcare spending.

  11. Development of a wearable system integrated with novel biomedical sensors for ubiquitous healthcare.

    PubMed

    Hung, Kevin; Lee, C C; Chan, W M; Choy, Sheung-On; Kwok, Paul

    2012-01-01

    The world's ageing population has led to an urgent need for long-term and patient-centered healthcare solutions. Hence, there is a growing need for wearable systems for physiologic monitoring. While various biosignals are monitored with traditional approaches, it is worthwhile to investigate alternative sensing techniques in order to improve accessibility and understanding of patients' conditions. This paper presents our laboratory's development of such a wearable system, which makes use of unconventional techniques for physiologic monitoring. With its integrated textile electrocardiogram (ECG) electrodes, intelligent finger-ring photoplethysmogram (PPG) sensor, miniaturized optical fiber-based temperature sensor, eye dynamics monitor, global positioning system (GPS) module, and wireless capability, it demonstrates a feasible solution for ubiquitous healthcare.

  12. Harvard Catalyst | The Clinical Translational Science Center IND/IDE Consult Service: providing an IND/IDE consult service in a decentralized network of academic healthcare centers.

    PubMed

    Kim, Min J; Winkler, Sabune J; Bierer, Barbara E; Wolf, Delia

    2014-04-01

    The Food and Drug Administration (FDA) regulations require sponsors of clinical investigations involving an investigational drug or device to submit an Investigational New Drug (IND) or Investigational Device Exemption (IDE) application. Strict adherence to applicable regulations is vital to the success of clinical research. Unlike most major pharmaceutical sponsors, investigator sponsors often do not fully appreciate their regulatory obligations nor have resources to ensure compliance. As a result they can place themselves and their institutions at risk. Nevertheless, investigator-initiated clinical trials are vital to the further development of innovative drugs, biologics, and medical devices. The IND/IDE Subcommittee under the Regulatory Knowledge and Support Program at Harvard Catalyst, The Harvard Clinical and Translational Science Center worked in collaboration with Harvard and Harvard affiliated institutions to create and launch an IND/IDE Consult Service in a decentralized network of collaborating Academic Healthcare Centers (AHC). The IND/IDE Consult Service offers expertise, resources, and shared experiences to assist sponsor-investigators and IRBs in meeting regulatory requirements for conducting and reviewing investigator-initiated IND/IDE studies. The scope of the services provided by the Harvard Catalyst IND/IDE Consult Service are described, including the specifics of the service, lessons learned, and challenges faced, in a scalable model that builds inter-institutional capacity.

  13. 'I think it will eventually be done away with': Attitudes among healthcare professionals towards the current system of animal experimentation.

    PubMed

    Dignon, Andrée

    2016-08-01

    This article describes a study of attitudes to the current system of animal experimentation (for the production of health interventions) among 52 UK healthcare professionals. These healthcare professionals participated in three separate focus groups (of 18, 17 and 17 participants) and were invited to respond to the question 'what is your opinion about the current system of animal testing?' The study focused specifically on their views of the current system (rather than their views of animal testing in general). The healthcare professionals were critical of the current system, particularly with regard to regulation, secrecy, validity, unnecessary suffering and welfare.

  14. An RF-based wearable sensor system for indoor tracking to facilitate efficient healthcare management.

    PubMed

    Yuzhe Ouyang; Shan, Kai; Bui, Francis Minhthang

    2016-08-01

    To understand the utilization of clinical resources and improve the efficiency of healthcare, it is often necessary to accurately locate patients and doctors in a healthcare facility. However, existing tracking methods, such as GPS, Wi-Fi and RFID, have technological drawbacks or impose significant costs, thus limiting their applications in many clinical environments, especially those with indoor enclosures. This paper proposes a low-cost and flexible tracking system that is well suited for operating in an indoor environment. Based on readily available RF transceivers and microcontrollers, our wearable sensor system can facilitate locating users (e.g., patients or doctors) or objects (e.g., medical devices) in a building. The strategic construction of the sensor system, along with a suitably designed tracking algorithm, together provide for reliability and dispatch in localization performance. For demonstration purposes, several simplified experiments, with different configurations of the system, are implemented in two testing rooms to assess the baseline performance. From the obtained results, our system exhibits immense promise in acquiring a user location and corresponding time-stamp, with high accuracy and rapid response. This capability is conducive to both short- and long-term data analytics, which are crucial for improving healthcare management.

  15. Healthcare Lean.

    PubMed

    Long, John C

    2003-01-01

    Lean Thinking is an integrated approach to designing, doing and improving the work of people that have come together to produce and deliver goods, services and information. Healthcare Lean is based on the Toyota production system and applies concepts and techniques of Lean Thinking to hospitals and physician practices.

  16. Addressing healthcare.

    PubMed

    Daly, Rich

    2013-02-11

    Though President Barack Obama has rarely made healthcare references in his State of the Union addresses, health policy experts are hoping he changes that strategy this year. "The question is: Will he say anything? You would hope that he would, given that that was the major issue he started his presidency with," says Dr. James Weinstein, left, of the Dartmouth-Hitchcock health system.

  17. Epigenetics: Its Understanding Is Crucial to a Sustainable Healthcare System

    PubMed Central

    Thunders, Michelle

    2015-01-01

    Understanding the molecular impact of lifestyle factors has never been so important; a period in time where there are so many adults above retirement age has been previously unknown. As a species, our life expectancy is increasing yet the period of our lives where we enjoy good health is not expanding proportionately. Over the next 50 years we will need to almost double the percentage of GDP spent on health care, largely due to the increasing incidence of obesity related chronic diseases. A greater understanding and implementation of an integrated approach to health is required. Research exploring the impact of nutritional and exercise intervention on the epigenetically flexible genome is up front in terms of addressing healthy aging. Alongside this, we need a greater understanding of the interaction with our immune and nervous systems in preserving and maintaining health and cognition. PMID:27417756

  18. Actualizing Personalized Healthcare for Women through Connected Data Systems: Breast Cancer Screening and Diagnosis

    PubMed Central

    Weerasinghe, Roshanthi

    2013-01-01

    Background: Healthcare organizations have invested in electronic patient data systems, yet use of health data to optimize personalized care has been limited. Primary Study Objective: To develop and pilot an integrated source of health system data related to breast healthcare. Methods/Design: This study is a quality improvement project. Patient-level data from multiple internal sources were identified, mapped to a common data model, linked, and validated to create a breast healthcare-specific data mart. Linkages were based on matching algorithms using patient identifiers to group data from the same patient. Data definitions, a data dictionary, and indicators for quality and benchmarking aligned with standardized measures. Clinical pathways were developed to outline the patient populations, data elements, decision points, and outcomes for specific conditions. Setting: Electronic data sources in a community-based health system in the United States. Participants: Women receiving breast cancer screening, prevention, and diagnosis services. Main Outcome Measures: Distribution of mammography examinations and pathologic results of breast biopsies. Results: From 2008 to 2011, 200768 screening and 50200 diagnostic mammograms were obtained; rates varied by age over time. Breast biopsies for 7332 women indicated 23.3% with invasive breast cancer, 6.7% with ductal carcinoma in situ, and 70.0% with nonmalignant diagnoses that would not have been further differentiated by administrative codes alone. Limitations: Evaluation of validity and efficiency and additional tracking of clinical outcomes are needed. Conclusions: The creation of a patient-centered data system by connecting and integrating disparate data sources within a large health system allows customized analyses of data and improves capacity for clinical decision making and personalized healthcare. PMID:24416691

  19. Healthcare under the Panchayati Raj Institutions (PRIs) in a decentralised health system.

    PubMed

    Kumar, Virendra; Jayanta Mishra, Anindya

    2016-05-03

    Purpose This paper aims to explore the challenges and benefits arising from the involvement of Panchayati Raj Institutions (PRIs) in the provisioning of primary healthcare in a decentralised health system of India. Design/methodology/approach A qualitative study design was used in this study. Data were collected through semi-structured interviews from 89 respondents selected from nine primary health centres across the district. A thematic analytical framework approach was used to analyse the data. Findings The research results indicate that there are several challenges resulting from PRIs involvement, including prioritisation of service providers and users, coercive unethical work and lack of communication. However, there are some benefits associated with the involvement of the PRIs in service provisioning, including improved availability and regularity of healthcare providers at the health centres. Research limitations/implications The implications of the findings suggest that the PRIs play an important role in healthcare provisioning; however, their involvement is ineffective due to their partial capabilities and approach, which creates a non-conducive environment. Practical implications Health issues are among the most important human concerns, and recognising and addressing the grassroot challenges help to locate, and overcome the challenges that hinder the smooth healthcare provisioning process. Originality/value National Rural Health Mission has recognised the PRIs as a platform to promote decentralised health planning and for achieving its goals in India. The PRIs are significantly involved in planning, monitoring and provisioning of primary healthcare services at grassroot level. This paper addresses the challenges and benefits that emerged due to their involvement.

  20. The incidence of thyroid cancer is affected by the characteristics of a healthcare system.

    PubMed

    Lee, Tae-Jin; Kim, Sun; Cho, Hong-Jun; Lee, Jae-Ho

    2012-12-01

    The aim of this study was to investigate the associations between the incidence of thyroid cancer and the characteristics of healthcare systems in OECD countries and to demonstrate that the increasing incidence of thyroid cancer is mainly due to overdiagnosis. We used a random effects panel model to regress the incidence of thyroid cancer on the characteristics of healthcare systems (i.e., share of public expenditure on health, mode of health financing, existence of referral system to secondary care, mode of payment to primary care physicians), controlling for macro context variables (i.e., GDP per capita, educational level) on a country level. Data were derived from 34 OECD countries for 2002 and 2008. The share of public expenditure on health was negatively associated with the incidence of thyroid cancer. However, it had no statistically significant effect on the mortality of thyroid cancer and on the incidence of stomach and lung cancer. In the case of colorectal cancer, it had a positive effect on the incidence rate. The upward trend of the incidence of thyroid cancer is closely related to the healthcare system that permits overdiagnosis. Increases in the proportion of public financing may help reduce the overdiagnosis of thyroid cancer.

  1. Real-time locating systems (RTLS) in healthcare: a condensed primer

    PubMed Central

    2012-01-01

    Real-time locating systems (RTLS, also known as real-time location systems) have become an important component of many existing ubiquitous location aware systems. While GPS (global positioning system) has been quite successful as an outdoor real-time locating solution, it fails to repeat this success indoors. A number of RTLS technologies have been used to solve indoor tracking problems. The ability to accurately track the location of assets and individuals indoors has many applications in healthcare. This paper provides a condensed primer of RTLS in healthcare, briefly covering the many options and technologies that are involved, as well as the various possible applications of RTLS in healthcare facilities and their potential benefits, including capital expenditure reduction and workflow and patient throughput improvements. The key to a successful RTLS deployment lies in picking the right RTLS option(s) and solution(s) for the application(s) or problem(s) at hand. Where this application-technology match has not been carefully thought of, any technology will be doomed to failure or to achieving less than optimal results. PMID:22741760

  2. Perceptions of dental students regarding dentistry, the job market and the public healthcare system.

    PubMed

    Costa, Simone de Melo; Silveira, Marise Fagundes; Durães, Sarah Jane Alves; Abreu, Mauro Henrique Nogueira Guimarães de; Bonan, Paulo Rogério Ferreti

    2012-05-01

    The scope was to analyze the perceptions of dentistry students at the State University of Montes Claros, Brazil, regarding dentistry, the job market and the public healthcare system. For this, a triangulation method was employed, using a self-administered questionnaire and interviews. The quantitative data were submitted to univariate and multivariate analysis, using Poisson regression, where p<0.05. Content analysis was used for the qualitative data. The majority reported expecting to obtain work in the public healthcare system, stated that the dentistry course prepares students for this market as the curriculum integrates both teaching and service, reported being in favor of greater experience in the public healthcare system and said they would not take classes in Public Health if they were optional. Contact with the social context through teaching/service integration in the advanced semesters of the dentistry course appears to contribute to the development of new professional skills for working in the public sector. However, the students' perceptions revealed contradictions, considering the low value they attributed to the classes on Public Health and their perception of the public system as a residual job option.

  3. A telemedicine system for wireless home healthcare based on Bluetooth and the Internet.

    PubMed

    Zhao, Xiaoming; Fei, Ding-Yu; Doarn, Charles R; Harnett, Brett; Merrell, Ronald

    2004-01-01

    The VitalPoll Telemedicine System (VTS) was designed and developed for wireless home healthcare. The aims of this study were: to design the architecture and communication methods for a telemedicine system; to implement a physiologic routing hub to collect data from different medical devices and sensors; and to evaluate the feasibility of this system for applications in wireless home healthcare. The VTS was built using Bluetooth wireless and Internet technologies with client/server architecture. Several medical devices, which acquire vital signs, such as real-time electrocardiogram signals, heart rate, body temperature, and activity (physical motion), were integrated into the VTS. Medical information and data were transmitted over short-range interface (USB, RS232), wireless communication, and the Internet. The medical results were stored in a database and presented using a web browser. The patient's vital signals can be collected, transmitted, and displayed in real time by the VTS. The experiments verified no data loss during Bluetooth and Internet communication. Bluetooth and the Internet provide enough bandwidth channels to tranmit these vital signs. The experimental results show that VTS may be suitable for a practical telemedicine system in home healthcare.

  4. A systems-based partnership learning model for strengthening primary healthcare

    PubMed Central

    2013-01-01

    Background Strengthening primary healthcare systems is vital to improving health outcomes and reducing inequity. However, there are few tools and models available in published literature showing how primary care system strengthening can be achieved on a large scale. Challenges to strengthening primary healthcare (PHC) systems include the dispersion, diversity and relative independence of primary care providers; the scope and complexity of PHC; limited infrastructure available to support population health approaches; and the generally poor and fragmented state of PHC information systems. Drawing on concepts of comprehensive PHC, integrated quality improvement (IQI) methods, system-based research networks, and system-based participatory action research, we describe a learning model for strengthening PHC that addresses these challenges. We describe the evolution of this model within the Australian Aboriginal and Torres Strait Islander primary healthcare context, successes and challenges in its application, and key issues for further research. Discussion IQI approaches combined with system-based participatory action research and system-based research networks offer potential to support program implementation and ongoing learning across a wide scope of primary healthcare practice and on a large scale. The Partnership Learning Model (PLM) can be seen as an integrated model for large-scale knowledge translation across the scope of priority aspects of PHC. With appropriate engagement of relevant stakeholders, the model may be applicable to a wide range of settings. In IQI, and in the PLM specifically, there is a clear role for research in contributing to refining and evaluating existing tools and processes, and in developing and trialling innovations. Achieving an appropriate balance between funding IQI activity as part of routine service delivery and funding IQI related research will be vital to developing and sustaining this type of PLM. Summary This paper draws together

  5. Influence of immigration on prematurity in the context of a free healthcare system with universal coverage.

    PubMed

    Cortés, Ernesto; Mercedes Rizo-Baeza, María; Palazón-Bru, Antonio; Aguilar-Cordero, María José; Francisco Gil-Guillén, Vicente

    2015-05-22

    We assessed the risk of preterm birth according to the mother's place of origin in the context of a free and universal healthcare system. We analysed 75,292 newborn infants born between 2008-2011 in Alicante (Spain). The outcomes were: 1) very preterm (gestational age ≤ 32 weeks) and 2) moderate-to-late preterm (gestational age 33-37 weeks). Other variables: infant's gender, maternal age and origin. We estimated adjusted odds ratios to analyse the relationship between the outcomes and the other variables. The distribution of the gestational age groups in our sample was: very preterm, 812; moderate-to-late preterm, 5,295; full-term, 69,997. There were no statistically significant differences between the mother's place of origin and the outcomes in this free universal healthcare system, which is experiencing the recent phenomenon of immigration. This equality should be maintained throughout the time the immigrants remain in the country.

  6. Embedded sensor systems for health - providing the tools in future healthcare.

    PubMed

    Lindén, Maria; Björkman, Mats

    2014-01-01

    Wearable, embedded sensor systems for health applications are foreseen to be enablers in the future healthcare. They will provide ubiquitous monitoring of multiple parameters without restricting the person to stay at home or in the hospital. By following trend changes in the health status, early deteriorations will be detected and treatment can start earlier. Also health prevention will be supported. Such future healthcare requires technology development, including miniaturized sensors, smart textiles and wireless communication. The tremendous amount of data generated by these systems calls for both signal processing and decision support to guarantee the quality of data and avoid overflow of information. Safe and secure communications have to protect the integrity of the persons monitored.

  7. The Copernican era of healthcare terminology: a re-centering of health information systems.

    PubMed

    Chute, C G

    1998-01-01

    Health terminology and classifications have been an unseen backwater in healthcare practice and information systems development. Today however, the recognized need for comparable patient data is driving a new discovery about its strategic importance. Consistent patient descriptions and concept-centered data representations are crucial for efficient discovery of optimal treatments, best outcomes, and efficient practice patterns. The fabled linkage of knowledge sources at the time and place of care requires the conceptual intermediary of common terminology. A brief history overviewing the evolution of health classifications will provide the foundation for considering present and evolving health terminology developments. Their roles in health information systems will be characterized. Discussion will focus on the likely influences of the HIPAA legislation nationally and the new ISO Healthcare Informatics Technical Committee internationally, on terminology adaptation and incorporation.

  8. Knowledge Discovery from Massive Healthcare Claims Data

    SciTech Connect

    Chandola, Varun; Sukumar, Sreenivas R; Schryver, Jack C

    2013-01-01

    The role of big data in addressing the needs of the present healthcare system in US and rest of the world has been echoed by government, private, and academic sectors. There has been a growing emphasis to explore the promise of big data analytics in tapping the potential of the massive healthcare data emanating from private and government health insurance providers. While the domain implications of such collaboration are well known, this type of data has been explored to a limited extent in the data mining community. The objective of this paper is two fold: first, we introduce the emerging domain of big"healthcare claims data to the KDD community, and second, we describe the success and challenges that we encountered in analyzing this data using state of art analytics for massive data. Specically, we translate the problem of analyzing healthcare data into some of the most well-known analysis problems in the data mining community, social network analysis, text mining, and temporal analysis and higher order feature construction, and describe how advances within each of these areas can be leveraged to understand the domain of healthcare. Each case study illustrates a unique intersection of data mining and healthcare with a common objective of improving the cost-care ratio by mining for opportunities to improve healthcare operations and reducing hat seems to fall under fraud, waste,and abuse.

  9. Understanding public perception of the need for major change in Latin American healthcare systems.

    PubMed

    Pérez-Cuevas, Ricardo; Guanais, Frederico C; Doubova, Svetlana V; Pinzón, Leonardo; Tejerina, Luis; Pinto Masis, Diana; Rocha, Marcia; Harris, Donna O; Macinko, James

    2017-03-17

    The opinions and experiences of the public regarding health services are valuable insights into identifying opportunities to improve healthcare systems. We analyzed the 2012-2013 Public Opinion Health Policy Survey carried out in Brazil (n = 1486), Colombia (n = 1485), El Salvador (n = 1460), Jamaica (n = 1480), México (n = 1492) and Panama (n = 1475). In these countries between 82 and 96% of participants perceived that their health systems needed fundamental changes. The most frequent barrier to access to healthcare was lack of the primary medical home, difficulties in obtaining medical care during the weekends and financial barriers. Type of health insurance and challenges in obtaining medical care during the weekends were associated with an increased opinion for the need for fundamental changes in healthcare systems, whereas having a primary medical home showed a protective effect. Focusing on tackling organizational and financial barriers and ensuring access to a primary medical home should be placed on the agenda of Latin American countries.

  10. Creation of a RFID based real time tracking (R-RTT) system for small healthcare clinics.

    PubMed

    Chen, Joseph C; Collins, Thomas J

    2012-12-01

    A well-managed healthcare system improves the quality of the patient experience. However, many small healthcare clinics have suboptimal systems for scheduling and locating patients and medical staff, delaying the relay of information and creating poor resource and room utilization. This paper proposes a Radio Frequency Identification (RFID)-based Real-Time Tracking (R-RTT) System for optimizing small healthcare facility operations, enabling further optimization of throughput time, room utilization, and patient flow. In the proposed scenario, RFID readers were equipped in strategic locations throughout the facility. Patients and medical staff were issued personalized RFID tags. When they pass through the reader's interrogation zone, it reads their RFID tag and sends the information to a central computer equipped with software capable of filtering the RFID data into useable information. A Visual Basic Application (VBA) program uses the information received from the ID tags to display the location of the patients and staff as they move throughout the facility. This increases their visibility within the facility by allowing medical staff to determine where their colleagues and patients are at all times. The VBA program was also able to record the data in order to track the time each stage of the appointment process takes to complete. The recorded time data can be broken into processes, making it easier to determine if it adds value. This data can then be transformed into a value stream map for further analysis and improvement.

  11. Nonattendance at a hospital-based otolaryngology clinic: a preliminary analysis within a universal healthcare system.

    PubMed

    Zirkle, Molly S; McNelles, Laurie R

    2011-08-01

    Missed appointments at specialty clinics generate concerns for physicians and clinic administrators. Appointment nonattendance obstructs the provision of timely medical interventions and the maximization of systemic efficiencies. Yet, empiric study of factors associated with missed appointments at adult specialty clinics has received little attention in North America. We conducted a preliminary study of otolaryngology clinic nonattendance in the context of a universal healthcare system environment in Canada. Our data were based on the schedule of 1,512 new patient appointments at a hospital-based clinic from May 1 through Sept. 30, 2008. Gathered information included the employment status of the attending physician (i.e., full-time vs. part-time), the patient's sex and age, the day of the week and the time of the appointment, and the attendance status. We found that the rate of nonattendance was 24.4% (n = 369). Nonattendance rates varied significantly according to physician employment status (more common for part-time physicians), patient sex (women) and age (younger adults), and the day of the appointment (Wednesdays), but not according to the time of day. Our findings suggest that there are predictable patient and systemic factors that influence nonattendance at medical appointments. Awareness of these factors can have implications for the delivery of healthcare services within a universal healthcare context.

  12. Cost-Effective Mobile-Based Healthcare System for Managing Total Joint Arthroplasty Follow-Up

    PubMed Central

    Koutras, George; Heep, Hansjoerg; Koutras, Christos

    2017-01-01

    Objectives Long-term follow-up care after total joint arthroplasty is essential to evaluate hip and knee arthroplasty outcomes, to provide information to physicians and improve arthroplasty performance, and to improve patients' health condition. In this paper, we aim to improve the communication between arthroplasty patients and physicians and to reduce the cost of follow-up controls based on mobile application technologies and cloud computing. Methods We propose a mobile-based healthcare system that provides cost-effective follow-up controls for primary arthroplasty patients through questions about symptoms in the replaced joint, questionnaires (WOMAC and SF-36v2) and the radiological examination of knee or hip joint. We also perform a cost analysis for a set of 423 patients that were treated in the University Clinic for Orthopedics in Essen-Werden. Results The estimation of healthcare costs shows significant cost savings (a reduction of 63.67% for readmission rate 5%) in both the University Clinic for Orthopedics in Essen-Werden and the state of North Rhine-Westphalia when the mobile-based healthcare system is applied. Conclusions We propose a mHealth system to reduce the cost of follow-up assessments of arthroplasty patients through evaluation of diagnosis, self-monitoring, and regular review of their health status. PMID:28261533

  13. Fraud Detection in Healthcare

    SciTech Connect

    Chandola, Varun; Schryver, Jack C; Sukumar, Sreenivas R

    2015-01-01

    We discuss the problem of fraud detection in healthcare in this chapter. Given the recent scrutiny of the ineciencies in the US healthcare system, identifying fraud has been on the forefront of the eorts towards reducing the healthcare costs. In this chapter we will focus on understanding the issue of healthcare fraud in detail, and review methods that have been proposed in the literature to combat this issue using data driven approach.

  14. Child-Sized Gaps in the System: Case Studies of Child Suicidality and Support within the Australian Healthcare System

    ERIC Educational Resources Information Center

    McKay, Kathy; Shand, Fiona

    2016-01-01

    While children both understand the concept of, and have died by, suicide, little research has been conducted on children's experiences of healthcare systems during and after a suicidal crisis. This article focuses on three case studies of mothers with suicidal daughters and aims to describe the health service experiences of parents whose children…

  15. What ails India's two-tiered healthcare system? A philosophical enquiry.

    PubMed

    Ghoshal, Rakhi

    2015-01-01

    India's two-tiered healthcare system (viz the public and private sectors) has been suffering from various ailments, and each sector has been criticised for its own set of deficiencies. Against this backdrop, this article explores whether there is any possible commonality between the two sectors, and suggests that the "common logic", or common ground, is the model of biomedical knowledge, which forms the foundation of both sectors. It is to problems inherent in the "model of biomedical knowledge" that certain gaps in each sector can be traced. It is only when we have identified the lapses at the root of the structures of each sector that we can plug the gaps in healthcare. The author suggests that it would be best to analyse the gaps through a philosophical enquiry, and to offer a probable solution, turns to the methodologies of care ethics and feminist standpoint epistemology.

  16. Shopping in the healthcare information systems market--a search for well-camouflaged land mines.

    PubMed

    Grams, R R

    1998-10-01

    The selection of a healthcare information system is analogous to a big game hunt. The buyers perceive themselves as the hunters while the truth is just the opposite. To strip away the carefully crafted facade of corporate marketing is an art form and requires due diligence on the part of the shopper. Suggestions are offered to the consumer on how to pierce the shell of corporate silence and find the facts that will make a significant difference in product selection. The objectives on the seller's side are to make as much profit as possible and give as little as required to make the sale. The buyer is looking for the best product, the best company, and the most painless installation. The ground between these two vastly different goals is the battlefield of healthcare computer procurement. May the best shopper win! Caveat emptor.

  17. Using heterogeneous wireless sensor networks in a telemonitoring system for healthcare.

    PubMed

    Corchado, Juan M; Bajo, Javier; Tapia, Dante I; Abraham, Ajith

    2010-03-01

    Ambient intelligence has acquired great importance in recent years and requires the development of new innovative solutions. This paper presents a distributed telemonitoring system, aimed at improving healthcare and assistance to dependent people at their homes. The system implements a service-oriented architecture based platform, which allows heterogeneous wireless sensor networks to communicate in a distributed way independent of time and location restrictions. This approach provides the system with a higher ability to recover from errors and a better flexibility to change their behavior at execution time. Preliminary results are presented in this paper.

  18. RFID sensor-tags feeding a context-aware rule-based healthcare monitoring system.

    PubMed

    Catarinucci, Luca; Colella, Riccardo; Esposito, Alessandra; Tarricone, Luciano; Zappatore, Marco

    2012-12-01

    Along with the growing of the aging population and the necessity of efficient wellness systems, there is a mounting demand for new technological solutions able to support remote and proactive healthcare. An answer to this need could be provided by the joint use of the emerging Radio Frequency Identification (RFID) technologies and advanced software choices. This paper presents a proposal for a context-aware infrastructure for ubiquitous and pervasive monitoring of heterogeneous healthcare-related scenarios, fed by RFID-based wireless sensors nodes. The software framework is based on a general purpose architecture exploiting three key implementation choices: ontology representation, multi-agent paradigm and rule-based logic. From the hardware point of view, the sensing and gathering of context-data is demanded to a new Enhanced RFID Sensor-Tag. This new device, de facto, makes possible the easy integration between RFID and generic sensors, guaranteeing flexibility and preserving the benefits in terms of simplicity of use and low cost of UHF RFID technology. The system is very efficient and versatile and its customization to new scenarios requires a very reduced effort, substantially limited to the update/extension of the ontology codification. Its effectiveness is demonstrated by reporting both customization effort and performance results obtained from validation in two different healthcare monitoring contexts.

  19. Process techniques for human thoracic electrical bio-impedance signal in remote healthcare systems.

    PubMed

    Rahman, Muhammad Zia Ur; Mirza, Shafi Shahsavar

    2016-06-01

    Analysis of thoracic electrical bio-impedance (TEB) facilitates heart stroke volume in sudden cardiac arrest. This Letter proposes several efficient and computationally simplified adaptive algorithms to display high-resolution TEB component. In a clinical environment, TEB signal encounters with various physiological and non-physiological phenomenon, which masks the tiny features that are important in identifying the intensity of the stroke. Moreover, computational complexity is an important parameter in a modern wearable healthcare monitoring tool. Hence, in this Letter, the authors propose a new signal conditioning technique for TEB enhancement in remote healthcare systems. For this, the authors have chosen higher order adaptive filter as a basic element in the process of TEB. To improve filtering capability, convergence speed, to reduce computational complexity of the signal conditioning technique, the authors apply data normalisation and clipping the data regressor. The proposed implementations are tested on real TEB signals. Finally, simulation results confirm that proposed regressor clipped normalised higher order filter is suitable for a practical healthcare system.

  20. Smart healthcare textile sensor system for unhindered-pervasive health monitoring

    NASA Astrophysics Data System (ADS)

    Rai, Pratyush; Kumar, Prashanth S.; Oh, Sechang; Kwon, Hyeokjun; Mathur, Gyanesh N.; Varadan, Vijay K.; Agarwal, M. P.

    2012-04-01

    Simultaneous monitoring of physiological parameters- multi-lead Electrocardiograph (ECG), Heart rate variability, and blood pressure- is imperative to all forms of medical treatments. Using an array of signal recording devices imply that the patient will have to be confined to a bed. Textiles offer durable platform for embedded sensor and communication systems. The smart healthcare textile, presented here, is a mobile system for remote/wireless data recording and conditioning. The wireless textile system has been designed to monitor a patient in a non-obstructive way. It has a potential for facilitating point of care medicine and streamlining ambulatory medicine. The sensor systems were designed and fabricated with textile based components for easy integration on textile platform. An innovative plethysmographic blood pressure monitoring system was designed and tested as an alternative to inflatable blood pressure sphygmomanometer. Flexible dry electrodes technology was implemented for ECG. The sensor systems were tested and conditioned to daily activities of patients, which is not permissible with halter type systems. The signal quality was assessed for it applicability to medical diagnosis. The results were used to corroborate smart textile sensor system's ability to function as a point of care system that can provide quality healthcare.

  1. Involving private healthcare practitioners in an urban NCD sentinel surveillance system: lessons learned from Pune, India

    PubMed Central

    Kroll, Mareike; Phalkey, Revati; Dutta, Sayani; Shukla, Sharvari; Butsch, Carsten; Bharucha, Erach; Kraas, Frauke

    2016-01-01

    Background Despite the rising impact of non-communicable diseases (NCDs) on public health in India, lack of quality data and routine surveillance hampers the planning process for NCD prevention and control. Current surveillance programs focus largely on communicable diseases and do not adequately include the private healthcare sector as a major source of care in cities. Objective The objective of the study was to conceptualize, implement, and evaluate a prototype for an urban NCD sentinel surveillance system among private healthcare practitioners providing primary care in Pune, India. Design We mapped all private healthcare providers in three selected areas of the city, conducted a knowledge, attitude, and practice survey with regard to surveillance among 258 consenting practitioners, and assessed their willingness to participate in a routine NCD surveillance system. In total, 127 practitioners agreed and were included in a 6-month surveillance study. Data on first-time diagnoses of 10 selected NCDs alongside basic demographic and socioeconomic patient information were collected onsite on a monthly basis using a paper-based register. Descriptive and regression analyses were performed. Results In total, 1,532 incident cases were recorded that mainly included hypertension (n=622, 41%) and diabetes (n=460, 30%). Dropout rate was 10% (n=13). The monthly reporting consistency was quite constant, with the majority (n=63, 50%) submitting 1–10 cases in 6 months. Average number of submitted cases was highest among allopathic practitioners (17.4). A majority of the participants (n=104, 91%) agreed that the surveillance design could be scaled up to cover the entire city. Conclusions The study indicates that private primary healthcare providers (allopathic and alternate medicine practitioners) play an important role in the diagnosis and treatment of NCDs and can be involved in NCD surveillance, if certain barriers are addressed. Main barriers observed were lack of regulation

  2. National healthcare information system in Croatian primary care: the foundation for improvement of quality and efficiency in patient care.

    PubMed

    Gvozdanović, Darko; Koncar, Miroslav; Kojundzić, Vinko; Jezidzić, Hrvoje

    2007-01-01

    In order to improve the quality of patient care, while at the same time keeping up with the pace of increased needs of the population for healthcare services that directly impacts on the cost of care delivery processes, the Republic of Croatia, under the leadership of the Ministry of Health and Social Welfare, has formed a strategy and campaign for national public healthcare system reform. The strategy is very comprehensive and addresses all niches of care delivery processes; it is founded on the enterprise information systems that will aim to support end-to-end business processes in the healthcare domain. Two major requirements are in focus: (1) to provide efficient healthcare-related data management in support of decision-making processes; (2) to support a continuous process of healthcare resource spending optimisation. The first project is the Integrated Healthcare Information System (IHCIS) on the primary care level; this encompasses the integration of all primary point-of-care facilities and subjects with the Croatian Institute for Health Insurance and Croatian National Institute of Public Health. In years to come, IHCIS will serve as the main integration platform for connecting all other stakeholders and levels of health care (that is, hospitals, pharmacies, laboratories) into a single enterprise healthcare network. This article gives an overview of Croatian public healthcare system strategy aims and goals, and focuses on properties and characteristics of the primary care project implementation that started in 2003; it achieved a major milestone in early 2007 - the official grand opening of the project with 350 GPs already fully connected to the integrated healthcare information infrastructure based on the IHCIS solution.

  3. Design and implementation of a smart card based healthcare information system.

    PubMed

    Kardas, Geylani; Tunali, E Turhan

    2006-01-01

    Smart cards are used in information technologies as portable integrated devices with data storage and data processing capabilities. As in other fields, smart card use in health systems became popular due to their increased capacity and performance. Their efficient use with easy and fast data access facilities leads to implementation particularly widespread in security systems. In this paper, a smart card based healthcare information system is developed. The system uses smart card for personal identification and transfer of health data and provides data communication via a distributed protocol which is particularly developed for this study. Two smart card software modules are implemented that run on patient and healthcare professional smart cards, respectively. In addition to personal information, general health information about the patient is also loaded to patient smart card. Health care providers use their own smart cards to be authenticated on the system and to access data on patient cards. Encryption keys and digital signature keys stored on smart cards of the system are used for secure and authenticated data communication between clients and database servers over distributed object protocol. System is developed on Java platform by using object oriented architecture and design patterns.

  4. Effectiveness of an electronic hand hygiene monitoring system on healthcare workers' compliance to guidelines.

    PubMed

    Al Salman, J M; Hani, S; de Marcellis-Warin, N; Isa, Sister Fatima

    2015-01-01

    Hand hygiene is a growing concern among populations and is a crucial element in ensuring patient safety in a healthcare environment. Numerous management efforts have been conducted in that regard, including education, awareness and observations. To better evaluate the possible impact of technology on a healthcare setting, we observed the impact of a particular niche technology developed as an answer to the growing hand hygiene concerns. A study was conducted at Salmaniya Medical Complex (SMC) in Bahrain on a total of 16 Coronary Care Unit (CCU) beds where the system was installed, and the hand hygiene activity of healthcare workers (HCWs) in this area was monitored for a total period of 28 days. Comments, remarks and suggestions were noted, and improvements were made to the technology during the course of the trial. While resistance to change was significant, overall results were satisfactory. Compliance with hand hygiene techniques went from 38-42% to 60% at the beginning of the trial and then increased to an average of 75% at the end of the 28-day trial. In some cases, compliance peaked at 85% or even at 100%. Our case study demonstrates that technology can be used effectively in promoting and improving hand hygiene compliance in hospitals, which is one way to prevent cross-infections, especially in critical care areas.

  5. Systems approach to address incivility and disruptive behaviors in health-care organizations.

    PubMed

    Holloway, Elizabeth; Kusy, Mitchell

    2011-01-01

    In response to the growing evidence that disruptive behaviors within health-care teams constitute a major threat to the quality of care, the Joint Commission on Accreditation of Healthcare Organization (JCAHO; Joint Commission Resources, 2008) has a new leadership standard that addresses disruptive and inappropriate behaviors effective January 1, 2009. For professionals who work in human resources and organization development, these standards represent a clarion call to design and implement evidence-based interventions to create health-care communities of respectful engagement that have zero tolerance for disruptive, uncivil, and intimidating behaviors by any professional. In this chapter, we will build an evidence-based argument that sustainable change must include organizational, team, and individual strategies across all professionals in the organization. We will then describe an intervention model--Toxic Organization Change System--that has emerged from our own research on toxic behaviors in the workplace (Kusy & Holloway, 2009) and provide examples of specific strategies that we have used to prevent and ameliorate toxic cultures.

  6. Human Microbiome and Learning Healthcare Systems: Integrating Research and Precision Medicine for Inflammatory Bowel Disease.

    PubMed

    Chuong, Kim H; Mack, David R; Stintzi, Alain; O'Doherty, Kieran C

    2017-03-10

    Healthcare institutions face widespread challenges of delivering high-quality and cost-effective care, while keeping up with rapid advances in biomedical knowledge and technologies. Moreover, there is increased emphasis on developing personalized or precision medicine targeted to individuals or groups of patients who share a certain biomarker signature. Learning healthcare systems (LHS) have been proposed for integration of research and clinical practice to fill major knowledge gaps, improve care, reduce healthcare costs, and provide precision care. To date, much discussion in this context has focused on the potential of human genomic data, and not yet on human microbiome data. Rapid advances in human microbiome research suggest that profiling of, and interventions on, the human microbiome can provide substantial opportunity for improved diagnosis, therapeutics, risk management, and risk stratification. In this study, we discuss a potential role for microbiome science in LHSs. We first review the key elements of LHSs, and discuss possibilities of Big Data and patient engagement. We then consider potentials and challenges of integrating human microbiome research into clinical practice as part of an LHS. With rapid growth in human microbiome research, patient-specific microbial data will begin to contribute in important ways to precision medicine. Hence, we discuss how patient-specific microbial data can help guide therapeutic decisions and identify novel effective approaches for precision care of inflammatory bowel disease. To the best of our knowledge, this expert analysis makes an original contribution with new insights poised at the emerging intersection of LHSs, microbiome science, and postgenomics medicine.

  7. A Survey on Wireless Body Area Networks for eHealthcare Systems in Residential Environments

    PubMed Central

    Ghamari, Mohammad; Janko, Balazs; Sherratt, R. Simon; Harwin, William; Piechockic, Robert; Soltanpur, Cinna

    2016-01-01

    Current progress in wearable and implanted health monitoring technologies has strong potential to alter the future of healthcare services by enabling ubiquitous monitoring of patients. A typical health monitoring system consists of a network of wearable or implanted sensors that constantly monitor physiological parameters. Collected data are relayed using existing wireless communication protocols to a base station for additional processing. This article provides researchers with information to compare the existing low-power communication technologies that can potentially support the rapid development and deployment of WBAN systems, and mainly focuses on remote monitoring of elderly or chronically ill patients in residential environments. PMID:27338377

  8. A Survey on Wireless Body Area Networks for eHealthcare Systems in Residential Environments.

    PubMed

    Ghamari, Mohammad; Janko, Balazs; Sherratt, R Simon; Harwin, William; Piechockic, Robert; Soltanpur, Cinna

    2016-06-07

    Current progress in wearable and implanted health monitoring technologies has strong potential to alter the future of healthcare services by enabling ubiquitous monitoring of patients. A typical health monitoring system consists of a network of wearable or implanted sensors that constantly monitor physiological parameters. Collected data are relayed using existing wireless communication protocols to a base station for additional processing. This article provides researchers with information to compare the existing low-power communication technologies that can potentially support the rapid development and deployment of WBAN systems, and mainly focuses on remote monitoring of elderly or chronically ill patients in residential environments.

  9. The Relationship Between Burnout Syndrome Among the Medical Staff and Work Conditions in the Polish Healthcare System.

    PubMed

    Głębocka, Alicja

    2016-12-31

    Psychologists emphasize that people employed in social service organizations are vulnerable to chronic stress and burnout syndrome caused by a close and unsatisfied interpersonal relationship. However, emotional exhaustion, depersonalization, and a feeling of diminished personal accomplishment can be attributed to other external factors. One of them is poor living and occupational conditions. According to a report by OECD, the healthcare system in Poland is the worst among the member countries. The aim of the present study was to define the relationship between occupational burnout and the rating of the Polish healthcare system among the medical staff. The study included 224 participants. The Maslach Burnout Inventory and the Dehumanized Behavior and the Głębocka and Rużyczka scale of Behavioral Indicators of Patient's Dehumanization were applied. The evaluations of the healthcare system were also collected. The results demonstrate that physicians were the group of most emotionally exhausted and, simultaneously, most life-satisfied persons, while nurses presented the highest level of dehumanization and the lowest level of satisfaction from life achievements. Only did physicians evaluate the healthcare system as a relatively good one. They were also more tolerant of latent dehumanization. A relationship between the dimensions of burnout and the evaluation of healthcare system were observed. The emotionally exhausted or prone to dehumanization persons were more likely to evaluate the Polish healthcare system negatively.

  10. Geographic information system-based healthcare waste management planning for treatment site location and optimal transportation routeing.

    PubMed

    Shanmugasundaram, Jothiganesh; Soulalay, Vongdeuane; Chettiyappan, Visvanathan

    2012-06-01

    In Lao People's Democratic Republic (Lao PDR), a growth of healthcare centres, and the environmental hazards and public health risks typically accompanying them, increased the need for healthcare waste (HCW) management planning. An effective planning of an HCW management system including components such as the treatment plant siting and an optimized routeing system for collection and transportation of waste is deemed important. National government offices at developing countries often lack the proper tools and methodologies because of the high costs usually associated with them. However, this study attempts to demonstrate the use of an inexpensive GIS modelling tool for healthcare waste management in the country. Two areas were designed for this study on HCW management, including: (a) locating centralized treatment plants and designing optimum travel routes for waste collection from nearby healthcare facilities; and (b) utilizing existing hospital incinerators and designing optimum routes for collecting waste from nearby healthcare facilities. Spatial analysis paved the way to understand the spatial distribution of healthcare wastes and to identify hotspots of higher waste generating locations. Optimal route models were designed for collecting and transporting HCW to treatment plants, which also highlights constraints in collecting and transporting waste for treatment and disposal. The proposed model can be used as a decision support tool for the efficient management of hospital wastes by government healthcare waste management authorities and hospitals.

  11. The outcomes of regional healthcare information systems in health care: a review of the research literature.

    PubMed

    Mäenpää, Tiina; Suominen, Tarja; Asikainen, Paula; Maass, Marianne; Rostila, Ilmari

    2009-11-01

    The resulting regional healthcare information systems were expected to have effects and impacts on health care procedures, work practices and treatment outcomes. The aim is to find out how health information systems have been investigated, what has been investigated and what are the outcomes. A systematic review was carried out of the research on the regional health information systems or organizations. The literature search was conducted on four electronic Cinahl Medline, Medline/PubMed and Cochrane. The common type of study design was the survey research and case study, and the data collection was carried out via different methodologies. They found out different types of regional health information systems (RHIS). The systems were heterogeneous and were in different phases of these developments. The RHIS outcomes focused on the five main areas: flow of information, collaboration, process redesign, system usability and organization culture. The RHIS improved the clinical data access, timely information, and clinical data exchange and improvement in communication and coordination within a region between professionals but also there was inadequate access to patient relevant clinical data. There were differences in organization culture, vision and expectations of leadership and consistency of strategic plan. Nevertheless, there were widespread participation by both healthcare providers and patients.

  12. [ZHU Lian's New Acupuncture Academic System and acupuncture science initialization].

    PubMed

    Zhang, Shujian; Zhang, Lijian

    2015-11-01

    Acupuncture scientization was a consensus of most of acupuncture scholars who had long-term perspectives in the 20th century, among them Ms. ZHULian was the important one. Ms. ZHU Lian built a systemic new acupuncture" academic structure in practice and theory aspects. At the same time, as the main architect of Institute of Acupuncture-moxibustion of China Academy of Traditional Chinese Medicine, Ms. ZHU Lian was the first one who began to carry out the acupuncture clinical trail and laboratory experiment in modern way, which meant "acupuncture therapy" was transformed into "acupuncture science" by Ms. ZHULian's endeavor.

  13. Embedding 'speaking up' into systems for safe healthcare product development and marketing surveillance.

    PubMed

    Edwards, Brian; Hugman, Bruce; Tobin, Mary; Whalen, Matthew

    2012-04-01

    Robust, active cooperation, and effective, open communication between all stakeholders is essential for ensuring regulatory compliance and healthcare product safety; avoiding the necessity for whistle-blowing; and, most essentially, meeting the transparency requirements of public trust.The focus here is on what can be done within a healthcare product organization (HPO) to achieve actionable, sustainable policies and practices such as leadership, management, and supervision role-modelling of best practice; ongoing process review and improvements in every department; protection of those who report concerns through robust policies endorsed at Board level throughout an organization to eliminate the fear of retaliation; training in open, non-defensive team-working principles; and mediation structure and process for resolution of differences of opinion or interpretation of contradictory and volatile data.Based on analyses of other safety systems, workplace silence and interpersonal breakdowns are warning signs of defective systems underlying poor compliance and compromising safety. Remedying the situation requires attention to the root causes underlying such symptoms of dysfunction, especially the human factor, i.e. those factors that influence human performance. It is essential that leadership and management listen to employees' concerns about systems and processes, assess them impartially and reward contributions that improve safety.Fundamentally, the safety, transparency, and trustworthiness of HPOs, both commercial and regulatory, can be judged by the extent of the freedom of their staff to 'speak up' when the time is right. This, in turn, consolidates the trust of external stakeholders in the safety of a system and its products. The promotion of 'speaking up' in an organization provides an important safeguard against the risk of poor compliance and the undermining of societal confidence in the safety of healthcare products.

  14. Healthcare policy tools as determinants of health-system efficiency: evidence from the OECD.

    PubMed

    Wranik, Dominika

    2012-04-01

    This paper assesses which policy-relevant characteristics of a healthcare system contribute to health-system efficiency. Health-system efficiency is measured using the stochastic frontier approach. Characteristics of the health system are included as determinants of efficiency. Data from 21 OECD countries from 1970 to 2008 are analysed. Results indicate that broader health-system structures, such as Beveridgian or Bismarckian financing arrangements or gatekeeping, are not significant determinants of efficiency. Significant contributors to efficiency are policy instruments that directly target patient behaviours, such as insurance coverage and cost sharing, and those that directly target physician behaviours, such as physician payment methods. From the perspective of the policymaker, changes in cost-sharing arrangements or physician remuneration are politically easier to implement than changes to the foundational financing structure of the system.

  15. Integrative Literature Review: A Review of Literature Related to Geographical Information Systems, Healthcare Access, and Health Outcomes

    PubMed Central

    Graves, Barbara Ann

    2008-01-01

    Differences in access to healthcare services and the resulting adverse health outcomes are major public health priorities. The Institute of Medicine and the Department of Health and Human Services have identified the need for strategies to improve access to healthcare services and to support the improvement of health outcomes. The literature documents health disparities associated with healthcare access and health outcomes from a geographic perspective. Place of residence, location of healthcare services, and geography in general are important factors in the analysis of health. Geographical information systems (GISs) are an emerging technology in the analysis of health from a geographical or location context. As a type of information technology, GISs are potentially powerful assessment tools for the investigation of healthcare access, health outcomes, and the possible resulting health disparities. Their ability to integrate health data with mapping functions allows for visualization, exploration, and modeling of health patterns. Application of GIS technology using health data can help in describing and explaining disparities in healthcare access and health outcomes. The studies reviewed demonstrated the use of GISs to investigate various aspects of healthcare access and health outcomes, including environmental variables of Lyme disease, sociodemographic variables and teen pregnancy, geographical disparities in breast cancer mortality by racial groups, PCP and AIDS prevalence, and factors of a leptospirosis disease outbreak. The literature reviewed shows effective integration and analysis of health data using GIS technology. PMID:18698429

  16. Healthcare System Effects of Pay-for-performance for Smoking Status Documentation

    PubMed Central

    Kruse, Gina; Chang, Yuchiao; Kelley, Jennifer HK; Linder, Jeffrey A; Einbinder, Jonathan; Rigotti, Nancy A.

    2013-01-01

    OBJECTIVE To evaluate the impact on smoking status documentation of a payer-sponsored P4P incentive that targeted a minority of an integrated healthcare delivery system’s patients. STUDY DESIGN Three commercial insurers simultaneously adopted P4P incentives to document smoking status of their members with three chronic diseases. The healthcare system responded by adding a smoking status reminder to all patients’ EHR. We measured change in smoking status documentation before (2008–09) and after (2010–11) P4P implementation by P4P-eligibility. METHODS P4P-eligible patients were compared primarily to a subset of non-P4P-eligible patients who resembled P4P-eligible patients and also to all non-P4P-eligible patients. Multivariate models adjusted for patient and provider characteristics and accounted for provider-level clustering and pre-implementation trends. RESULTS Documentation increased from 48% of 207,471 patients before P4P to 71% of 227,574 patients after P4P. Improvement occurred both among P4P-eligible patients, 56% to 83% (AOR, 3.6; 95% CI, 2.9 to 4.5) and the comparable subset of non-P4P-eligible patients, 56% to 80% (AOR, 3.0; 95% CI, 2.3 to 3.9). The difference in improvement between groups was significant (AOR, 1.3; 95% CI, 1.1 to 1.4, p=0.009). CONCLUSIONS A P4P incentive targeting a minority of a healthcare system’s patients stimulated adoption of a system-wide EHR reminder and improved smoking status documentation overall. Combining a P4P incentive with an EHR reminder might help health care systems improve treatment delivery for smokers and meet Meaningful Use standards for EHRs. PMID:23919419

  17. Development of an ease-of-use remote healthcare system architecture using RFID and networking technologies.

    PubMed

    Lin, Shih-Sung; Hung, Min-Hsiung; Tsai, Chang-Lung; Chou, Li-Ping

    2012-12-01

    The study aims to provide an ease-of-use approach for senior patients to utilize remote healthcare systems. An ease-of-use remote healthcare system (RHS) architecture using RFID (Radio Frequency Identification) and networking technologies is developed. Specifically, the codes in RFID tags are used for authenticating the patients' ID to secure and ease the login process. The patient needs only to take one action, i.e. placing a RFID tag onto the reader, to automatically login and start the RHS and then acquire automatic medical services. An ease-of-use emergency monitoring and reporting mechanism is developed as well to monitor and protect the safety of the senior patients who have to be left alone at home. By just pressing a single button, the RHS can automatically report the patient's emergency information to the clinic side so that the responsible medical personnel can take proper urgent actions for the patient. Besides, Web services technology is used to build the Internet communication scheme of the RHS so that the interoperability and data transmission security between the home server and the clinical server can be enhanced. A prototype RHS is constructed to validate the effectiveness of our designs. Testing results show that the proposed RHS architecture possesses the characteristics of ease to use, simplicity to operate, promptness in login, and no need to preserve identity information. The proposed RHS architecture can effectively increase the willingness of senior patients who act slowly or are unfamiliar with computer operations to use the RHS. The research results can be used as an add-on for developing future remote healthcare systems.

  18. Financial implications of a model heart failure disease management program for providers, hospital, healthcare systems, and payer perspectives.

    PubMed

    Whellan, David J; Reed, Shelby D; Liao, Lawrence; Gould, Stuart D; O'connor, Christopher M; Schulman, Kevin A

    2007-01-15

    Although heart failure disease management (HFDM) programs improve patient outcomes, the implementation of these programs has been limited because of financial barriers. We undertook the present study to understand the economic incentives and disincentives for adoption of disease management strategies from the perspectives of a physician (group), a hospital, an integrated health system, and a third-party payer. Using the combined results of a group of randomized controlled trials and a set of financial assumptions from a single academic medical center, a financial model was developed to compute the expected costs before and after the implementation of a HFDM program by 3 provider types (physicians, hospitals, and health systems), as well as the costs incurred from a payer perspective. The base-case model showed that implementation of HFDM results in a net financial loss to all potential providers of HFDM. Implementation of HFDM as described in our base-case analysis would create a net loss of US dollars 179,549 in the first year for a physician practice, US dollars 464,132 for an integrated health system, and US dollars 652,643 in the first year for a hospital. Third-party payers would be able to save US dollars 713,661 annually for the care of 350 patients with heart failure in a HFDM program. In conclusion, although HFDM programs may provide patients with improved clinical outcomes and decreased hospitalizations that save third-party payers money, limited financial incentives are currently in place for healthcare providers and hospitals to initiate these programs.

  19. Demonstration of Advanced Technologies for Multi-Load Washers in Hospitality and Healthcare -- Ozone Based Laundry Systems

    SciTech Connect

    Boyd, Brian K.; Parker, Graham B.; Petersen, Joseph M.; Sullivan, Greg; Goetzler, W.; Sutherland, T. A.; Foley, K. J.

    2014-08-14

    The objective of this demonstration project was to evaluate market-ready retrofit technologies for reducing the energy and water use of multi-load washers in healthcare and hospitality facilities. Specifically, this project evaluated laundry wastewater recycling technology in the hospitality sector and ozone laundry technology in both the healthcare and hospitality sectors. This report documents the demonstration of ozone laundry system installations at the Charleston Place Hotel in Charleston, South Carolina, and the Rogerson House assisted living facility in Boston, Massachusetts.

  20. A Cloud-Based X73 Ubiquitous Mobile Healthcare System: Design and Implementation

    PubMed Central

    Ji, Zhanlin; O'Droma, Máirtín; Zhang, Xin; Zhang, Xueji

    2014-01-01

    Based on the user-centric paradigm for next generation networks, this paper describes a ubiquitous mobile healthcare (uHealth) system based on the ISO/IEEE 11073 personal health data (PHD) standards (X73) and cloud computing techniques. A number of design issues associated with the system implementation are outlined. The system includes a middleware on the user side, providing a plug-and-play environment for heterogeneous wireless sensors and mobile terminals utilizing different communication protocols and a distributed “big data” processing subsystem in the cloud. The design and implementation of this system are envisaged as an efficient solution for the next generation of uHealth systems. PMID:24737958

  1. [Current challenges of external quality assurance in the German healthcare system].

    PubMed

    Willms, Gerald; Bramesfeld, Anke; Pottkämper, Karen; Broge, Björn; Szecsenyi, Joachim

    2013-01-01

    External quality assurance has three main aims: to make service provision in medicine and nursing comparable, to systematically identify deficits in service quality and to support the introduction of measures for quality improvement. This article reflects on three major developments in mandatory external quality assurance in the German healthcare system that took place during the last five years. These developments include the implementation of cross-sectoral quality assurance, the utilisation of new data sources and a new focus on quality deficits and practicability. The article highlights the challenges that come along with these developments.

  2. A systems-based medication reconciliation process: with implications for home healthcare.

    PubMed

    Myrka, Anne; Butterfield, Sara; B, Goss J; Amin, Piyush; Ambrosy, Susan; Woellmer, Cynthia; Glock, Shelly

    2011-01-01

    This article describes the medication reconciliation process applied on hospital discharge of patients to home with home care services within Seton Health System, an integrated health delivery network located in Troy, New York. The project, which was not research based, was characterized by an intensive pharmacotherapeutic medication reconciliation at hospital discharge by the hospital-based pharmacist with continued pharmacist support available to home healthcare nurses collaboratively at the time of start of care and resumption of care. The goal of this process was to identify and resolve medication-related problems and reduce hospital readmissions.

  3. The politics of healthcare informatics: knowledge management using an electronic medical record system.

    PubMed

    Bar-Lev, Shirly

    2015-03-01

    The design and implementation of an electronic medical record system pose significant epistemological and practical complexities. Despite optimistic assessments of their potential contribution to the quality of care, their implementation has been problematic, and their actual employment in various clinical settings remains controversial. Little is known about how their use actually mediates knowing. Employing a variety of qualitative research methods, this article attempts an answer by illustrating how omitting, editing and excessive reporting were employed as part of nurses' and physicians' political efforts to shape knowledge production and knowledge sharing in a technologically mediated healthcare setting.

  4. A network approach for researching political feasibility of healthcare reform: the case of universal healthcare system in Taiwan.

    PubMed

    Wang, Guang-Xu

    2012-12-01

    This study evaluates the political feasibility of healthcare reform taking place in Taiwan in the past decade. Since Taiwan adopted National Health Insurance (NHI) in 1995, it has provided coverage for virtually all of the island's citizens. However, the imbalance between expenditure and revenue has resulted in a cycle of unsustainable spending which has necessitated financial reforms and political confrontations. By applying social network analysis, this paper examines multiple types of ties between policy elites and power distribution that have evolved in crucial policy events of the NHI's financial reforms between 1998 and 2010. Data sources include official documents and 62 social network interviews that were held with government officials and related unofficial policy participants. Blockmodeling and multidimensional scaling (MDS) are used to determine the major participants and network structures in the NHI domain, as well as the influential policy actors, based on information transmission, resource exchange, reputation attribution and action-set coalition networks in Taiwan's current political situation. The results show that although both public actors and all medical associations are the leading actors in the NHI reform, without good communication with societal actors, the promotion of reform proposals ends in failure. As a tool of political feasibility evaluation, social network analysis can map the political conflict between policy stakeholders systematically when policy makers pursue the result of policy adoption.

  5. Provincial health accounts in Kerman, Iran: an evidence of a “mixed” healthcare financing system

    PubMed Central

    Mehrolhassani, Mohammad Hossein; Jafari, Mohammad; Zeinali, Javad; Ansari, Mina

    2014-01-01

    Background: Provincial Health Accounts (PHA) as a subset of National Health Accounts (NHA) present financial information for health sectors. It leads to a logical decision making for policy-makers in order to achieve health system goals, especially Fair Financial Contribution (FFC). This study aimed to examine Health Accounts in Kerman Province. Methods: The present analytical study was carried out retrospectively between 2008 and 2011. The research population consisted of urban and rural households as well as providers and financial agents in health sectors of Kerman Province. The purposeful sampling included 16 provincial organizations. To complete data, the report on Kerman household expenditure was taken as a data source from the Governor-General’s office. In order to classify the data, the International Classification for Health Accounts (ICHA) method was used, in which data set was adjusted for the province. Results: During the study, the governmental and non-governmental fund shares of the health sector in Kerman were 27.22% and 72.78% respectively. The main portion of financial sources (59.41) was related to private household funds, of which the Out-of-Pocket (OOP) payment mounted to 92.35%. Overall, 54.86% of all financial sources were covered by OOP. The greatest portion of expenditure of Total Healthcare Expenditures (THEs) (65.19%) was related to curative services. Conclusion: The major portion of healthcare expenditures was related to the OOP payment which is compatible with the national average rate in Iran. However, health expenditure per capita, was two and a half times higher than the national average. By emphasizing on Social Determinant of Health (SDH) approach in the Iranian health system, the portion of OOP payment and curative expenditure are expected to be controlled in the medium term. It is suggested that PHA should be examined annually in a more comprehensive manner to monitor initiatives and reforms in healthcare sector. PMID:24639980

  6. A hybrid mobile-based patient location tracking system for personal healthcare applications.

    PubMed

    Chew, S H; Chong, P A; Gunawan, E; Goh, K W; Kim, Y; Soh, C B

    2006-01-01

    In the next generation of Infocommunications, mobile Internet-enabled devices and third generation mobile communication networks have become reality, location based services (LBS) are expected to be a major area of growth. Providing information, content and services through positioning technologies forms the platform for new services for users and developers, as well as creating new revenue channels for service providers. These crucial advances in location based services have opened up new opportunities in real time patient tracking for personal healthcare applications. In this paper, a hybrid mobile-based location technique using the global positioning system (GPS) and cellular mobile network infrastructure is employed to provide the location tracking capability. This function will be integrated into the patient location tracking system (PLTS) to assist caregivers or family members in locating patients such as elderly or dependents when required, especially in emergencies. The capability of this PLTS is demonstrated through a series of location detection tests conducted over different operating conditions. Although the model is at its initial stage of development, it has shown relatively good accuracy for position tracking and potential of using integrated wireless technology to enhance the existing personal healthcare communication system through location based services.

  7. System Integration and Network Planning in the Academic Health Center

    PubMed Central

    Testa, Marcia A.; Spackman, Thomas J.

    1985-01-01

    The transfer of information within the academic health center is complicated by the complex nature of the institution's multi-dimensional role. The diverse functions of patient care, administration, education and research result in a complex web of information exchange which requires an integrated approach to system management. System integration involves a thorough assessment of “end user” needs in terms of hardware and software as well as specification of the communications network architecture. The network will consist of a series of end user nodes which capture, process, archive and display information. This paper will consider some requirements of these nodes, also called intelligent workstations, relating to their management and integration into a total health care network.

  8. Understanding requirements of novel healthcare information systems for management of advanced prostate cancer.

    PubMed

    Wagholikar, Amol S; Fung, Maggie; Nelson, Colleen C

    2012-01-01

    Effective management of chronic diseases is a global health priority. A healthcare information system offers opportunities to address challenges of chronic disease management. However, the requirements of health information systems are often not well understood. The accuracy of requirements has a direct impact on the successful design and implementation of a health information system. Our research describes methods used to understand the requirements of health information systems for advanced prostate cancer management. The research conducted a survey to identify heterogeneous sources of clinical records. Our research showed that the General Practitioner was the common source of patient's clinical records (41%) followed by the Urologist (14%) and other clinicians (14%). Our research describes a method to identify diverse data sources and proposes a novel patient journey browser prototype that integrates disparate data sources.

  9. Nanoparticles functionalized with supramolecular host-guest systems for nanomedicine and healthcare.

    PubMed

    Wu, Zilong; Song, Nan; Menz, Ryan; Pingali, Bharadwaj; Yang, Ying-Wei; Zheng, Yuebing

    2015-05-01

    Synthetic macrocyclic host compounds can interact with suitable guest molecules via noncovalent interactions to form functional supramolecular systems. With the synergistic integration of the response of molecules and the unique properties at the nanoscale, nanoparticles functionalized with the host-guest supramolecular systems have shown great potentials for a broad range of applications in the fields of nanoscience and nanotechnology. In this review article, we focus on the applications of the nanoparticles functionalized with supramolecular host-guest systems in nanomedicine and healthcare, including therapeutic delivery, imaging, sensing and removal of harmful substances. A large number of examples are included to elucidate the working mechanisms, advantages, limitations and future developments of the nanoparticle-supramolecule systems in these applications.

  10. Authorization & security aspects in the middleware-based healthcare information system.

    PubMed

    Andany, J; Bjorkendal, C; Ferrara, F M; Scherrer, J R; Spahni, S

    1999-01-01

    The integration and evolution of existing systems represents one of the most urgent priorities of health care information systems in order to allow the whole organisation to meet the increasing clinical organisational and managerial needs. The CEN ENV 12967-1 'Healthcare Information Systems Architecture'(HISA) standard defines an architectural approach based on a middleware of business-specific common services, enabling all parts of the local and geographical system to operate on the common information heritage of the organisation and on exploiting a set of common business-oriented functionality. After an overview on the key aspects of HISA, this paper discusses the positioning of the authorization and security aspects in the overall architecture. A global security framework is finally proposed.

  11. How can we deliver high-quality cancer care in a healthcare system in crisis?

    PubMed

    Mayer, Deborah K

    2014-08-01

    This provocative question was addressed in a report from the Institute of Medicine ([IOM], 2013), Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. An interdisciplinary committee synthesized many of the changes that are occurring in our society and health care that will challenge our existing cancer care system. These changes are familiar to many of us: an aging population along with the resulting increase in the number of cancer survivors, an inadequate number of and increased demand for trained healthcare providers, and rising healthcare costs. The IOM report recommended a framework of six interconnected components for improving the quality of cancer care (see Figures 1 and 2). Each of these components is worthy of an editorial and more. I would like to focus, however, on one of them: an adequately staffed, trained, and coordinated workforce. And, for good reason, as I want to retire someday and know that others will be taking my place in caring for cancer survivors across the care continuum. So let's explore this one component in more detail.

  12. Orthopedic surgeons’ and neurologists’ attitudes towards second opinions in the Israeli healthcare system: a qualitative study

    PubMed Central

    2012-01-01

    Background Second opinion is a treatment ratification tool that may critically influence diagnosis, treatment, and prognosis. Second opinions constitute one of the largest expenditures of the supplementary health insurance programs provided by the Israeli health funds. The scarcity of data on physicians’ attitudes toward second opinion motivated this study to explore those attitudes within the Israeli healthcare system. Methods We interviewed 35 orthopedic surgeons and neurologists in Israel and qualitatively analyzed the data using the Grounded Theory approach. Results As a common tool, second opinion reflects the broader context of the Israeli healthcare system, specifically tensions associated with health inequalities. We identified four issues: (1) inequalities between central and peripheral regions of Israel; (2) inequalities between private and public settings; (3) implementation gap between the right to a second opinion and whether it is covered by the National Health Insurance Law; and (4) tension between the authorities of physicians and religious leaders. The physicians mentioned that better mechanisms should be implemented for guiding patients to an appropriate consultant for a second opinion and for making an informed choice between the two opinions. Conclusions While all the physicians agreed on the importance of the second opinion as a tool, they raised concerns about the way it is provided and utilized. To be optimally implemented, second opinion should be institutionalized and regulated. The National Health Insurance Law should strive to provide the mechanisms to access second opinion as stipulated in the Patient’s Rights Law. Further studies are needed to assess the patients' perspectives. PMID:22913507

  13. Ambulatory Healthcare Utilization in the United States: A System Dynamics Approach

    NASA Technical Reports Server (NTRS)

    Diaz, Rafael; Behr, Joshua G.; Tulpule, Mandar

    2011-01-01

    Ambulatory health care needs within the United States are served by a wide range of hospitals, clinics, and private practices. The Emergency Department (ED) functions as an important point of supply for ambulatory healthcare services. Growth in our aging populations as well as changes stemming from broader healthcare reform are expected to continue trend in congestion and increasing demand for ED services. While congestion is, in part, a manifestation of unmatched demand, the state of the alignment between the demand for, and supply of, emergency department services affects quality of care and profitability. The central focus of this research is to provide an explanation of the salient factors at play within the dynamic demand-supply tensions within which ambulatory care is provided within an Emergency Department. A System Dynamics (SO) simulation model is used to capture the complexities among the intricate balance and conditional effects at play within the demand-supply emergency department environment. Conceptual clarification of the forces driving the elements within the system , quantifying these elements, and empirically capturing the interaction among these elements provides actionable knowledge for operational and strategic decision-making.

  14. National Healthcare Delivery Systems Influence Lung Transplant Outcomes for Cystic Fibrosis.

    PubMed

    Merlo, C A; Clark, S C; Arnaoutakis, G J; Yonan, N; Thomas, D; Simon, A; Thompson, R; Thomas, H; Orens, J; Shah, A S

    2015-07-01

    Successful lung transplantation (LTx) depends on multiple components of healthcare delivery and performance. Therefore, we conducted an international registry analysis to compare post-LTx outcomes for cystic fibrosis (CF) patients using the UNOS registry in the United States and the National Health Service (NHS) Transplant Registry in the United Kingdom. Patients with CF who underwent lung or heart-lung transplantation in the United States or United Kingdom between January 1, 2000 and December 31, 2011 were included. The primary outcome was all-cause mortality. Kaplan-Meier analysis and Cox proportional hazards regression evaluated the effect of healthcare system and insurance on mortality after LTx. 2,307 US LTx recipients and 451 individuals in the United Kingdom were included. 894 (38.8%) US LTx recipients had publically funded Medicare/Medicaid insurance. US private insurance and UK patients had improved median predicted survival compared with US Medicare/Medicaid recipients (p < 0.001). In multivariable Cox regression, US Medicare/Medicaid insurance was associated with worse survival after LTx (US private: HR0.78,0.68-0.90,p = 0.001 and UK: HR0.63,0.41-0.97, p = 0.03). This study in CF patients is the largest comparison of LTx in two unique health systems. Both the United States and United Kingdom have similar early survival outcomes, suggesting important dissemination of best practices internationally. However, the performance of US public insurance is significantly worse and may put patients at risk.

  15. Critical Incident Stress Management (CISM) in complex systems: cultural adaptation and safety impacts in healthcare.

    PubMed

    Müller-Leonhardt, Alice; Mitchell, Shannon G; Vogt, Joachim; Schürmann, Tim

    2014-07-01

    In complex systems, such as hospitals or air traffic control operations, critical incidents (CIs) are unavoidable. These incidents can not only become critical for victims but also for professionals working at the "sharp end" who may have to deal with critical incident stress (CIS) reactions that may be severe and impede emotional, physical, cognitive and social functioning. These CIS reactions may occur not only under exceptional conditions but also during every-day work and become an important safety issue. In contrast to air traffic management (ATM) operations in Europe, which have readily adopted critical incident stress management (CISM), most hospitals have not yet implemented comprehensive peer support programs. This survey was conducted in 2010 at the only European general hospital setting which implemented CISM program since 2004. The aim of the article is to describe possible contribution of CISM in hospital settings framed from the perspective of organizational safety and individual health for healthcare professionals. Findings affirm that daily work related incidents also can become critical for healthcare professionals. Program efficiency appears to be influenced by the professional culture, as well as organizational structure and policies. Overall, findings demonstrate that the adaptation of the CISM program in general hospitals takes time but, once established, it may serve as a mechanism for changing professional culture, thereby permitting the framing of even small incidents or near misses as an opportunity to provide valuable feedback to the system.

  16. A wireless multi-channel bioimpedance measurement system for personalized healthcare and lifestyle.

    PubMed

    Ramos, Javier; Ausín, José Luis; Lorido, Antonio Manuel; Redondo, Francisco; Duque-Carrillo, Juan Francisco

    2013-01-01

    Miniaturized, noninvasive, wearable sensors constitute a fundamental prerequisite for pervasive, predictive, and preventive healthcare systems. In this sense, this paper presents the design, realization, and evaluation of a wireless multi-channel measurement system based on a cost-effective high-performance integrated circuit for electrical bioimpedance (EBI) measurements in the frequency range from 1 kHz to 1 MHz. The resulting on-chip spectrometer provides high measuring EBI capabilities and together with a low-cost, commercially available radio frequency transceiver device. It provides reliable wireless communication, constitutes the basic node to build EBI wireless sensor networks (EBI-WSNs). The proposed EBI-WSN behaves as a high-performance wireless multi-channel EBI spectrometer, where the number of channels is completely scalable and independently configurable to satisfy specific measurement requirements of each individual. A prototype of the EBI node leads to a very small printed circuit board of approximately 8 cm2 including chip-antenna, which can operate several years on one 3-V coin cell battery and make it suitable for long-term preventive healthcare monitoring.

  17. Systems of evidence-based healthcare and personalised health information: some international and national trends.

    PubMed

    Gordon, C; Gray, J A; Toth, B; Veloso, M

    2000-01-01

    In Europe, North America and elsewhere, growing interest has focussed on evidence-based healthcare systems, incorporating the deployment of practice guidelines, as a field of application for health telematics. The clinical benefit and technical feasibility of common European approaches to this task has recently been demonstrated. In Europe it is likely that, building on recent progress in electronic health record architecture (EHRA) standards, a sufficient state of maturity can be reached to justify initiation within CEN TC251 of a prestandards process on guideline content formats during the current 5th Framework of EC RT&D activity. There is now a similar impetus to agree standards for this field in North America. Thanks to fruitful EC-USA contacts during the 4th Framework programme, there is now a chance, given well-planned coordination, to establish a global consensus optimally suited to serve the world-wide delivery and application of evidence-based medicine. This review notes three factors which may accelerate progress to convergence: (1) revolutionary changes in the knowledge basis of professional/patient/public healthcare partnerships, involving the key role of the Web as a health knowledge resource for citizens, and a rapidly growing market for personalised health information and advice; (2) the emergence at national levels of digital warehouses of clinical guidelines and EBM knowledge resources, agencies which are capable of brokering common mark-up and interchange media definitions between knowledge providers, industry and healthcare organizations; (3) the closing gap in knowledge management technology, with the advent of XML and RDF, between approaches and services based respectively on text mark-up and knowledge-base paradigms. A current project in the UK National Health Service (the National electronic Library of Health) is cited as an example of a national initiative designed to harness these trends.

  18. Transition of the detainee healthcare system to a correctional model: an interagency approach.

    PubMed

    Holman, Vincent

    2008-01-01

    The Army Medical Department (AMEDD) will play a key role in the transition of detainee healthcare operations from US control to a designated authority, whether it is Iraq or a third party. Although the AMEDD has garnered significant experience in the provision of detainee healthcare over the past 5 years, it would be prudent to implement an interagency approach to transitioning detainee healthcare. That transition must start with leveraging of the subject matter expertise of the US Bureau of Prisons and National Commission on Correctional Healthcare. Curriculum development of detainee healthcare in the program of instruction at the AMEDD Center and School is critical.

  19. Do Capitation-based Reimbursement Systems Underfund Tertiary Healthcare Providers? Evidence from New Zealand.

    PubMed

    Shin, Somi; Schumacher, Christoph; Feess, Eberhard

    2017-02-01

    One of the main concerns about capitation-based reimbursement systems is that tertiary institutions may be underfunded due to insufficient reimbursements of more complicated cases. We test this hypothesis with a data set from New Zealand that, in 2003, introduced a capitation system where public healthcare provider funding is primarily based on the characteristics of the regional population. Investigating the funding for all cases from 2003 to 2011, we find evidence that tertiary providers are at a disadvantage compared with secondary providers. The reasons are that tertiary providers not only attract the most complicated, but also the highest number of cases. Our findings suggest that accurate risk adjustment is crucial to the success of a capitation-based reimbursement system. Copyright © 2017 John Wiley & Sons, Ltd.

  20. Normative models and healthcare planning: network-based simulations within a geographic information system environment.

    PubMed Central

    Walsh, S J; Page, P H; Gesler, W M

    1997-01-01

    OBJECTIVES: Network analysis to integrate patient, transportation and hospital characteristics for healthcare planning in order to assess the role of geographic information systems (GIS). A normative model of base-level responses of patient flows to hospitals, based on estimated travel times, was developed for this purpose. DATA SOURCES/STUDY SETTING: A GIS database developed to include patient discharge data, locations of hospitals, US TIGER/Line files of the transportation network, enhanced address-range data, and U.S. Census variables. The study area included a 16-county region centered on the city of Charlotte and Mecklenburg County, North Carolina, and contained 25 hospitals serving nearly 2 million people over a geographic area of nearly 9,000 square miles. STUDY DESIGN: Normative models as a tool for healthcare planning were derived through a spatial Network analysis and a distance optimization model that was implemented within a GIS. Scenarios were developed and tested that involved patient discharge data geocoded to the five-digit zip code, hospital locations geocoded to their individual addresses, and a transportation network of varying road types and corresponding estimated travel speeds to examine both patient discharge levels and a doubling of discharge levels associated with total discharges and DRG 391 (Normal Newborns). The Network analysis used location/allocation modeling to optimize for travel time and integrated measures of supply, demand, and impedance. DATA COLLECTION/EXTRACTION METHODS: Patient discharge data from the North Carolina Medical Database Commission, address-ranges from the North Carolina Institute for Transportation Research and Education, and U.S. Census TIGER/Line files were entered-into the ARC/INFO GIS software system for analysis. A relational database structure was used to organize the information and to link spatial features to their attributes. PRINCIPAL FINDINGS: Advances in healthcare planning can be achieved by

  1. Development of Effective Academic Affairs Administration System in Thai Primary Schools

    ERIC Educational Resources Information Center

    Thongnoi, Niratchakorn; Srisa-ard, Boonchom; Sri-ampai, Anan

    2013-01-01

    This research aimed to: 1) study current situations and problems of academic affairs administration system in Primary Schools. 2) develop an effective academic affairs administration system, and 3) evaluate the implementation of the developed system in the primary school, Thailand. Research and Development (R&D) was employed which consisted of…

  2. The Influence of Trust in Physicians and Trust in the Healthcare System on Linkage, Retention, and Adherence to HIV Care.

    PubMed

    Graham, James L; Shahani, Lokesh; Grimes, Richard M; Hartman, Christine; Giordano, Thomas P

    2015-12-01

    Lack of trust by the patient in the physicians or the healthcare system has been associated with poorer health outcomes. The present study was designed to determine if trust in physicians and the healthcare system among persons newly diagnosed with HIV infection was predictive of patients' subsequent linkage, retention, and adherence to HIV care. 178 newly diagnosed HIV infected patients were administered the trust-in-physicians and trust-in-healthcare system scales. Median trust-in-physicians and trust-in-healthcare system scores were compared for all the mentioned subsequent linkage, retention, and adherence to HIV care. Univariate logistic regression using the trust-in-physician scale confirmed significant association with retention in care (p = 0.04), which persisted in multivariate analyses (p = 0.04). No significant association was found between trust-in-physicians and linkage to care or adherence to antiretroviral therapy. Trust in the healthcare system was not associated with any of the outcomes. Patients with higher trust in physicians were more likely to be retained in HIV care. Trust at diagnosis may not be a barrier to better clinical outcomes, either because trust changes based on subsequent interactions, or because trust is not a determining feature. Interventions to improve retention in care could include improving trust in physicians or target persons with low trust in physicians.

  3. Creating value-focused healthcare delivery systems: Part three--Core competencies.

    PubMed

    Beveridge, R N

    1997-01-01

    Value is created through the delivery of high-quality, cost--effective healthcare services. The ability to create value from the providers' perspective is facilitated through the development and implementation of essential, customer-focused core competencies. These core competencies include customer relationship management, payer/provider relationship management, disease management, outcomes management, financial/cost management, and information management. Customer relationship management is the foundation upon which all core competencies must be built. All of the core competencies must focus on the needs of the customers, both internal and external. Structuring all processes involved in the core competencies from the perspective of the customer will ensure that value is created throughout the system. Payer/provider relationship management will become a crucial pillar for healthcare providers in the future. As more vertical integration among providers occurs, the management of the relationships among providers and with payers will become more important. Many of the integration strategies being implemented across the country involve the integration of hospitals, physicians, and payers to form accountable health plans. The relationships must be organized to form "win/win" situations, where all parties are focused on a shared vision of creating value and none of the parties benefits at the expense of the others. Disease management in creating value requires that we begin examining the disease process along the entire continuum. Not only must providers be able to provide high-quality acute and chronic care, but they must also begin to focus more heavily on programs of prevention. Value is created throughout the system through reducing the prevalence and incidence of disease. Only through managing the full continuum of health will value be created throughout the healthcare delivery system. Outcomes management ensures that the outcomes are the highest quality at a cost

  4. A wireless sensor network compatible wearable u-healthcare monitoring system using integrated ECG, accelerometer and SpO2.

    PubMed

    Chung, Wan-Young; Lee, Young-Dong; Jung, Sang-Joong

    2008-01-01

    This paper presents the design and development of a wearable ubiquitous healthcare monitoring system using integrated electrocardiogram (ECG), accelerometer and oxygen saturation (SpO(2)) sensors. In this design, non-intrusive healthcare system was designed based on wireless sensor network (WSN) for wide area coverage with minimum battery power to support RF transmission. We have developed various devices such as wearable ubiquitous sensor network (USN) node, wearable chest sensor belt and wrist pulse oximeter for this system. Low power ECG, accelerometer and SpO(2) sensors board was integrated to the wearable USN node for user's health monitoring. The wearable ubiquitous healthcare monitoring system allows physiological data to be transmitted in wireless sensor network using IEEE 802.15.4 from on-body wearable sensor devices to a base-station which is connected to a server PC. Physiological data can be displayed and stored in the server PC continuously.

  5. Reliability of tonosafe disposable tonometer prisms: clinical implications from the Veterans Affairs Boston Healthcare System Quality Assurance Study

    PubMed Central

    Thomas, V; Daly, M K; Cakiner-Egilmez, T; Baker, E

    2011-01-01

    Purpose Given the Veterans Affairs Boston Healthcare System's recent introduction of single-use Tonosafe disposable tonometer prisms as an alternative to Goldmann applanation tonometers (GATs), this study had two aims: to conduct a large-scale quality assurance trial to assess the reliability of intraocular pressure (IOP) measurements of the Tonosafe disposable tonometer compared with GAT, particularly at extremes of pressure; to evaluate the suitability of Tonosafe disposable tonometer prisms as an acceptable substitute for GATs and for clinic-wide implementation in an academic tertiary referral setting. Methods Ophthalmology resident physicians measured the IOPs of patients in general and specialty eye clinics with the Tonosafe disposable tonometer and GAT. Tonosafe test–retest reliability data were also collected. A retrospective review of patient charts and data analysis were performed to determine the reliability of measurements. Results The IOPs of 652 eyes (326 patients) were measured with both GAT and Tonosafe, with a range of 3–34 mm Hg. Linear regression analysis showed R=0.93, slope=0.91, both of which supported the proposed hypothesis, and the y-intercept=−1.05 was significantly different from the hypothesized value. The Tonosafe test–retest repeatability (40 eyes of 40 patients), r=0.977, was very high, which was further supported by linear regression slope=0.993, y-intercept=0.118, and a Tonosafe repeatability coefficient of 2.06, similar to GAT repeatability. Conclusions The IOP measurements by Tonosafe disposable prisms correlated closely with Goldmann measurements, with similar repeated measurement variability to GAT. This suggests that the Tonosafe is an acceptable substitute for GAT to measure IOP in ophthalmology clinic settings. PMID:21455241

  6. Evaluation and implementation of QR Code Identity Tag system for Healthcare in Turkey.

    PubMed

    Uzun, Vassilya; Bilgin, Sami

    2016-01-01

    For this study, we designed a QR Code Identity Tag system to integrate into the Turkish healthcare system. This system provides QR code-based medical identification alerts and an in-hospital patient identification system. Every member of the medical system is assigned a unique QR Code Tag; to facilitate medical identification alerts, the QR Code Identity Tag can be worn as a bracelet or necklace or carried as an ID card. Patients must always possess the QR Code Identity bracelets within hospital grounds. These QR code bracelets link to the QR Code Identity website, where detailed information is stored; a smartphone or standalone QR code scanner can be used to scan the code. The design of this system allows authorized personnel (e.g., paramedics, firefighters, or police) to access more detailed patient information than the average smartphone user: emergency service professionals are authorized to access patient medical histories to improve the accuracy of medical treatment. In Istanbul, we tested the self-designed system with 174 participants. To analyze the QR Code Identity Tag system's usability, the participants completed the System Usability Scale questionnaire after using the system.

  7. Graph Databases for Large-Scale Healthcare Systems: A Framework for Efficient Data Management and Data Services

    SciTech Connect

    Park, Yubin; Shankar, Mallikarjun; Park, Byung H.; Ghosh, Dr. Joydeep

    2014-01-01

    Designing a database system for both efficient data management and data services has been one of the enduring challenges in the healthcare domain. In many healthcare systems, data services and data management are often viewed as two orthogonal tasks; data services refer to retrieval and analytic queries such as search, joins, statistical data extraction, and simple data mining algorithms, while data management refers to building error-tolerant and non-redundant database systems. The gap between service and management has resulted in rigid database systems and schemas that do not support effective analytics. We compose a rich graph structure from an abstracted healthcare RDBMS to illustrate how we can fill this gap in practice. We show how a healthcare graph can be automatically constructed from a normalized relational database using the proposed 3NF Equivalent Graph (3EG) transformation.We discuss a set of real world graph queries such as finding self-referrals, shared providers, and collaborative filtering, and evaluate their performance over a relational database and its 3EG-transformed graph. Experimental results show that the graph representation serves as multiple de-normalized tables, thus reducing complexity in a database and enhancing data accessibility of users. Based on this finding, we propose an ensemble framework of databases for healthcare applications.

  8. A Secure Dynamic Identity and Chaotic Maps Based User Authentication and Key Agreement Scheme for e-Healthcare Systems.

    PubMed

    Li, Chun-Ta; Lee, Cheng-Chi; Weng, Chi-Yao; Chen, Song-Jhih

    2016-11-01

    Secure user authentication schemes in many e-Healthcare applications try to prevent unauthorized users from intruding the e-Healthcare systems and a remote user and a medical server can establish session keys for securing the subsequent communications. However, many schemes does not mask the users' identity information while constructing a login session between two or more parties, even though personal privacy of users is a significant topic for e-Healthcare systems. In order to preserve personal privacy of users, dynamic identity based authentication schemes are hiding user's real identity during the process of network communications and only the medical server knows login user's identity. In addition, most of the existing dynamic identity based authentication schemes ignore the inputs verification during login condition and this flaw may subject to inefficiency in the case of incorrect inputs in the login phase. Regarding the use of secure authentication mechanisms for e-Healthcare systems, this paper presents a new dynamic identity and chaotic maps based authentication scheme and a secure data protection approach is employed in every session to prevent illegal intrusions. The proposed scheme can not only quickly detect incorrect inputs during the phases of login and password change but also can invalidate the future use of a lost/stolen smart card. Compared the functionality and efficiency with other authentication schemes recently, the proposed scheme satisfies desirable security attributes and maintains acceptable efficiency in terms of the computational overheads for e-Healthcare systems.

  9. Effects of high-involvement work systems on employee satisfaction and service costs in veterans healthcare.

    PubMed

    Harmon, Joel; Scotti, Dennis J; Behson, Scott; Farias, Gerard; Petzel, Robert; Neuman, Joel H; Keashly, Loraleigh

    2003-01-01

    Two strong imperatives for healthcare managers are reducing costs of service and attracting and retaining highly dedicated and competent patient care and support employees. Is there a trade-off or are there organizational practices that can further both objectives at the same time? High-involvement work systems (HIWS) represent a holistic work design that includes interrelated core features such as involvement, empowerment, development, trust, openness, teamwork, and performance-based rewards. HIWS have been linked to higher productivity, quality, employee and customer satisfaction, and market and financial performance in Fortune 1000 firms. Apparently, few prior studies have looked at the impacts of this holistic design within the healthcare sector. This research found that HIWS were associated with both greater employee satisfaction and lower patient service costs in 146 Veterans Health Administration centers, indicating that such practices pay off in both humanistic and financial terms. This suggests that managers implementing HIWS will incur real expenses that are likely to be more than offset by more satisfied employees, less organizational turmoil, and lower service delivery costs, which, in this study, amounted to over $1.2 million in savings for an average VHA facility.

  10. Research ethics and law of healthcare system quality improvement: the conflict of cost containment and quality.

    PubMed

    Kofke, W Andrew; Rie, Michael A

    2003-03-01

    Quality improvement (QI) activities have been done as long as medicine has been practiced and are integral to safety and efficacy of patient care. The 20th century witnessed sophisticated advances of QI methods, with concurrent advances in research ethics. The suggestion that some interventional QI activities resemble research has led to a complex conundrum, with disparate forces driving for improvement and maintenance of patient care quality vs. the societal mandate to control healthcare costs. In the middle of these conflicting priorities are QI systems charged with effecting cost-effective and efficacious healthcare processes. Given the advances in research ethics, substantially grounded in the Nuremberg Code, and the increasing resemblance of interventional QI activities to research, the concern is raised of widespread and systematic Nuremberg Code violations occurring under the guise of QI in health care. Moreover, evidence is cited to suggest that if this is the case, then such activities may be subject to litigation or prosecutorial action. The ethical and legal foundations exist to support the systematic practice of informing patients of their participation in some types of QI procedures.

  11. Leadership and transformational change in healthcare organisations: a qualitative analysis of the North East Transformation System.

    PubMed

    Erskine, Jonathan; Hunter, David J; Small, Adrian; Hicks, Chris; McGovern, Tom; Lugsden, Ed; Whitty, Paula; Steen, Nick; Eccles, Martin Paul

    2013-02-01

    The research project 'An Evaluation of Transformational Change in NHS North East' examines the progress and success of National Health Service (NHS) organisations in north east England in implementing and embedding the North East Transformation System (NETS), a region-wide programme to improve healthcare quality and safety, and to reduce waste, using a combination of Vision, Compact, and Lean-based Method. This paper concentrates on findings concerning the role of leadership in enabling tranformational change, based on semi-structured interviews with a mix of senior NHS managers and quality improvement staff in 14 study sites. Most interviewees felt that implementing the NETS requires committed, stable leadership, attention to team-building across disciplines and leadership development at many levels. We conclude that without senior leader commitment to continuous improvement over a long time scale and serious efforts to distribute leadership tasks to all levels, healthcare organisations are less likely to achieve positive changes in managerial-clinical relations, sustainable improvements to organisational culture and, ultimately, the region-wide step change in quality, safety and efficiency that the NETS was designed to deliver.

  12. Efficacy of a New Medical Information system, Ubiquitous Healthcare Service with Voice Inception Technique in Elderly Diabetic Patients

    PubMed Central

    Kim, Kyoung Min; Park, Kyeong Seon; Lee, Hyun Ju; Lee, Yun Hee; Bae, Ji Seon; Lee, Young Joon; Choi, Sung Hee; Jang, Hak Chul; Lim, Soo

    2015-01-01

    We have demonstrated previously that an individualized health management system using advanced medical information technology, named ubiquitous (u)-healthcare, was helpful in achieving better glycemic control than routine care. Recently, we generated a new u-healthcare system using a voice inception technique for elderly diabetic patients to communicate information about their glucose control, physical activity, and diet more easily. In a randomized clinical trial, 70 diabetic patients aged 60–85 years were assigned randomly to a standard care group or u-healthcare group for 6 months. The primary end points were the changes in glycated hemoglobin (HbA1c) and glucose fluctuation assessed by the mean amplitude glycemic excursion (MAGE). Changes in body weight, lifestyle, and knowledge about diabetes were also investigated. After 6 months, the HbA1c levels decreased significantly in the u-healthcare group (from 8.6 ± 1.0% to 7.5 ± 0.6%) compared with the standard care group (from 8.7 ± 0.9% to 8.2 ± 1.1%, P < 0.01). The MAGE decreased more in the u-healthcare group than in the standard care group. Systolic blood pressure and body weight decreased and liver functions improved in the u-healthcare group, but not in the standard care group. The u-healthcare system with voice inception technique was effective in achieving glycemic control without hypoglycemia in elderly diabetic patients (Clinicaltrials.gov: NCT01891474). PMID:26658492

  13. Efficacy of a New Medical Information system, Ubiquitous Healthcare Service with Voice Inception Technique in Elderly Diabetic Patients.

    PubMed

    Kim, Kyoung Min; Park, Kyeong Seon; Lee, Hyun Ju; Lee, Yun Hee; Bae, Ji Seon; Lee, Young Joon; Choi, Sung Hee; Jang, Hak Chul; Lim, Soo

    2015-12-11

    We have demonstrated previously that an individualized health management system using advanced medical information technology, named ubiquitous (u)-healthcare, was helpful in achieving better glycemic control than routine care. Recently, we generated a new u-healthcare system using a voice inception technique for elderly diabetic patients to communicate information about their glucose control, physical activity, and diet more easily. In a randomized clinical trial, 70 diabetic patients aged 60-85 years were assigned randomly to a standard care group or u-healthcare group for 6 months. The primary end points were the changes in glycated hemoglobin (HbA1c) and glucose fluctuation assessed by the mean amplitude glycemic excursion (MAGE). Changes in body weight, lifestyle, and knowledge about diabetes were also investigated. After 6 months, the HbA1c levels decreased significantly in the u-healthcare group (from 8.6 ± 1.0% to 7.5 ± 0.6%) compared with the standard care group (from 8.7 ± 0.9% to 8.2 ± 1.1%, P < 0.01). The MAGE decreased more in the u-healthcare group than in the standard care group. Systolic blood pressure and body weight decreased and liver functions improved in the u-healthcare group, but not in the standard care group. The u-healthcare system with voice inception technique was effective in achieving glycemic control without hypoglycemia in elderly diabetic patients (Clinicaltrials.gov: NCT01891474).

  14. Construction and application of an intelligent air quality monitoring system for healthcare environment.

    PubMed

    Yang, Chao-Tung; Liao, Chi-Jui; Liu, Jung-Chun; Den, Walter; Chou, Ying-Chyi; Tsai, Jaw-Ji

    2014-02-01

    Indoor air quality monitoring in healthcare environment has become a critical part of hospital management and policy. Manual air sampling and analysis are cost-inhibitive and do not provide real-time air quality data and response measures. In this month-long study over 14 sampling locations in a public hospital in Taiwan, we observed a positive correlation between CO(2) concentration and population, total bacteria, and particulate matter concentrations, thus monitoring CO(2) concentration as a general indicator for air quality could be a viable option. Consequently, an intelligent environmental monitoring system consisting of a CO(2)/temperature/humidity sensor, a digital plug, and a ZigBee Router and Coordinator was developed and tested. The system also included a backend server that received and analyzed data, as well as activating ventilation and air purifiers when CO(2) concentration exceeded a pre-set value. Alert messages can also be delivered to offsite users through mobile devices.

  15. Automatic Identification System modular receiver for academic purposes

    NASA Astrophysics Data System (ADS)

    Cabrera, F.; Molina, N.; Tichavska, M.; Araña, V.

    2016-07-01

    The Automatic Identification System (AIS) standard is encompassed within the Global Maritime Distress and Safety System (GMDSS), in force since 1999. The GMDSS is a set of procedures, equipment, and communication protocols designed with the aim of increasing the safety of sea crossings, facilitating navigation, and the rescue of vessels in danger. The use of this system not only is increasingly attractive to security issues but also potentially creates intelligence products throughout the added-value information that this network can transmit from ships on real time (identification, position, course, speed, dimensions, flag, among others). Within the marine electronics market, commercial receivers implement this standard and allow users to access vessel-broadcasted information if in the range of coverage. In addition to satellite services, users may request actionable information from private or public AIS terrestrial networks where real-time feed or historical data can be accessed from its nodes. This paper describes the configuration of an AIS receiver based on a modular design. This modular design facilitates the evaluation of specific modules and also a better understanding of the standard and the possibility of changing hardware modules to improve the performance of the prototype. Thus, the aim of this paper is to describe the system's specifications, its main hardware components, and to present educational didactics on the setup and use of a modular and terrestrial AIS receiver. The latter is for academic purposes and in undergraduate studies such as electrical engineering, telecommunications, and maritime studies.

  16. Exploring the drivers of health and healthcare access in Zambian prisons: a health systems approach

    PubMed Central

    Topp, Stephanie M.; Moonga, Clement N.; Luo, Nkandu; Kaingu, Michael; Chileshe, Chisela; Magwende, George; Heymann, S. Jody; Henostroza, German

    2016-01-01

    Background Prison populations in sub-Saharan Africa (SSA) experience a high burden of disease and poor access to health care. Although it is generally understood that environmental conditions are dire and contribute to disease spread, evidence of how environmental conditions interact with facility-level social and institutional factors is lacking. This study aimed to unpack the nature of interactions and their influence on health and healthcare access in the Zambian prison setting. Methods We conducted in-depth interviews of a clustered random sample of 79 male prisoners across four prisons, as well as 32 prison officers, policy makers and health care workers. Largely inductive thematic analysis was guided by the concepts of dynamic interaction and emergent behaviour, drawn from the theory of complex adaptive systems. Results A majority of inmates, as well as facility-based officers reported anxiety linked to overcrowding, sanitation, infectious disease transmission, nutrition and coercion. Due in part to differential wealth of inmates and their support networks on entering prison, and in part to the accumulation of authority and material wealth within prison, we found enormous inequity in the standard of living among prisoners at each site. In the context of such inequities, failure of the Zambian prison system to provide basic necessities (including adequate and appropriate forms of nutrition, or access to quality health care) contributed to high rates of inmate-led and officer-led coercion with direct implications for health and access to healthcare. Conclusions This systems-oriented analysis provides a more comprehensive picture of the way resource shortages and human interactions within Zambian prisons interact and affect inmate and officer health. While not a panacea, our findings highlight some strategic entry-points for important upstream and downstream reforms including urgent improvement in the availability of human resources for health; strengthening of

  17. Crossing the Boundaries of Our Current Healthcare System by Integrating Ultra-Weak Photon Emissions with Metabolomics

    PubMed Central

    Burgos, Rosilene C. Rossetto; van Wijk, Eduard P. A.; van Wijk, Roeland; He, Min; van der Greef, Jan

    2016-01-01

    The current healthcare system is hampered by a reductionist approach in which diagnostics and interventions focus on a specific target, resulting in medicines that center on generic, static phenomena while excluding inherent dynamic nature of biological processes, let alone psychosocial parameters. In this essay, we present some limitations of the current healthcare system and introduce the novel and potential approach of combining ultra-weak photon emission (UPE) with metabolomics technology in order to provide a dynamic readout of higher organizational systems. We argue that the combination of metabolomics and UPE can bring a new, broader, view of health state and can potentially help to shift healthcare toward more personalized approach that improves patient well-being. PMID:28018239

  18. Crossing the Boundaries of Our Current Healthcare System by Integrating Ultra-Weak Photon Emissions with Metabolomics.

    PubMed

    Burgos, Rosilene C Rossetto; van Wijk, Eduard P A; van Wijk, Roeland; He, Min; van der Greef, Jan

    2016-01-01

    The current healthcare system is hampered by a reductionist approach in which diagnostics and interventions focus on a specific target, resulting in medicines that center on generic, static phenomena while excluding inherent dynamic nature of biological processes, let alone psychosocial parameters. In this essay, we present some limitations of the current healthcare system and introduce the novel and potential approach of combining ultra-weak photon emission (UPE) with metabolomics technology in order to provide a dynamic readout of higher organizational systems. We argue that the combination of metabolomics and UPE can bring a new, broader, view of health state and can potentially help to shift healthcare toward more personalized approach that improves patient well-being.

  19. Impacts of Personal Characteristics on Computer Attitude and Academic Users Information System Satisfaction.

    ERIC Educational Resources Information Center

    Lim, Kee-Sook

    2002-01-01

    Describes a study that evaluated the effects of computer experience, gender, and academic performance on computer attitude and user information system satisfaction in a university setting. Results of an analysis of variance showed that the personal characteristics made a difference in computer attitudes but not in academic computer system user…

  20. 34 CFR 200.3 - Designing State Academic Assessment Systems.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... § 200.1(b); (ii) Be valid, reliable, and of high technical quality; (iii) Express student results in terms of the State's student academic achievement standards; and (iv) Be designed to provide a coherent... accurately the depth and breadth of the State's academic content standards; and (B) Express student...

  1. What works and what doesn't work well in the US healthcare system.

    PubMed

    Luft, Harold S

    2006-12-01

    Most observers agree that the US healthcare system is expensive, provides variable quality and leaves many without coverage. The policy challenge is that there is little consensus on how to approach reform. Many proposals assume that systems appearing to work in one nation can be transferred in toto to another or, alternatively, that only minor tweaking of an existing system is possible. The former approach ignores fundamental social, political and legal realities, and the latter ignores the potential for increased benefits. Additionally, many proposals are ideologically driven, focusing on how to finance expanded coverage. Broadening the discussion to examine other components of the system that do not work well may identify sufficient benefits for various stakeholders to engage them in finding more comprehensive solutions that address a range of problems. This paper examines areas in which the US healthcare system performs worse than one would like and areas in which it appears to work well. In the first category is the high proportion of people without coverage, the inefficient and inequitable incentives for the purchase and provision of insurance, the problems in deciding what should be covered, the ineffective payment incentives, administrative costs and complexities, the variable quality and lack of responsiveness to patient preferences, the less than optimal safety, under-valued primary care, provider de-professionalisation, and the costs that appear to be on auto-pilot. In the second category is the rapid and wide-reaching technological innovation, the ready access to care for the insured, and clinical and patient autonomy. Among the things taken as given is our constitutional (rather than parliamentary) political system and underlying public values about the roles of individuals and government. Current players will be active in any debate about reform, so their interests must be addressed. Likewise, certain underlying economic and social drivers of

  2. A systematic review of Human Factors and Ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety

    PubMed Central

    Xie, Anping; Carayon, Pascale

    2014-01-01

    Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how Human Factors and Ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified twelve projects representing 23 studies and addressing different physical, cognitive and organizational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care. Practitioner Summary Existing evidence shows that HFE-based healthcare system redesign has the potential to improve quality of care and patient safety. Healthcare organizations need to recognize the importance of HFE-based healthcare system redesign to quality of care and patient safety, and invest resources to integrate HFE in healthcare improvement activities. PMID:25323570

  3. Healthcare Engineering Defined: A White Paper.

    PubMed

    Chyu, Ming-Chien; Austin, Tony; Calisir, Fethi; Chanjaplammootil, Samuel; Davis, Mark J; Favela, Jesus; Gan, Heng; Gefen, Amit; Haddas, Ram; Hahn-Goldberg, Shoshana; Hornero, Roberto; Huang, Yu-Li; Jensen, Øystein; Jiang, Zhongwei; Katsanis, J S; Lee, Jeong-A; Lewis, Gladius; Lovell, Nigel H; Luebbers, Heinz-Theo; Morales, George G; Matis, Timothy; Matthews, Judith T; Mazur, Lukasz; Ng, Eddie Yin-Kwee; Oommen, K J; Ormand, Kevin; Rohde, Tarald; Sánchez-Morillo, Daniel; Sanz-Calcedo, Justo García; Sawan, Mohamad; Shen, Chwan-Li; Shieh, Jiann-Shing; Su, Chao-Ton; Sun, Lilly; Sun, Mingui; Sun, Yi; Tewolde, Senay N; Williams, Eric A; Yan, Chongjun; Zhang, Jiajie; Zhang, Yuan-Ting

    2015-01-01

    Engineering has been playing an important role in serving and advancing healthcare. The term "Healthcare Engineering" has been used by professional societies, universities, scientific authors, and the healthcare industry for decades. However, the definition of "Healthcare Engineering" remains ambiguous. The purpose of this position paper is to present a definition of Healthcare Engineering as an academic discipline, an area of research, a field of specialty, and a profession. Healthcare Engineering is defined in terms of what it is, who performs it, where it is performed, and how it is performed, including its purpose, scope, topics, synergy, education/training, contributions, and prospects.

  4. Nested Quantization Index Modulation for Reversible Watermarking and Its Application to Healthcare Information Management Systems

    PubMed Central

    Ko, Lu-Ting; Chen, Jwu-E.; Shieh, Yaw-Shih; Hsin, Hsi-Chin; Sung, Tze-Yun

    2012-01-01

    Digital watermarking has attracted lots of researches to healthcare information management systems for access control, patients' data protection, and information retrieval. The well-known quantization index modulation-(QIM-) based watermarking has its limitations as the host image will be destroyed; however, the recovery of medical images is essential to avoid misdiagnosis. In this paper, we propose the nested QIM-based watermarking, which is preferable to the QIM-based watermarking for the medical image applications. As the host image can be exactly reconstructed by the nested QIM-based watermarking. The capacity of the embedded watermark can be increased by taking advantage of the proposed nest structure. The algorithm and mathematical model of the nested QIM-based watermarking including forward and inverse model is presented. Due to algorithms and architectures of forward and inverse nested QIM, the concurrent programs and special processors for the nested QIM-based watermarking are easily implemented. PMID:22194776

  5. [The challenge for healthcare systems in the XXI century: how to incorporate the focus of social determinants in healthcare?].

    PubMed

    Cuadrado, Cristóbal

    2015-10-20

    During the 20th century, a series of reflections on the role of biomedicine and social factors in the concept of health and disease processes served as a necessary prelude to the conceptual and empirical development of what later became known as the social determinants of health. In relation to this perspective, the question arises: What is the role of modern health systems from the perspective of the social determinants of health? This article presents an alternative view of the role of health systems from the focus of the social determinants of health, raising its importance and influence on the structural level, while addressing its implications as an intermediary determinant of health inequalities.

  6. Flash crashes, bursts, and black swans: parallels between financial markets and healthcare systems.

    PubMed

    West, Bruce J; Clancy, Thomas R

    2010-11-01

    As systems evolve over time, their natural tendency is to become increasingly more complex. Studies in the field of complex systems have generated new perspectives on management in social organizations such as hospitals. Much of this research appears as a natural extension of the cross-disciplinary field of systems theory. This is the 16th in a series of articles applying complex systems science to the traditional management concepts of planning, organizing, directing, coordinating, and controlling. In this article, Dr Clancy, the editor of this column, and co-author, Dr West, discuss how the collapse of global financial markets in 2008 may provide valuable insight into mechanisms of complex system behavior in healthcare. Dr West, a physicist and expert in the field of complex systems and network science, is author of a chapter in the book, On the Edge: Nursing in the Age of Complexity (Lindberg C, Nash S, Linberg C. Bordertown, NJ: Plexus Press; 2008) and his most recent book, Disrupted Networks: From Physics to Climate Change (West BJ, Scafetta N. Singapore: Disrupted Networks, World Scientific Publishing; 2010).

  7. Development of a computerised decisions support system for renal risk drugs targeting primary healthcare

    PubMed Central

    Helldén, Anders; Al-Aieshy, Fadiea; Bastholm-Rahmner, Pia; Bergman, Ulf; Gustafsson, Lars L; Höök, Hans; Sjöviker, Susanne; Söderström, Anders; Odar-Cederlöf, Ingegerd

    2015-01-01

    Objectives To assess general practitioners (GPs) experience from the implementation and use of a renal computerised decision support system (CDSS) for drug dosing, developed for primary healthcare, integrated into the patient’s electronic health record (EHR), and building on estimation of the patient's creatinine clearance (ClCG). Design Qualitative research design by a questionnaire and a focus group discussion. Setting and participants Eight GPs at two primary healthcare centres (PHCs). Interventions The GP at PHC 1, and the project group, developed and tested the technical solution of the CDSS. Proof-of-concept was tested by seven GPs at PHC 2. They also participated in a group discussion and answered a questionnaire. A web window in the EHR gave drug and dosage in relation to ClCG. Each advice was according to three principles: If? Why? Because. Outcome measures (1) The GPs’ experience of ‘easiness to use’ and ‘perceived usefulness’ at PHC 2, based on loggings of use, answers from a questionnaire using a 5-point Likert scale, and answers from a focus group discussion. (2) The number of patients aged 65 years and older with an estimation of ClCG before and after the implementation of the CDSS. Results The GPs found the CDSS fast, simple and easy to use. They appreciated the automatic presentation of the CICG status on opening the medication list, and the ability to actively look up specific drug recommendations in two steps. The CDSS scored high on the Likert scale. All GPs wanted to continue the use of the CDSS and to recommend it to others. The number of patients with an estimated ClCG increased 1.6-fold. Conclusions Acceptance of the simple graphical interface of this push and pull renal CDSS was high among the primary care physicians evaluating this proof of concept. The graphical model should be useful for further development of renal decision support systems. PMID:26150141

  8. Academic-community partnerships for sustainable preparedness and response systems.

    PubMed

    Isakov, Alexander; O'Neal, Patrick; Prescott, John; Stanley, Joan; Herrmann, Jack; Dunlop, Anne

    2014-01-01

    Academic institutions possess tremendous resources that could be important for community disaster response and preparedness activities. In-depth exploration of the role of academic institutions in community disaster response has elicited information about particular academic resources leveraged for and essential to community preparedness and response; factors that contribute to the decision-making process for partner engagement; and facilitators of and barriers to sustainable collaborations from the perspectives of academic institutions, public health and emergency management agencies, and national association and agency leaders. The Academic-Community Partnership Project of the Emory University Preparedness and Emergency Response Research Center in collaboration with the Association of Schools of Public Health convened an invitational summit which included leadership from the National Association of County and City Health Officials, Association of State and Territorial Health Officials, Directors of Public Health Preparedness, Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, CDC Office of Public Health Preparedness and Response, Association of Schools of Public Health, Association of American Medical Colleges, Association of Academic Health Centers, American Association of Colleges of Nursing, Council of State and Territorial Epidemiologists, and American Association of Poison Control Centers. From this convention, emerged recommendations for building and sustaining academic-public health-community collaborations for preparedness locally and regionally.

  9. A baseline survey of the Primary Healthcare system in south eastern Nigeria.

    PubMed

    Chukwuani, Chinyere Mercellina; Olugboji, Akindeji; Akuto, Edward Erdorga; Odebunmi, Akim; Ezeilo, Ezenta; Ugbene, Emmanuel

    2006-07-01

    A baseline survey to audit the PHC operations and determine community perception and expectations of PHC service delivery was conducted in 72 communities in Enugu state, southeastern Nigeria. The study was intended to facilitate the development of intermediate performance indicators for monitoring the progress of an ongoing health sector reform and to gather baseline data for planning and policy formulation. The tools used for the operations audit assessed indicators for evaluating: (a) Stewardship, (b) Service Provision and (c) Administrative and financial management; while the community survey was assessed by, (a) utilization of health services, (b) perception of service delivery and (c) health care financing. One hundred and sixteen respondents from each of the facilities in the sample frame were interviewed using a structured self-assessment questionnaire and a qualitative assessment was undertaken in 53 of the facilities using an audit guide. Focus group discussions (FGD) were conducted with the policy makers and planners in each of the 17 LGAs in the state. A total of 832 respondents were interviewed in the communities (using a structured questionnaire) and 42 community FGDs were conducted. The results indicate a lack of operational efficiency in the majority of the facilities audited. It was also observed that majority of the facilities do not provide all services required of it, are poorly maintained, do not have enough skilled health workers and operate without a budget. There appears to be no formal financial management system in place and no policy on financial resource generation. The community survey identified two major problems; low utilization of PHCs and poor service provision. The key indicator identified by the community for evaluating performance of the PHCs remains "access to essential drugs". The major prospect was the willingness of an appreciable number of respondents to invest in health financing through insurance schemes and payment of

  10. Assessment and improvement of the Italian healthcare system: first evidence from a pilot national performance evaluation system.

    PubMed

    Nuti, Sabina; Seghieri, Chiara; Vainieri, Milena; Zett, Silvia

    2012-01-01

    The Italian National Health System (NHS), established in 1978, follows a model similar to the Beveridge model developed by the British NHS (Beveridge 1942; Musgrove 2000). Like the British NHS, healthcare coverage for the Italian population is provided and financed by the government through taxes. Universal coverage provides uniform healthcare access to citizens and is the characteristic usually considered the added value of a welfare system financed by tax revenues. Nonetheless, in Italy the strong policy of decentralization, which has been taking place since the early 1990s, has gradually shifted powers from the state to the 21 Italian regions. Consequently, the state now retains limited supervisory control and continues to have overall responsibility for the NHS in order to ensure uniform and essential levels of health services across the country. In this context, it has become essential, both for the ministry and for regions, to adopt a common performance evaluation system (PES). This article reports the definition, implementation, and first evidences of a pilot PES at a national level. It shows how this PES can be viewed as a strategic tool supporting the Ministry of Health (MoH) in ensuring uniform levels of care for the population and assisting regional managers to evaluate performance in benchmarking. Finally, lessons for other health systems, based on the Italian experience, are provided.

  11. Socio-economic differences in healthcare access from a welfare system perspective, Italy: 2007-2010.

    PubMed

    Braggion, M; Campostrini, S; Bertin, G

    2015-09-01

    Inequalities between poorer and wealthier people in accessing healthcare services have been widely studied, but the mechanisms generating them are still to be fully understood. Among these, there is still a lack of evidence of relationships between health prevention/health promotion policies, welfare systems and social differences. We analysed 68 201 females from the PASSI Italian surveillance system for the years 2007-2010. The prevalence of women undergoing Pap testing was used as an example of access to preventive services. An odds ratio gradient was found with regard to different welfare system clusters: the probability of undergoing a screening test is higher for more advanced welfare systems. A strong association was found between having received a letter from the local health unit and having undergone the screening test. Significant differences still exist between high- and low-income women and their access to Italian preventive public services. As we expected, social determinants play an important role in health disparities, as these are also strongly influenced by typologies of welfare systems and by health policies.

  12. "Why Give up Something That Works so Well?": Retirement Expectations among Academic Physicians

    ERIC Educational Resources Information Center

    Silver, Michelle Pannor; Pang, N. Celeste; Williams, Sarah A.

    2015-01-01

    For individuals with strong work identities, the decision to retire can be particularly challenging. For academic physicians, retirement is an important personal decision that also has far-reaching implications for the healthcare system. This is because academic physicians are responsible for producing the research from which key medical decisions…

  13. Exploring Healthcare Consumer Acceptance of Personal Health Information Management Technology through Personal Health Record Systems

    ERIC Educational Resources Information Center

    Wu, Huijuan

    2013-01-01

    Healthcare technologies are evolving from a practitioner-centric model to a patient-centric model due to the increasing need for technology that directly serves healthcare consumers, including healthy people and patients. Personal health information management (PHIM) technology is one of the technologies designed to enhance an individual's ability…

  14. Improvement and modification of the routing system for the health-care waste collection and transportation in Istanbul.

    PubMed

    Alagöz, Aylin Zeren; Kocasoy, Günay

    2008-01-01

    Handling of health-care wastes is among the most important environmental problems in Turkey as it is in the whole world. Approximately 25-30tons of health-care wastes, in addition to the domestic and recyclable wastes, are generated from hospitals, clinics and other small health-care institutions daily on the European and the Asian sides of Istanbul [Kocasoy, G., Topkaya, B., Zeren, B.A., Kiliç, M., et al., 2004. Integrated Health-care Waste Management in Istanbul, Final Report of the LIFE00 TCY/TR/054 Project, Turkish National Committee on Solid Wastes, Istanbul, Turkey; Zeren, B.A., 2004. The Health-care Waste Management of the Hospitals in the European Side of Istanbul, M.S. Thesis, Boğaziçi University, Istanbul, Turkey; Kiliç, M., 2004. Determination of the Health-care Waste Handling and Final Disposal of the Infected Waste of Hospital-Medical Centers in the Anatolian Side of Istanbul. M.S. Thesis, Boğaziçi University, Istanbul, Turkey]. Unfortunately, these wastes are not handled, collected or temporarily stored at the institutions properly according to the published Turkish Medical Waste Control Regulation [Ministry of Environment and Forestry, 2005. Medical Waste Control Regulation. Official Gazette No. 25883, Ankara, Turkey]. Besides the inappropriate handling at the institutions, there is no systematic program for the transportation of the health-care wastes to the final disposal sites. The transportation of these wastes is realized by the vehicles of the municipalities in an uncontrolled, very primitive way. As a consequence, these improperly managed health-care wastes cause many risks to the public health and people who handle them. This study has been conducted to develop a health-care waste collection and transportation system for the city of Istanbul, Turkey. Within the scope of the study, the collection of health-care wastes from the temporary storage rooms of the health-care institutions, transportation of these wastes to the final disposal

  15. Improvement and modification of the routing system for the health-care waste collection and transportation in Istanbul

    SciTech Connect

    Alagoez, Aylin Zeren; Kocasoy, Guenay

    2008-07-01

    Handling of health-care wastes is among the most important environmental problems in Turkey as it is in the whole world. Approximately 25-30 tons of health-care wastes, in addition to the domestic and recyclable wastes, are generated from hospitals, clinics and other small health-care institutions daily on the European and the Asian sides of Istanbul [Kocasoy, G., Topkaya, B., Zeren, B.A., Kilic, M., et al., 2004. Integrated Health-care Waste Management in Istanbul, Final Report of the LIFE00 TCY/TR/054 Project, Turkish National Committee on Solid Wastes, Istanbul, Turkey; Zeren, B.A., 2004. The Health-care Waste Management of the Hospitals in the European Side of Istanbul, M.S. Thesis, Bogazici University, Istanbul, Turkey; Kilic, M., 2004. Determination of the Health-care Waste Handling and Final Disposal of the Infected Waste of Hospital-Medical Centers in the Anatolian Side of Istanbul. M.S. Thesis, Bogazici University, Istanbul, Turkey]. Unfortunately, these wastes are not handled, collected or temporarily stored at the institutions properly according to the published Turkish Medical Waste Control Regulation [Ministry of Environment and Forestry, 2005. Medical Waste Control Regulation. Official Gazette No. 25883, Ankara, Turkey]. Besides the inappropriate handling at the institutions, there is no systematic program for the transportation of the health-care wastes to the final disposal sites. The transportation of these wastes is realized by the vehicles of the municipalities in an uncontrolled, very primitive way. As a consequence, these improperly managed health-care wastes cause many risks to the public health and people who handle them. This study has been conducted to develop a health-care waste collection and transportation system for the city of Istanbul, Turkey. Within the scope of the study, the collection of health-care wastes from the temporary storage rooms of the health-care institutions, transportation of these wastes to the final disposal areas

  16. Strategic enterprise resource planning in a health-care system using a multicriteria decision-making model.

    PubMed

    Lee, Chang Won; Kwak, N K

    2011-04-01

    This paper deals with strategic enterprise resource planning (ERP) in a health-care system using a multicriteria decision-making (MCDM) model. The model is developed and analyzed on the basis of the data obtained from a leading patient-oriented provider of health-care services in Korea. Goal criteria and priorities are identified and established via the analytic hierarchy process (AHP). Goal programming (GP) is utilized to derive satisfying solutions for designing, evaluating, and implementing an ERP. The model results are evaluated and sensitivity analyses are conducted in an effort to enhance the model applicability. The case study provides management with valuable insights for planning and controlling health-care activities and services.

  17. An IoT-cloud Based Wearable ECG Monitoring System for Smart Healthcare.

    PubMed

    Yang, Zhe; Zhou, Qihao; Lei, Lei; Zheng, Kan; Xiang, Wei

    2016-12-01

    Public healthcare has been paid an increasing attention given the exponential growth human population and medical expenses. It is well known that an effective health monitoring system can detect abnormalities of health conditions in time and make diagnoses according to the gleaned data. As a vital approach to diagnose heart diseases, ECG monitoring is widely studied and applied. However, nearly all existing portable ECG monitoring systems cannot work without a mobile application, which is responsible for data collection and display. In this paper, we propose a new method for ECG monitoring based on Internet-of-Things (IoT) techniques. ECG data are gathered using a wearable monitoring node and are transmitted directly to the IoT cloud using Wi-Fi. Both the HTTP and MQTT protocols are employed in the IoT cloud in order to provide visual and timely ECG data to users. Nearly all smart terminals with a web browser can acquire ECG data conveniently, which has greatly alleviated the cross-platform issue. Experiments are carried out on healthy volunteers in order to verify the reliability of the entire system. Experimental results reveal that the proposed system is reliable in collecting and displaying real-time ECG data, which can aid in the primary diagnosis of certain heart diseases.

  18. Increasing consumer demand for tobacco treatments: Ten design recommendations for clinicians and healthcare systems.

    PubMed

    Woods, Susan Swartz; Jaén, Carlos Roberto

    2010-03-01

    Health professionals play an important role in addressing patient tobacco use in clinical settings. While there is clear evidence that identifying tobacco use and assisting smokers in quitting affects outcomes, challenges to improve routine, clinician-delivered tobacco intervention persist. The Consumer Demand Initiative has identified simple design principles to increase consumers' use of proven tobacco treatments. Applying these design strategies to activities across the healthcare system, we articulate ten recommendations that can be implemented in the context of most clinical systems where most clinicians work. The recommendations are: (1) reframe the definition of success, (2) portray proven treatments as the best care, (3) redesign the 5A's of tobacco intervention, (4) be ready to deliver the right treatment at the right time, (5) move tobacco from the social history to the problem list, (6) use words as therapy and language that makes sense, (7) fit tobacco treatment into clinical team workflows, (8) embed tobacco treatment into health information technology, (9) make every encounter an opportunity to intervene, and (10) end social disparities for tobacco users. Clinical systems need to change to improve tobacco treatment implementation. The consumer- and clinician-centered recommendations provide a roadmap that focuses on increasing clinician performance through greater understanding of the clinician's role in helping tobacco users, highlighting the value of evidence-based tobacco treatments, employing shared decision-making skills, and integrating routine tobacco treatment into clinical system routines.

  19. Introduction of Sap ERP System Into a Heterogeneous Academic Community

    NASA Astrophysics Data System (ADS)

    Mornar, Vedran; Fertalj, Krešimir; Kalpić, Damir

    2010-06-01

    Introduction of a complex ERP system like SAP into a heterogeneous academic environment like the University of Zagreb is far from being a trivial task. The University comprises more than 30 constituents, called faculties or academies, geographically dispersed, with long and specific traditions. Financing according to the lump sum principle, enforced in Croatia as a side effect of the in Europe obligatory and omnipresent Bologna process, requires a unified view on the educational institutions in order to provide a more just and appropriate financing scheme than the current one. After the experience with own development to support educational tasks and student administration, for standard financial and administration tasks SAP has been chosen as the most appropriate platform. The developer was selected after public bidding and the authors' institution was chosen for the pilot project. The authors were playing principal roles in the process of successful deployment and still expect to offer their expertise for implementation in the rest of the University. However, serious risks stemming from lack of motivation by some constituents are present.

  20. [Neutralizing science citation index as an academic evaluation system].

    PubMed

    Liu, Xiu-Hua; Tang, Chao-Shu

    2009-01-01

    Research papers are published in thousands of scientific journals every year in the world. The quality of these papers has to be evaluated to determine their accuracy and contribution to their research fields. Science citation index (SCI) is a citation-based metric used to rank scientific journals. The importation of SCI from abroad contributed much both to encourage Chinese scientific community to collaborate with scientists all over the world, and the development of science and technology at home. However, there have been numerous criticisms over the years of the misuse of SCI, especially impact factor, as a measure of the quality of individual research papers. This review article analyzes the history and current situation of using SCI to evaluate scientific papers, discusses how to objectively consider SCI and the other new practices to evaluate research papers. It is also suggested in the present article that the impact of domestic scientific journals on the world should be improved, and that more attention should be paid to the quality of the research papers to improve the academic evaluation system and the development of science and technology in our country.

  1. Electronic Medical Records (EMR): An Empirical Testing of Factors Contributing to Healthcare Professionals' Resistance to Use EMR Systems

    ERIC Educational Resources Information Center

    Bazile, Emmanuel Patrick

    2016-01-01

    The benefits of using electronic medical records (EMRs) have been well documented; however, despite numerous financial benefits and cost reductions being offered by the federal government, some healthcare professionals have been reluctant to implement EMR systems. In fact, prior research provides evidence of failed EMR implementations due to…

  2. Academic Building Systems. A Technique to Maximize Control of Construction Costs.

    ERIC Educational Resources Information Center

    Clark, Donald H.

    1972-01-01

    Academic Building Systems (ABS) is an architectural planning and design method which allows the construction owner to respond to the need for less expensive structures, economically adaptable to the changing conditions of the academic world, by providing the owner with the maximum controls over the variable cost factors in educational facility…

  3. The Construction of the Chinese Academic System: Its History and Present Challenges

    ERIC Educational Resources Information Center

    Yan, Guangcai

    2009-01-01

    The rise and development of China's academic system is a process that started from "passively accepting Western Learning" to today's "catching up with Western Learning and even exceeding it". In the last century, China experienced a turbulent and unstable social environment in which academics and politics have always been…

  4. Performance Appraisal System Impact on University Academic Staff Job Satisfaction and Productivity

    ERIC Educational Resources Information Center

    Ndambakuwa, Yustina; Mufunda, Jacob

    2006-01-01

    The University of Zimbabwe (UZ) introduced a performance appraisal system (PAS) designed to improve performance indicators across the board in Public Service including academic/faculty staff at the University of Zimbabwe as part of a nation wide strategy. The Public service is a body responsible for all civil workers including academic staff,…

  5. Web-Based Adaptive Testing System (WATS) for Classifying Students Academic Ability

    ERIC Educational Resources Information Center

    Lee, Jaemu; Park, Sanghoon; Kim, Kwangho

    2012-01-01

    Computer Adaptive Testing (CAT) has been highlighted as a promising assessment method to fulfill two testing purposes: estimating student academic ability and classifying student academic level. In this paper, assessment for we introduced the Web-based Adaptive Testing System (WATS) developed to support a cost effective assessment for classifying…

  6. Challenges and Opportunities of Information Technology in the 90s. Track VI: Managing Academic Information Systems.

    ERIC Educational Resources Information Center

    CAUSE, Boulder, CO.

    Six papers from the 1990 CAUSE conference's Track VI, Managing Academic Information Systems are presented. Papers discuss issues related to the integration of merging technologies - computing, communications, classrooms - and their effects on the way "academic business" is conducted. Papers and their authors are as follows:…

  7. The Rhetoric of "Job Market" and the Reality of the Academic Labor System

    ERIC Educational Resources Information Center

    Bousquet, Marc

    2003-01-01

    One way of describing the recent movement of thought about the academic labor system is as a series of waves. A "first wave" of labor consciousness emerged before 1970, propelling the self-organization of the academic work force, especially in public institutions, where more than half the faculty are unionized. This labor awareness was…

  8. Maltreatment, Academic Difficulty, and Systems-Involved Youth: Current Evidence and Opportunities

    ERIC Educational Resources Information Center

    Stone, Susan; Zibulsky, Jamie

    2015-01-01

    Youth involved in child-serving systems of care (e.g., child welfare and juvenile justice) often exhibit specific academic performance problems. The magnitude of academic risk among these students is a serious concern given that school attachment, performance, and attainment closely relate to indicators of well-being across the lifespan. It is…

  9. Developing a conceptual model for the application of patient and public involvement in the healthcare system in Iran

    PubMed Central

    Azmal, Mohammad; Sari, Ali Akbari; Foroushani, Abbas Rahimi; Ahmadi, Batoul

    2016-01-01

    Introduction Patient and public involvement is engaging patients, providers, community representatives, and the public in healthcare planning and decision-making. The purpose of this study was to develop a model for the application of patient and public involvement in decision making in the Iranian healthcare system. Methods A mixed qualitative-quantitative approach was used to develop a conceptual model. Thirty three key informants were purposely recruited in the qualitative stage, and 420 people (patients and their companions) were included in a protocol study that was implemented in five steps: 1) Identifying antecedents, consequences, and variables associated with the patient and the publics’ involvement in healthcare decision making through a comprehensive literature review; 2) Determining the main variables in the context of Iran’s health system using conceptual framework analysis; 3) Prioritizing and weighting variables by Shannon entropy; 4) designing and validating a tool for patient and public involvement in healthcare decision making; and 5) Providing a conceptual model of patient and the public involvement in planning and developing healthcare using structural equation modeling. We used various software programs, including SPSS (17), Max QDA (10), EXCEL, and LISREL. Content analysis, Shannon entropy, and descriptive and analytic statistics were used to analyze the data. Results In this study, seven antecedents variable, five dimensions of involvement, and six consequences were identified. These variables were used to design a valid tool. A logical model was derived that explained the logical relationships between antecedent and consequent variables and the dimensions of patient and public involvement as well. Conclusion Given the specific context of the political, social, and innovative environments in Iran, it was necessary to design a model that would be compatible with these features. It can improve the quality of care and promote the patient and

  10. Collecting, Integrating, and Disseminating Patient-Reported Outcomes for Research in a Learning Healthcare System

    PubMed Central

    Harle, Christopher A.; Lipori, Gloria; Hurley, Robert W.

    2016-01-01

    Introduction: Advances in health policy, research, and information technology have converged to increase the electronic collection and use of patient-reported outcomes (PROs). Therefore, it is important to share lessons learned in implementing PROs in research information systems. Case Description: The purpose of this case study is to describe a novel information system for electronic PROs and lessons learned in implementing that system to support research in an academic health center. The system incorporates freely available and commercial software and involves clinical and research workflows that support the collection, transformation, and research use of PRO data. The software and processes that comprise the system serve three main functions, (i) collecting electronic PROs in clinical care, (ii) integrating PRO data with non-patient generated clinical data, and (iii) disseminating data to researchers through the institution’s research informatics infrastructure, including the i2b2 (Informatics for Integrating Biology and the Bedside) system. Strategies: Our successful design and implementation was driven by three overarching strategies. First, we selected and implemented multiple interfaced technologies to support PRO collection, management, and research use. Second, we aimed to use standardized approaches to measuring PROs, sending PROs between systems, and disseminating PROs. Finally, we focused on using technologies and processes that aligned with existing clinical research information management strategies within our organization. Conclusion: These experiences and lessons may help future implementers and researchers enhance the scale and sustainable use of systems for research use of PROs. PMID:27563683

  11. A systematic review of human factors and ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety.

    PubMed

    Xie, Anping; Carayon, Pascale

    2015-01-01

    Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how human factors and ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified 12 projects representing 23 studies and addressing different physical, cognitive and organisational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care.

  12. An intelligent healthcare management system: a new approach in work-order prioritization for medical equipment maintenance requests.

    PubMed

    Hamdi, Naser; Oweis, Rami; Abu Zraiq, Hamzeh; Abu Sammour, Denis

    2012-04-01

    The effective maintenance management of medical technology influences the quality of care delivered and the profitability of healthcare facilities. Medical equipment maintenance in Jordan lacks an objective prioritization system; consequently, the system is not sensitive to the impact of equipment downtime on patient morbidity and mortality. The current work presents a novel software system (EQUIMEDCOMP) that is designed to achieve valuable improvements in the maintenance management of medical technology. This work-order prioritization model sorts medical maintenance requests by calculating a priority index for each request. Model performance was assessed by utilizing maintenance requests from several Jordanian hospitals. The system proved highly efficient in minimizing equipment downtime based on healthcare delivery capacity, and, consequently, patient outcome. Additionally, a preventive maintenance optimization module and an equipment quality control system are incorporated. The system is, therefore, expected to improve the reliability of medical equipment and significantly improve safety and cost-efficiency.

  13. Performance Evaluation of an Enhanced Uplink 3.5G System for Mobile Healthcare Applications

    PubMed Central

    Komnakos, Dimitris; Vouyioukas, Demosthenes; Maglogiannis, Ilias; Constantinou, Philip

    2008-01-01

    The present paper studies the prospective and the performance of a forthcoming high-speed third generation (3.5G) networking technology, called enhanced uplink, for delivering mobile health (m-health) applications. The performance of 3.5G networks is a critical factor for successful development of m-health services perceived by end users. In this paper, we propose a methodology for performance assessment based on the joint uplink transmission of voice, real-time video, biological data (such as electrocardiogram, vital signals, and heart sounds), and healthcare records file transfer. Various scenarios were concerned in terms of real-time, nonreal-time, and emergency applications in random locations, where no other system but 3.5G is available. The accomplishment of quality of service (QoS) was explored through a step-by-step improvement of enhanced uplink system's parameters, attributing the network system for the best performance in the context of the desired m-health services. PMID:19132096

  14. Patients’ perceptions of the triage system in a primary healthcare facility, Cape Town, South Africa

    PubMed Central

    Adeniji, Adeloye Amoo

    2016-01-01

    Background In public healthcare facilities, where the patient numbers and the available resources are often disproportionate, triage is used to prioritise when patients are seen. Patients may not understand the triage process and have strong views on how to improve their experience. Aim This study explored the views of patients who had undergone triage in the emergency centre of a primary care facility. Setting Gugulethu Community Health Centre, Cape Town. Methods A purposive sample consisted of five women (one coded green, three orange, one yellow) and four men (one coded green and three yellow). A semi-structured qualitative interview was conducted in either Xhosa or English and the transcripts analysed using the framework method. Results All of the respondents complained of a lack of information and poor understanding of the triage process. Those coded green experienced the process as biased and unfair and reported that the triage nurse was rude and unprofessional. By contrast, those coded yellow or orange found the triage nurse to be helpful and professional. Most patients turned to support staff (e.g. security staff or cleaners) for assistance in dealing with the triage system. Most patients waited longer than the guidelines recommend and the green-coded patients complained about this issue. Conclusion Patients did not have a good experience of the triage system. Managers of the triage system need to design better strategies to improve patient acceptance and share information. The important role of support staff needs to be recognised and strengthened. PMID:27380788

  15. Novel non-contact control system of electric bed for medical healthcare.

    PubMed

    Lo, Chi-Chun; Tsai, Shang-Ho; Lin, Bor-Shyh

    2017-03-01

    A novel non-contact controller of the electric bed for medical healthcare was proposed in this study. Nowadays, the electric beds are widely used for hospitals and home-care, and the conventional control method of the electric beds usually involves in the manual operation. However, it is more difficult for the disabled and bedridden patients, who might totally depend on others, to operate the conventional electric beds by themselves. Different from the current controlling method, the proposed system provides a new concept of controlling the electric bed via visual stimuli, without manual operation. The disabled patients could operate the electric bed by focusing on the control icons of a visual stimulus tablet in the proposed system. Besides, a wearable and wireless EEG acquisition module was also implemented to monitor the EEG signals of patients. The experimental results showed that the proposed system successfully measured and extracted the EEG features related to visual stimuli, and the disabled patients could operate the adjustable function of the electric bed by themselves to effectively reduce the long-term care burden.

  16. Taking charge of high-risk and high-cost patients in the public healthcare system.

    PubMed

    Denis, Jean-Louis; Cambourieu, Caroline; Roy, Denis A

    2014-01-01

    Many healthcare systems are struggling with the issue of providing high-quality care to high-needs patients at lower costs. Our comments in this paper draw on insights that we have gained from the development and implementation of integrated models of care in Québec. This experience highlights the importance of developing a clear clinical approach to the delivery and coordination of care and to support providers in new roles. Our second insight is that system-level policy guidelines may help to focus the attention of organizations and providers on key priorities, but they need to take into account differing needs in various contexts. Third, a crucial factor for success over the longer term is the ability of local networks to reshape the allocation and use of resources to bring about change in day-to-day operations. We conclude by highlighting key characteristics of high-performing health systems and with the final observation that politicians and policymakers need to allow enough time to harness the full benefit of change initiatives.

  17. Context-aware access control for pervasive access to process-based healthcare systems.

    PubMed

    Koufi, Vassiliki; Vassilacopoulos, George

    2008-01-01

    Healthcare is an increasingly collaborative enterprise involving a broad range of healthcare services provided by many individuals and organizations. Grid technology has been widely recognized as a means for integrating disparate computing resources in the healthcare field. Moreover, Grid portal applications can be developed on a wireless and mobile infrastructure to execute healthcare processes which, in turn, can provide remote access to Grid database services. Such an environment provides ubiquitous and pervasive access to integrated healthcare services at the point of care, thus improving healthcare quality. In such environments, the ability to provide an effective access control mechanism that meets the requirement of the least privilege principle is essential. Adherence to the least privilege principle requires continuous adjustments of user permissions in order to adapt to the current situation. This paper presents a context-aware access control mechanism for HDGPortal, a Grid portal application which provides access to workflow-based healthcare processes using wireless Personal Digital Assistants. The proposed mechanism builds upon and enhances security mechanisms provided by the Grid Security Infrastructure. It provides tight, just-in-time permissions so that authorized users get access to specific objects according to the current context. These permissions are subject to continuous adjustments triggered by the changing context. Thus, the risk of compromising information integrity during task executions is reduced.

  18. Welfarism versus 'free enterprise': considerations of power and justice in the Philippine healthcare system.

    PubMed

    Sy, Peter A

    2003-10-01

    The just distribution of benefits and burdens of healthcare, at least in the contemporary Philippine context, is an issue that gravitates towards two opposing doctrines of welfarism and 'free enterprise.' Supported largely by popular opinion, welfarism maintains that social welfare and healthcare are primarily the responsibility of the government. Free enterprise (FE) doctrine, on the other hand, maintains that social welfare is basically a market function and that healthcare should be a private industry that operates under competitive conditions with minimal government control. I will examine the ethical implications of these two doctrines as they inform healthcare programmes by business and government, namely: (a) the Devolution of Health Services and (b) the Philippine Health Maintenance Organization (HMO). I will argue that these doctrines and the health programmes they inform are deficient in following respects: (1) equitable access to healthcare, (2) individual needs for premium healthcare, (3) optimal utilisation of health resources, and (4) the equitable assignment of burdens that healthcare entails. These respects, as considerations of justice, are consistent with an operational definition of 'power' proposed here as 'access to and control of resources.'

  19. Implementation and evaluation of an efficient secure computation system using ‘R’ for healthcare statistics

    PubMed Central

    Chida, Koji; Morohashi, Gembu; Fuji, Hitoshi; Magata, Fumihiko; Fujimura, Akiko; Hamada, Koki; Ikarashi, Dai; Yamamoto, Ryuichi

    2014-01-01

    Background and objective While the secondary use of medical data has gained attention, its adoption has been constrained due to protection of patient privacy. Making medical data secure by de-identification can be problematic, especially when the data concerns rare diseases. We require rigorous security management measures. Materials and methods Using secure computation, an approach from cryptography, our system can compute various statistics over encrypted medical records without decrypting them. An issue of secure computation is that the amount of processing time required is immense. We implemented a system that securely computes healthcare statistics from the statistical computing software ‘R’ by effectively combining secret-sharing-based secure computation with original computation. Results Testing confirmed that our system could correctly complete computation of average and unbiased variance of approximately 50 000 records of dummy insurance claim data in a little over a second. Computation including conditional expressions and/or comparison of values, for example, t test and median, could also be correctly completed in several tens of seconds to a few minutes. Discussion If medical records are simply encrypted, the risk of leaks exists because decryption is usually required during statistical analysis. Our system possesses high-level security because medical records remain in encrypted state even during statistical analysis. Also, our system can securely compute some basic statistics with conditional expressions using ‘R’ that works interactively while secure computation protocols generally require a significant amount of processing time. Conclusions We propose a secure statistical analysis system using ‘R’ for medical data that effectively integrates secret-sharing-based secure computation and original computation. PMID:24763677

  20. Innovation networks for improving access and quality across the healthcare ecosystem.

    PubMed

    Carroll, Mark; James, Judith A; Lardiere, Michael R; Proser, Michelle; Rhee, Kyu; Sayre, Michael H; Shore, Jay H; Ternullo, Joseph

    2010-01-01

    Partnerships between patient communities, healthcare providers, and academic researchers are key to stepping up the pace and public health impact of clinical and translational research supported by the National Institutes of Health. With emphasis shifting toward community engagement and faster translation of research advances into clinical practice, academic researchers have a vital stake in widening the use of health information technology systems and telehealth networks to support collaboration and innovation. However, limited interaction between academic institutions and healthcare providers hinders the ability to form and sustain the integrated networks that are needed to conduct meaningful community-engaged research that improves public health outcomes. Healthcare providers, especially those affiliated with smaller practices, will need sustainable infrastructure and real incentives to utilize such networks, as well as training and additional resources for ongoing technical assistance.

  1. Innovation Networks for Improving Access and Quality Across the Healthcare Ecosystem

    PubMed Central

    Carroll, Mark; James, Judith A.; Lardiere, Michael R.; Proser, Michelle; Rhee, Kyu; Sayre, Michael H.; Shore, Jay H.

    2010-01-01

    Abstract Partnerships between patient communities, healthcare providers, and academic researchers are key to stepping up the pace and public health impact of clinical and translational research supported by the National Institutes of Health. With emphasis shifting toward community engagement and faster translation of research advances into clinical practice, academic researchers have a vital stake in widening the use of health information technology systems and telehealth networks to support collaboration and innovation. However, limited interaction between academic institutions and healthcare providers hinders the ability to form and sustain the integrated networks that are needed to conduct meaningful community-engaged research that improves public health outcomes. Healthcare providers, especially those affiliated with smaller practices, will need sustainable infrastructure and real incentives to utilize such networks, as well as training and additional resources for ongoing technical assistance. PMID:20043702

  2. Quality use of medicine in a developing economy: Measures to overcome challenges in the Malaysian healthcare system

    PubMed Central

    Mohd-Tahir, Nurul-Ain; Paraidathathu, Thomas

    2015-01-01

    Malaysia inherits a highly subsidized tax-based public healthcare system complemented by a fee-for-service private sector. Population health in Malaysia has considerably improved since independence using a relatively small amount of gross domestic product (~4%). Brain drain of highly specialized personnel, growth in healthcare spending, demographic and disease pattern changes and increase in patients’ demands and expectations towards better medical care are exerting pressure on the sustainability of the system to continuously provide efficient and effective services at relatively low cost. Malaysia has adopted and implemented some of the quality use of medicine concepts such as National Essential Medicine List, health technology assessment and promotion of generic medicines in their health policy, but so far the results may not be optimal. Activities to further promote these strategies are needed for successful implementation to achieve more positive and sustained beneficial outcomes. Better strategic planning, management and collaboration between various stakeholders, considering the needs and barriers of the strategies, are important to ensure effective implementation of the strategies. More emphasis should be placed upon more equitable and rational distribution of healthcare resources to cater for rapid urbanization. Additionally, a sustainable health financing structure that is more progressive and does not encourage moral hazard should be established. In conclusion, Malaysia has achieved good outcomes in population health with relatively low financial inputs since independence. However, changes in the overall environment have created issues which would threaten the long-term viability of the healthcare system if not tackled properly. The numbers of internationally trialled strategies could be used to deal with these challenges. In addition, coordinated implementation of these strategies and effective engagement and communication between various stakeholders

  3. Quality use of medicine in a developing economy: Measures to overcome challenges in the Malaysian healthcare system.

    PubMed

    Mohd-Tahir, Nurul-Ain; Paraidathathu, Thomas; Li, Shu-Chuen

    2015-01-01

    Malaysia inherits a highly subsidized tax-based public healthcare system complemented by a fee-for-service private sector. Population health in Malaysia has considerably improved since independence using a relatively small amount of gross domestic product (~4%). Brain drain of highly specialized personnel, growth in healthcare spending, demographic and disease pattern changes and increase in patients' demands and expectations towards better medical care are exerting pressure on the sustainability of the system to continuously provide efficient and effective services at relatively low cost. Malaysia has adopted and implemented some of the quality use of medicine concepts such as National Essential Medicine List, health technology assessment and promotion of generic medicines in their health policy, but so far the results may not be optimal. Activities to further promote these strategies are needed for successful implementation to achieve more positive and sustained beneficial outcomes. Better strategic planning, management and collaboration between various stakeholders, considering the needs and barriers of the strategies, are important to ensure effective implementation of the strategies. More emphasis should be placed upon more equitable and rational distribution of healthcare resources to cater for rapid urbanization. Additionally, a sustainable health financing structure that is more progressive and does not encourage moral hazard should be established. In conclusion, Malaysia has achieved good outcomes in population health with relatively low financial inputs since independence. However, changes in the overall environment have created issues which would threaten the long-term viability of the healthcare system if not tackled properly. The numbers of internationally trialled strategies could be used to deal with these challenges. In addition, coordinated implementation of these strategies and effective engagement and communication between various stakeholders

  4. Cloud-based hospital information system as a service for grassroots healthcare institutions.

    PubMed

    Yao, Qin; Han, Xiong; Ma, Xi-Kun; Xue, Yi-Feng; Chen, Yi-Jun; Li, Jing-Song

    2014-09-01

    Grassroots healthcare institutions (GHIs) are the smallest administrative levels of medical institutions, where most patients access health services. The latest report from the National Bureau of Statistics of China showed that 96.04 % of 950,297 medical institutions in China were at the grassroots level in 2012, including county-level hospitals, township central hospitals, community health service centers, and rural clinics. In developing countries, these institutions are facing challenges involving a shortage of funds and talent, inconsistent medical standards, inefficient information sharing, and difficulties in management during the adoption of health information technologies (HIT). Because of the necessity and gravity for GHIs, our aim is to provide hospital information services for GHIs using Cloud computing technologies and service modes. In this medical scenario, the computing resources are pooled by means of a Cloud-based Virtual Desktop Infrastructure (VDI) to serve multiple GHIs, with different hospital information systems dynamically assigned and reassigned according to demand. This paper is concerned with establishing a Cloud-based Hospital Information Service Center to provide hospital information software as a service (HI-SaaS) with the aim of providing GHIs with an attractive and high-performance medical information service. Compared with individually establishing all hospital information systems, this approach is more cost-effective and affordable for GHIs and does not compromise HIT performance.

  5. An Ontology for Telemedicine Systems Resiliency to Technological Context Variations in Pervasive Healthcare

    PubMed Central

    Bults, Richard G. A.; Van Sinderen, Marten J.; Widya, Ing; Hermens, Hermie J.

    2015-01-01

    Clinical data are crucial for any medical case to study and understand a patient’s condition and to give the patient the best possible treatment. Pervasive healthcare systems apply information and communication technology to enable the usage of ubiquitous clinical data by authorized medical persons. However, quality of clinical data in these applications is, to a large extent, determined by the technological context of the patient. A technological context is characterized by potential technological disruptions that affect optimal functioning of technological resources. The clinical data based on input from these technological resources can therefore have quality degradations. If these degradations are not noticed, the use of this clinical data can lead to wrong treatment decisions, which potentially puts the patient’s safety at risk. This paper presents an ontology that specifies the relation among technological context, quality of clinical data, and patient treatment. The presented ontology provides a formal way to represent the knowledge to specify the effect of technological context variations in the clinical data quality and the impact of the clinical data quality on a patient’s treatment. Accordingly, this ontology is the foundation for a quality of data framework that enables the development of telemedicine systems that are capable of adapting the treatment when the quality of the clinical data degrades, and thus guaranteeing patients’ safety even when technological context varies. PMID:27170903

  6. Network security vulnerabilities and personal privacy issues in Healthcare Information Systems: a case study in a private hospital in Turkey.

    PubMed

    Namoğlu, Nihan; Ulgen, Yekta

    2013-01-01

    Healthcare industry has become widely dependent on information technology and internet as it moves from paper to electronic records. Healthcare Information System has to provide a high quality service to patients and a productive knowledge share between healthcare staff by means of patient data. With the internet being commonly used across hospitals, healthcare industry got its own share from cyber threats like other industries in the world. The challenge is allowing knowledge transfer to hospital staff while still ensuring compliance with security mandates. Working in collaboration with a private hospital in Turkey; this study aims to reveal the essential elements of a 21st century business continuity plan for hospitals while presenting the security vulnerabilities in the current hospital information systems and personal privacy auditing standards proposed by regulations and laws. We will survey the accreditation criteria in Turkey and counterparts in US and EU. We will also interview with medical staff in the hospital to understand the needs for personal privacy and the technical staff to perceive the technical requirements in terms of network security configuration and deployment. As hospitals are adopting electronic transactions, it should be considered a must to protect these electronic health records in terms of personal privacy aspects.

  7. Institutional trust in the national social security and municipal healthcare systems for the elderly in Japan.

    PubMed

    Murayama, Hiroshi; Taguchi, Atsuko; Ryu, Shuhei; Nagata, Satoko; Murashima, Sachiyo

    2012-09-01

    Japanese social security systems and institutions for the elderly, as well as the general attitude toward elderly care services among the Japanese population, have been undergoing a dramatic change. By examining the association between institutional trust, which is a representative element of social capital, and anxiety regarding receiving elderly care, we can uncover clues toward building a more robust social security system for the elderly. This study examines the relationship between institutional trust, in the national social security and municipal healthcare systems for the elderly, and anxiety with respect to receiving elderly care among the general Japanese population. A cross-sectional survey was conducted using a self-administered questionnaire that was returned by mail in January and February 2005. The target population was 4735 community residents aged 20-75 years, who lived in the city of Koka, Shiga, Japan. A total of 2264 questionnaires were included in the analysis. A binominal logistic regression analysis showed that responses of 'trust' [odds ratio (OR): 2.09, 95% confidence interval (95% CI): 1.01-4.30] and 'strongly trust' (OR: 3.80, 95% CI: 1.55-9.31) for the national system were associated with not having anxiety regarding elderly care, compared with the reference category of feeling strongly distrust. However, trust in the municipal system showed no association with this anxiety. These results indicate the importance of developing strategies to increase a common trust in the national care services for the elderly to reduce the anxiety people feel regarding whether they will be able to receive elderly care when required.

  8. Misinformation and misbeliefs in the Tuskegee Study of Untreated Syphilis fuel mistrust in the healthcare system.

    PubMed Central

    White, Robert M.

    2005-01-01

    The Tuskegee Study of Untreated Syphilis (TSUS) is an important issue in research, healthcare, ethics and race relations. The assumed consequences of knowledge of this study on the African-American community include mistrust of the healthcare system. In the July 2005 issue of the Journal of the National Medical Association, Brandon, Isaac and LaVeist (the authors), who were at the Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, reported the results of black-white differences in awareness of and knowledge about the TSUS and the effect of that awareness and knowledge on medical mistrust. The study surveyed blacks, whites and others in the Baltimore, MD community about their knowledge of and attitudes about the TSUS. The respondents who were aware of the TSUS were asked survey items to assess specific factual information about the TSUS. The respondents who were not aware of the TSUS were read a brief description of the TSUS taken from the CDC website. Both groups were asked if a similar study was possible today. The authors performed a regression analysis of mistrust of medical care based on race, knowledge of the TSUS and demographic variables. The editorial identified and explained challenges in the article, i.e., challenges in calculations, demographic analysis by race, knowledge of TSUS, cultural sensitivity and methodology. The authors miscalculated the "similar proportions" of blacks and whites who were aware of the TSUS; the recalculated proportions, favoring whites, were different than reported by others. There was no demographic analysis by race in their article--also different than other published reports. Most respondents--blacks and whites--who were aware of the TSUS at baseline answered incorrectly the author-selected questions about the TSUS, particularly the fact-based question of whether the TSUS researchers gave syphilis to the men-not dissimilar to one other report. The source for TSUS information (the CDC

  9. Communication technology and social media: opportunities and implications for healthcare systems.

    PubMed

    Weaver, Betsy; Lindsay, Bill; Gitelman, Betsy

    2012-09-30

    Electronic patient education and communications, such as email, text messaging, and social media, are on the rise in healthcare today. This article explores potential uses of technology to seek solutions in healthcare for such challenges as modifying behaviors related to chronic conditions, improving efficiency, and decreasing costs. A brief discussion highlights the role of technologies in healthcare informatics and considers two theoretical bases for technology implementation. Discussion focuses more extensively on the ability and advantages of electronic communication technology, such as e-mail, social media, text messaging, and electronic health records, to enhance patient-provider e-communications in nursing today. Effectiveness of e-communication in healthcare is explored, including recent and emerging applications designed to improve patient-provider connections and review of current evidence supporting positive outcomes. The conclusion addresses the vision of nurses' place in the vanguard of these developments.

  10. Integrating Low-Cost Rapid Usability Testing into Agile System Development of Healthcare IT: A Methodological Perspective.

    PubMed

    Kushniruk, Andre W; Borycki, Elizabeth M

    2015-01-01

    The development of more usable and effective healthcare information systems has become a critical issue. In the software industry methodologies such as agile and iterative development processes have emerged to lead to more effective and usable systems. These approaches highlight focusing on user needs and promoting iterative and flexible development practices. Evaluation and testing of iterative agile development cycles is considered an important part of the agile methodology and iterative processes for system design and re-design. However, the issue of how to effectively integrate usability testing methods into rapid and flexible agile design cycles has remained to be fully explored. In this paper we describe our application of an approach known as low-cost rapid usability testing as it has been applied within agile system development in healthcare. The advantages of the integrative approach are described, along with current methodological considerations.

  11. Does academic assessment system type affect levels of academic stress in medical students? A cross-sectional study from Pakistan.

    PubMed

    Ali, Madiha; Asim, Hamna; Edhi, Ahmed Iqbal; Hashmi, Muhammad Daniya; Khan, Muhammad Shahjahan; Naz, Farah; Qaiser, Kanza Noor; Qureshi, Sidra Masud; Zahid, Mohammad Faizan; Jehan, Imtiaz

    2015-01-01

    Introduction Stress among medical students induced by academic pressures is on the rise among the student population in Pakistan and other parts of the world. Our study examined the relationship between two different systems employed to assess academic performance and the levels of stress among students at two different medical schools in Karachi, Pakistan. Methods A sample consisting of 387 medical students enrolled in pre-clinical years was taken from two universities, one employing the semester examination system with grade point average (GPA) scores (a tiered system) and the other employing an annual examination system with only pass/fail grading. A pre-designed, self-administered questionnaire was distributed. Test anxiety levels were assessed by The Westside Test Anxiety Scale (WTAS). Overall stress was evaluated using the Perceived Stress Scale (PSS). Results There were 82 males and 301 females while four did not respond to the gender question. The mean age of the entire cohort was 19.7±1.0 years. A total of 98 participants were from the pass/fail assessment system while 289 were from the GPA system. There was a higher proportion of females in the GPA system (85% vs. 59%; p<0.01). Students in the pass/fail assessment system had a lower score on the WTAS (2.4±0.8 vs. 2.8±0.7; p=0.01) and the PSS (17.0±6.7 vs. 20.3±6.8; p<0.01), indicating lower levels of test anxiety and overall stress than in students enrolled in the GPA assessment system. More students in the pass/fail system were satisfied with their performance than those in the GPA system. Conclusion Based on the present study, we suggest governing bodies to revise and employ a uniform assessment system for all the medical colleges to improve student academic performance and at the same time reduce stress levels. Our results indicate that the pass/fail assessment system accomplishes these objectives.

  12. Does academic assessment system type affect levels of academic stress in medical students? A cross-sectional study from Pakistan

    PubMed Central

    Ali, Madiha; Asim, Hamna; Edhi, Ahmed Iqbal; Hashmi, Muhammad Daniyal; Khan, Muhammad Shahjahan; Naz, Farah; Qaiser, Kanza Noor; Qureshi, Sidra Masud; Zahid, Mohammad Faizan; Jehan, Imtiaz

    2015-01-01

    Introduction Stress among medical students induced by academic pressures is on the rise among the student population in Pakistan and other parts of the world. Our study examined the relationship between two different systems employed to assess academic performance and the levels of stress among students at two different medical schools in Karachi, Pakistan. Methods A sample consisting of 387 medical students enrolled in pre-clinical years was taken from two universities, one employing the semester examination system with grade point average (GPA) scores (a tiered system) and the other employing an annual examination system with only pass/fail grading. A pre-designed, self-administered questionnaire was distributed. Test anxiety levels were assessed by The Westside Test Anxiety Scale (WTAS). Overall stress was evaluated using the Perceived Stress Scale (PSS). Results There were 82 males and 301 females while four did not respond to the gender question. The mean age of the entire cohort was 19.7±1.0 years. A total of 98 participants were from the pass/fail assessment system while 289 were from the GPA system. There was a higher proportion of females in the GPA system (85% vs. 59%; p<0.01). Students in the pass/fail assessment system had a lower score on the WTAS (2.4±0.8 vs. 2.8±0.7; p=0.01) and the PSS (17.0±6.7 vs. 20.3±6.8; p<0.01), indicating lower levels of test anxiety and overall stress than in students enrolled in the GPA assessment system. More students in the pass/fail system were satisfied with their performance than those in the GPA system. Conclusion Based on the present study, we suggest governing bodies to revise and employ a uniform assessment system for all the medical colleges to improve student academic performance and at the same time reduce stress levels. Our results indicate that the pass/fail assessment system accomplishes these objectives. PMID:26112353

  13. Mainstreaming carbon management in healthcare systems: a bottom-up modeling approach.

    PubMed

    Pollard, Adam S; Taylor, Timothy J; Fleming, Lora E; Stahl-Timmins, Will; Depledge, Michael H; Osborne, Nicholas J

    2013-01-15

    Increasing greenhouse gas emissions threaten human health and the environment. In response, healthcare managers face significant challenges in balancing operational decisions about patient care with carbon mitigation targets. We explore a bottom-up modeling framework to aid in the decision-making for both carbon and cost in healthcare, using data from a case study in Cornwall, UK. A model was built and run for secondary healthcare, specifically outpatient clinics, theater lists, beds, and diagnostic facilities. Five scenarios were tested: business-as-usual; service expansion; site closure; water temperature reduction; and theater optimization. The estimated emissions from secondary healthcare in Cornwall ran to 5787 T CO(2)eq with patient travel adding 2215 T CO(2)eq. Closing selected sites would have reduced this by 4% (261 T CO(2)eq), a reduction less than the resulting increases in patient transport emissions. Reducing hot water temperatures by 5 °C and improving theater usage would lower the footprint by 0.7% (44 T CO(2)eq) and 0.08% (5 T CO(2)eq), respectively. We consider bottom-up models important tools in the process of estimating and modeling the carbon footprint of healthcare. For the carbon reduction targets of the healthcare sector to be met, the use of these bottom-up models in decision making and forward planning is pivotal.

  14. Health and health-care systems in southeast Asia: diversity and transitions.

    PubMed

    Chongsuvivatwong, Virasakdi; Phua, Kai Hong; Yap, Mui Teng; Pocock, Nicola S; Hashim, Jamal H; Chhem, Rethy; Wilopo, Siswanto Agus; Lopez, Alan D

    2011-01-29

    Southeast Asia is a region of enormous social, economic, and political diversity, both across and within countries, shaped by its history, geography, and position as a major crossroad of trade and the movement of goods and services. These factors have not only contributed to the disparate health status of the region's diverse populations, but also to the diverse nature of its health systems, which are at varying stages of evolution. Rapid but inequitable socioeconomic development, coupled with differing rates of demographic and epidemiological transitions, have accentuated health disparities and posed great public health challenges for national health systems, particularly the control of emerging infectious diseases and the rise of non-communicable diseases within ageing populations. While novel forms of health care are evolving in the region, such as corporatised public health-care systems (government owned, but operating according to corporate principles and with private-sector participation) and financing mechanisms to achieve universal coverage, there are key lessons for health reforms and decentralisation. New challenges have emerged with rising trade in health services, migration of the health workforce, and medical tourism. Juxtaposed between the emerging giant economies of China and India, countries of the region are attempting to forge a common regional identity, despite their diversity, to seek mutually acceptable and effective solutions to key regional health challenges. In this first paper in the Lancet Series on health in southeast Asia, we present an overview of key demographic and epidemiological changes in the region, explore challenges facing health systems, and draw attention to the potential for regional collaboration in health.

  15. Factors influencing healthcare service quality

    PubMed Central

    Mosadeghrad, Ali Mohammad

    2014-01-01

    Background: The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods: Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results: Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion: This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality. PMID:25114946

  16. [Classification on academic systems of acupuncture in Keynotes of Acupuncture-Moxibustion].

    PubMed

    Zhang, Jian-Bin; Dong, Qin

    2012-12-01

    The understanding and classification of academic systems of acupuncture-moxibustion of GAO Wu can be initially clarified through Keynotes of Acupuncture-Moxibustion. On the base of theoretical system of Neijing (Internal Classic) and Nanjing (Classic on Medical Problems), needling manipulations, treatment, meridians and acupoints were taken as the major knowledge models to construct the framework of the academic system by GAO Wu. The "nine needles" and "manipulations" were taken as the starting point of acupuncture. "Reducing and reinforcing methods" were held as the requirement for advanced skills of acupuncturists. Moreover, syndromes based on the theory of was 12 regular meridians was emphasized to combine the theory and clinical practice tightly. Therefore, it is concluded that GAO Wu's classification of acupuncture-moxibustion academic system enlightened and provided experiences for the modern acupuncture education and academic research.

  17. Adaptive motion artefact reduction in respiration and ECG signals for wearable healthcare monitoring systems.

    PubMed

    Zhang, Zhengbo; Silva, Ikaro; Wu, Dalei; Zheng, Jiewen; Wu, Hao; Wang, Weidong

    2014-12-01

    Wearable healthcare monitoring systems (WHMSs) have received significant interest from both academia and industry with the advantage of non-intrusive and ambulatory monitoring. The aim of this paper is to investigate the use of an adaptive filter to reduce motion artefact (MA) in physiological signals acquired by WHMSs. In our study, a WHMS is used to acquire ECG, respiration and triaxial accelerometer (ACC) signals during incremental treadmill and cycle ergometry exercises. With these signals, performances of adaptive MA cancellation are evaluated in both respiration and ECG signals. To achieve effective and robust MA cancellation, three axial outputs of the ACC are employed to estimate the MA by a bank of gradient adaptive Laguerre lattice (GALL) filter, and the outputs of the GALL filters are further combined with time-varying weights determined by a Kalman filter. The results show that for the respiratory signals, MA component can be reduced and signal quality can be improved effectively (the power ratio between the MA-corrupted respiratory signal and the adaptive filtered signal was 1.31 in running condition, and the corresponding signal quality was improved from 0.77 to 0.96). Combination of the GALL and Kalman filters can achieve robust MA cancellation without supervised selection of the reference axis from the ACC. For ECG, the MA component can also be reduced by adaptive filtering. The signal quality, however, could not be improved substantially just by the adaptive filter with the ACC outputs as the reference signals.

  18. [The pharmaceutical industry and the sustainability of healthcare systems in developed countries and in Latin America].

    PubMed

    Iñesta, Antonio; Oteo, Luis Angel

    2011-06-01

    The global economic crisis and its impact on public finances in most developed countries are giving rise to cost-containment policies in healthcare systems. Prevailing legislation on medication requires the safety, quality, and efficacy of these products. A few countries include efficiency criteria, primarily for new medication that they wish to include in public financing. The appropriate use of generic and "biosimilar medication" is very important for maintaining the financial equilibrium of the Health Services. The problem in Latin America is that not all multisource products are bioequivalent and not all countries have the resources to conduct bioequivalence studies in vivo. The European Medicines Agency in 2005 adopted guidelines on "biosimilar medicines" and thirteen of them were subsequently approved for general release. Benchmarking of this model by other countries would be important. The influence of the pharmaceutical industry on political and administrative areas is enormous and control is necessary. The pharmaceutical companies claim that they act with corporate social responsibility, therefore, they must ensure this responsibility toward society.

  19. P4 medicine: how systems medicine will transform the healthcare sector and society

    PubMed Central

    Glusman, Gustavo; Brogaard, Kristin; Price, Nathan D; Hood, Leroy

    2014-01-01

    Ten years ago, the proposition that healthcare is evolving from reactive disease care to care that is predictive, preventive, personalized and participatory was regarded as highly speculative. Today, the core elements of that vision are widely accepted and have been articulated in a series of recent reports by the US Institute of Medicine. Systems approaches to biology and medicine are now beginning to provide patients, consumers and physicians with personalized information about each individual’s unique health experience of both health and disease at the molecular, cellular and organ levels. This information will make disease care radically more cost effective by personalizing care to each person’s unique biology and by treating the causes rather than the symptoms of disease. It will also provide the basis for concrete action by consumers to improve their health as they observe the impact of lifestyle decisions. Working together in digitally powered familial and affinity networks, consumers will be able to reduce the incidence of the complex chronic diseases that currently account for 75% of disease-care costs in the USA. PMID:25342952

  20. A Study on the Secure User Profiling Structure and Procedure for Home Healthcare Systems.

    PubMed

    Ko, Hoon; Song, MoonBae

    2016-01-01

    Despite of various benefits such as a convenience and efficiency, home healthcare systems have some inherent security risks that may cause a serious leak on personal health information. This work presents a Secure User Profiling Structure which has the patient information including their health information. A patient and a hospital keep it at that same time, they share the updated data. While they share the data and communicate, the data can be leaked. To solve the security problems, a secure communication channel with a hash function and an One-Time Password between a client and a hospital should be established and to generate an input value to an OTP, it uses a dual hash-function. This work presents a dual hash function-based approach to generate the One-Time Password ensuring a secure communication channel with the secured key. In result, attackers are unable to decrypt the leaked information because of the secured key; in addition, the proposed method outperforms the existing methods in terms of computation cost.

  1. VehiHealth: An Emergency Routing Protocol for Vehicular Ad Hoc Network to Support Healthcare System.

    PubMed

    Bhoi, S K; Khilar, P M

    2016-03-01

    Survival of a patient depends on effective data communication in healthcare system. In this paper, an emergency routing protocol for Vehicular Ad hoc Network (VANET) is proposed to quickly forward the current patient status information from the ambulance to the hospital to provide pre-medical treatment. As the ambulance takes time to reach the hospital, ambulance doctor can provide sudden treatment to the patient in emergency by sending patient status information to the hospital through the vehicles using vehicular communication. Secondly, the experienced doctors respond to the information by quickly sending a treatment information to the ambulance. In this protocol, data is forwarded through that path which has less link breakage problem between the vehicles. This is done by calculating an intersection value I v a l u e for the neighboring intersections by using the current traffic information. Then the data is forwarded through that intersection which has minimum I v a l u e . Simulation results show VehiHealth performs better than P-GEDIR, GyTAR, A-STAR and GSR routing protocols in terms of average end-to-end delay, number of link breakage, path length, and average response time.

  2. P4 medicine: how systems medicine will transform the healthcare sector and society.

    PubMed

    Flores, Mauricio; Glusman, Gustavo; Brogaard, Kristin; Price, Nathan D; Hood, Leroy

    2013-01-01

    Ten years ago, the proposition that healthcare is evolving from reactive disease care to care that is predictive, preventive, personalized and participatory was regarded as highly speculative. Today, the core elements of that vision are widely accepted and have been articulated in a series of recent reports by the US Institute of Medicine. Systems approaches to biology and medicine are now beginning to provide patients, consumers and physicians with personalized information about each individual's unique health experience of both health and disease at the molecular, cellular and organ levels. This information will make disease care radically more cost effective by personalizing care to each person's unique biology and by treating the causes rather than the symptoms of disease. It will also provide the basis for concrete action by consumers to improve their health as they observe the impact of lifestyle decisions. Working together in digitally powered familial and affinity networks, consumers will be able to reduce the incidence of the complex chronic diseases that currently account for 75% of disease-care costs in the USA.

  3. Geographic Information Systems for healthcare organizations: a primer for nursing professions.

    PubMed

    Endacott, Ruth; Kamel Boulos, Maged N; Manning, Bryan R M; Maramba, Inocencio

    2009-01-01

    The sharing of spatial information among members of the health sector can have vast strategic and operational benefits. Geographic Information Systems, or GIS, can be a key technology in optimally using this information. There are two types of applications under GIS: (1) studying health outcomes and epidemiology and (2) studying and informing healthcare delivery. With the advent of GIS that can be used over the Internet, a wider audience of decision makers and stakeholders now has the opportunity to use these technologies through something as simple as a Web browser. There is a small but growing number of published articles giving examples of using GIS for nursing practice and research. However, increased efforts are needed to make nurses, other health professionals, and health organizations aware of the possibilities of these information products for empowering their decision making. An incremental "capacity building" approach is proposed as the best way forward for sustainable and sustained nursing GIS development. The aims of this article are (1) to provide a brief nontechnical overview for readers not familiar with GIS, (2) to provide a framework for the adoption of GIS in health service organizations, and (3) to identify ways in which GIS can impact on the nursing management of patients.

  4. Academic Management and Administration System Reform in Higher Education Institutions

    ERIC Educational Resources Information Center

    Xianming, Xiang

    2006-01-01

    Reforms in colleges and universities should promote the humanistic character of higher education--rather than simply serve for pure economic production--but also observe the sacred mission of transmitting and creating culture and knowledge, with these two possessing momentous differences. These then demand rationality in academic management to…

  5. Academically Under Prepared: Why a P-16 System is Needed

    ERIC Educational Resources Information Center

    Mason, Maralyn

    2009-01-01

    The intent of this paper is to examine the problem of the recent high school graduate who is not academically prepared to pursue college level work. The author reviews the literature to define the problems under prepared students face when they have to take remedial courses. How taking remedial courses impacts the likelihood of earning a degree is…

  6. A Multi-User Remote Academic Laboratory System

    ERIC Educational Resources Information Center

    Barrios, Arquimedes; Panche, Stifen; Duque, Mauricio; Grisales, Victor H.; Prieto, Flavio; Villa, Jose L.; Chevrel, Philippe; Canu, Michael

    2013-01-01

    This article describes the development, implementation and preliminary operation assessment of Multiuser Network Architecture to integrate a number of Remote Academic Laboratories for educational purposes on automatic control. Through the Internet, real processes or physical experiments conducted at the control engineering laboratories of four…

  7. Patients' participation in decision-making in the medical field--'projectification' of patients in a neoliberal framed healthcare system.

    PubMed

    Glasdam, Stinne; Oeye, Christine; Thrysoee, Lars

    2015-10-01

    This article focuses on patients' participation in decision-making in meetings with healthcare professionals in a healthcare system, based on neoliberal regulations and ideas. Drawing on two constructed empirical cases, primarily from the perspective of patients, this article analyses and discusses the clinical practice around decision-making meetings within a Foucauldian perspective. Patients' participation in decision-making can be seen as an offshoot of respect for patient autonomy. A treatment must be chosen, when patients consult physicians. From the perspective of patients, there is a tendency for healthcare professionals to supply the patients with the information that they think are necessary for them to make their own decision. But patients do not always want to be a 'customer' in the healthcare system; they want to be a patient, consulting an expert for help and advice, which creates resistance to some parts of the decision-making process. Both professionals and patients are subject to the structural frame of the medical field, formed of both neoliberal framework and medical logic. The decision-making competence in relation to the choice of treatment is placed away from the professionals and seen as belonging to the patient. A 'projectification' of the patient occurs, whereby the patient becomes responsible for his/her choices in treatment and care and the professionals support him/her with knowledge, preferences, and alternative views, out of which he/she must make his/her own choices, and the responsibility for those choices now and in the future. At the same time, there is a tendency towards de-professionalization. In that light, participation of patients in decision-making can be regarded as a tacit governmentality strategy that shapes the location of responsibility between individual and society, and independent patients and healthcare professionals, despite the basically desirable, appropriate, and necessary idea of involving patients in their own

  8. Integrated Library Systems in Canadian Public, Academic and Special Libraries: Fourth Annual Survey.

    ERIC Educational Resources Information Center

    Merilees, Bobbie

    1990-01-01

    Reports the results of a survey of integrated library system vendors that examined installations in Canadian academic, public and special libraries during 1989. Findings discussed include large library system versus PC-based system market shares, an analysis of system selection by type of library, and other factors that affect system selection. A…

  9. Characterization of epidemiological surveillance systems for healthcare-associated infections (HAI) in the world and challenges for Brazil.

    PubMed

    Nogueira Junior, Cassimiro; Mello, Débora Silva de; Padoveze, Maria Clara; Boszczowski, Icaro; Levin, Anna Sara; Lacerda, Rubia Aparecida

    2014-01-01

    Surveillance systems for healthcare-associated infections (HAI) are essential for planning actions in prevention and control. Important models have been deployed in recent decades in different countries. This study aims to present the historical and operational characteristics of these systems and discuss the challenges for Brazil. Various models around the world have drawn on the experience of the United States, which pioneered this process. In Brazil, several initiatives have been launched, but the country still lacks a full national information system on HAI, thus indicating the need to promote action strategies, strengthen the role of States in communication between the Federal and local levels, pursue a national plan to organize surveillance teams with the necessary technological infrastructure, besides updating the relevant legislation for dealing with these challenges. Such measures are essential in the Brazilian context for the unified surveillance of HAI, aimed at healthcare safety and quality.

  10. A New Socio-technical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems

    PubMed Central

    Sittig, Dean F.; Singh, Hardeep

    2011-01-01

    Conceptual models have been developed to address challenges inherent in studying health information technology (HIT). This manuscript introduces an 8-dimensional model specifically designed to address the socio-technical challenges involved in design, development, implementation, use, and evaluation of HIT within complex adaptive healthcare systems. The 8 dimensions are not independent, sequential, or hierarchical, but rather are interdependent and interrelated concepts similar to compositions of other complex adaptive systems. Hardware and software computing infrastructure refers to equipment and software used to power, support, and operate clinical applications and devices. Clinical content refers to textual or numeric data and images that constitute the “language” of clinical applications. The human computer interface includes all aspects of the computer that users can see, touch, or hear as they interact with it. People refers to everyone who interacts in some way with the system, from developer to end-user, including potential patient-users. Workflow and communication are the processes or steps involved in assuring that patient care tasks are carried out effectively. Two additional dimensions of the model are internal organizational features (e.g., policies, procedures, and culture) and external rules and regulations, both of which may facilitate or constrain many aspects of the preceding dimensions. The final dimension is measurement and monitoring, which refers to the process of measuring and evaluating both intended and unintended consequences of HIT implementation and use. We illustrate how our model has been successfully applied in real-world complex adaptive settings to understand and improve HIT applications at various stages of development and implementation. PMID:20959322

  11. Healthcare Industry Study

    DTIC Science & Technology

    2003-01-01

    expenditure through measures of access, cost and quality . While the quality of the U.S. healthcare system is unparalleled in the areas of acute...system’s outcomes as measured by cost, access and quality , and makes recommendations targeted at government’s role in promoting the health of our...the system combine to produce an output that we call healthcare. That output can be measured in terms of access, cost and quality --the same market

  12. Center differences in NEC within one health-care system may depend on feeding protocol.

    PubMed

    Wiedmeier, Susan E; Henry, Erick; Baer, Vicki L; Stoddard, Ronald A; Eggert, Larry D; Lambert, Diane K; Christensen, Robert D

    2008-01-01

    We tabulated the incidence of necrotizing enterocolitis (NEC) during a recent 4-year period among three neonatal intensive care units (NICUs) within a single health-care system. We then sought associations to explain differences in NEC incidence between the centers. Between January 1, 2002, and December 31, 2005, 6787 neonates were admitted to the three NICUs. The incidence of NEC (Bell's stage II or higher) among these patients was correlated with birthweight, gestational age, maternal and neonatal demographics, and various events and practices. These events and practices included feeding practices, the management of patent ductus arteriosus, rates of systemic bacterial and fungal infection, transfers to the regional children's hospital for surgical treatment, and mortality rate. Bell's stage II or higher NEC was documented in 131 of 6787 NICU patients. The incidence was 7.4% among those with birthweights <750 g (16 of 217), 6.9% among those of birthweights 750 to 1250 g (36 of 519), and 1.3% (79 of 6051) among those with birthweights >1250 g. Center A had an incidence of NEC significantly higher than the other two, accounting for 72% of the total cases (94 of 131). Among patients <1250 g, Center A had a rate of NEC of 14.5%; Centers B (2.3%) and C (2.3%) had lower rates ( P<0.0001). After controlling for gestational age, birthweight, small for gestational age status, and Apgar scores, the overall odds ratio of developing NEC in Center A, compared with the other two, was 21.6 (95% confidence interval, 14.7 to 31.6). This difference could not be accounted for by differences in maternal or neonatal demographic characteristics, bed occupancy rates, or a higher incidence of culture-proven nosocomial bacterial or fungal infections. Although the incidence of NEC was significantly higher at Center A, the percentage of patients with NEC transferred to the children's hospital for surgical evaluation and treatment was similar. The mortality rate of patients who developed

  13. Can delivery systems use cost-effectiveness analysis to reduce healthcare costs and improve value?

    PubMed Central

    Savitz, Lucy A.; Savitz, Samuel T.

    2016-01-01

    Understanding costs and ensuring that we demonstrate value in healthcare is a foundational presumption as we transform the way we deliver and pay for healthcare in the U.S. With a focus on population health and payment reforms underway, there is increased pressure to examine cost-effectiveness in healthcare delivery. Cost-effectiveness analysis (CEA) is a type of economic analysis comparing the costs and effects (i.e. health outcomes) of two or more treatment options. The result is expressed as a ratio where the denominator is the gain in health from a measure (e.g. years of life or quality-adjusted years of life) and the numerator is the incremental cost associated with that health gain. For higher cost interventions, the lower the ratio of costs to effects, the higher the value. While CEA is not new, the approach continues to be refined with enhanced statistical techniques and standardized methods. This article describes the CEA approach and also contrasts it to optional approaches, in order for readers to fully appreciate caveats and concerns. CEA as an economic evaluation tool can be easily misused owing to inappropriate assumptions, over reliance, and misapplication. Twelve issues to be considered in using CEA results to drive healthcare delivery decision-making are summarized. Appropriately recognizing both the strengths and the limitations of CEA is necessary for informed resource allocation in achieving the maximum value for healthcare services provided. PMID:27830055

  14. Sustainable interprofessional teamwork needs a team-friendly healthcare system: Experiences from a collaborative Dutch programme.

    PubMed

    van Dijk-de Vries, Anneke; van Dongen, Jerôme Jean Jacques; van Bokhoven, Marloes Amantia

    2017-03-01

    The significance of effective interprofessional teamwork to improve the quality of care has been widely recognised. Effective interprofessional teamwork calls on good collaboration between professionals and patients, coordination between professionals, and the development of teamwork over time. Effective development of teams also requires support from the wider organisational context. In a Dutch village, healthcare professionals work closely together, and mutual consultations as well as interprofessional meetings take place on a regular basis. The network was created as a precondition for sustainable interprofessional teamwork in elderly care. However, several external barriers were experienced regarding the supportive structure and cooperative attitude of the healthcare insurer and municipality. The aim of the article is to examine these experience-based issues regarding internal organisation, perspective, and definition of effective teamwork. Complicating factors refer to finding the right key figures, and the different perspectives on team development and team effectiveness. Our conclusion is that the organisation of healthcare insurance companies needs to implement fundamental changes to facilitate an interprofessional care approach. Furthermore, municipalities should work on their vision of the needs and benefits of a fruitful collaboration with interprofessional healthcare teams. The challenge for healthcare teams is to learn to speak the language of external partners. To support the development of interprofessional teams, external parties need to recognise and trust in a shared aim to provide quality of care in an efficient and effective way.

  15. Colon cancer treatment: Are there racial disparities in an equal-access healthcare system?

    PubMed Central

    Gill, Abegail A.; Enewold, Lindsey; Zahm, Shelia H.; Shriver, Craig D.; Stojadinovic, Alexander; McGlynn, Katherine A.; Zhu, Kangmin

    2014-01-01

    Background In the general US population, blacks and whites have been shown to undergo colon cancer treatment at disproportionate rates. Accessibility to medical care may be the most important factor influencing differences in colon cancer treatment among whites and blacks. Objective This study assessed whether racial disparities in colon cancer surgery and chemotherapy existed in an equal-access healthcare system. Additionally, we sought to examine whether racial differences varied by demographic and tumor characteristics. Design and Setting Database research using the United States Department of Defense’s (DoD) Military Health System. Patients Patients included 2,560 Non-Hispanic Whites (NHW) and Non-Hispanic Blacks (NHB) with colon cancer diagnosed from 1998 to 2007. Main Outcome Measures Logistic regression was used to assess the associations between race and the receipt of colon cancer surgery or chemotherapy, while controlling for available potential confounders, both overall and stratified by age at diagnosis, sex, and tumor stage. Results After multivariate adjustment, the odds of receiving colon cancer surgery or chemotherapy NHBs versus NHWs were similar (OR: 0.75, 95% CI: 0.37–1.53; OR: 0.79, 95% CI: 0.59–1.04; respectively). Additionally, no effect modification by age at diagnosis, sex, and tumor stage were observed. Limitations Treatment data might not be complete for beneficiaries who also had non-DoD health insurance. Conclusions When access to medical care is equal, racial disparities in the provision of colon cancer surgery and chemotherapy were not apparent. Thus, it is possible that the inequalities in access to care play a major role in the racial disparities seen in colon cancer treatment in the general population. PMID:25101601

  16. Using Appendiceal Perforation Rates to Measure Impact of a Disaster on Healthcare System Effectiveness

    PubMed Central

    Mack, Dominic; Rust, George Staben; Baltrus, Peter; Moore, Barbara; Sow, Charles; Patel, Vijaykumar; Thomas, Dwayne

    2015-01-01

    Objectives To understand baseline inequities in appendiceal perforation rates and the impact of hurricane destruction on the healthcare system with respect to perforation rates and racial disparities. Methods We used claims data extracted from Medicaid Analytic Extract files to identify appendicitis diagnoses in children and adolescents based on International Classification of Diseases-9 codes and appendectomy procedures based on Current Procedural Terminology codes in the hurricane-affected states of Mississippi and Louisiana. County-level summary data obtained from 2005 Area Resource Files were used to determine high and low hurricane-affected areas. We estimated logistic regression models, mutually adjusting for race, sex, and age, to examine disparities and mixed logistic regression models to determine whether county-level effects contributed to perforation rates. Results There were nine counties in the high-impact area and 133 counties in the low-impact area. Living in the high- or low-impact area was not associated with a statistically different rate of perforation before or after Hurricane Katrina; however, living in the high-impact area was associated with a change from a lower risk (odds ratio [OR] 0.62) of perforation prehurricane to a higher risk (OR 1.14) posthurricane compared with those living in the low-impact areas. African Americans had statistically higher perforation rates than whites in the high-impact areas both before (OR 1.46) and after (OR 1.71) Hurricane Katrina. Conclusions Health professionals and hospital systems were able to maintain effective levels of care before and after Hurricane Katrina; however, perforation rates in African Americans suggest ongoing racial disparities during disasters. PMID:23263319

  17. An integrated healthcare information system for end-to-end standardized exchange and homogeneous management of digital ECG formats.

    PubMed

    Trigo, Jesús Daniel; Martínez, Ignacio; Alesanco, Alvaro; Kollmann, Alexander; Escayola, Javier; Hayn, Dieter; Schreier, Günter; García, José

    2012-07-01

    This paper investigates the application of the enterprise information system (EIS) paradigm to standardized cardiovascular condition monitoring. There are many specifications in cardiology, particularly in the ECG standardization arena. The existence of ECG formats, however, does not guarantee the implementation of homogeneous, standardized solutions for ECG management. In fact, hospital management services need to cope with various ECG formats and, moreover, several different visualization applications. This heterogeneity hampers the normalization of integrated, standardized healthcare information systems, hence the need for finding an appropriate combination of ECG formats and a suitable EIS-based software architecture that enables standardized exchange and homogeneous management of ECG formats. Determining such a combination is one objective of this paper. The second aim is to design and develop the integrated healthcare information system that satisfies the requirements posed by the previous determination. The ECG formats selected include ISO/IEEE11073, Standard Communications Protocol for Computer-Assisted Electrocardiography, and an ECG ontology. The EIS-enabling techniques and technologies selected include web services, simple object access protocol, extensible markup language, or business process execution language. Such a selection ensures the standardized exchange of ECGs within, or across, healthcare information systems while providing modularity and accessibility.

  18. Development of a Mobile System Decision-support for Medical Diagnosis of Asthma in Primary Healthcare--InteliMED.

    PubMed

    Menezes, Júlio; Gusmão, Cristine

    2015-01-01

    The structure of public and primary healthcare in Brazil is organized in a way to provide decentralized services. In theory, this scenario could enable the usage of mobile devices integrated with information systems of several purposes. In addition, there is a need of decision-support tools that are based on collected evidences, once the professional of primary healthcare, which essentially has general knowledge (non-specialist). Therefore there is a need of information that support the decision-making process on more specific contexts. This paper presents the proposal, experience of development and application of the InteliMED, a decision-support system to asthma diagnosis of children and adolescents through decision-trees and mobile devices (smartphones and tablets).

  19. Peer-Led Team Learning in an Online Course on Controversial Medication Issues and the US Healthcare System

    PubMed Central

    LimBybliw, Amy L.

    2013-01-01

    Objective. To implement peer-led team learning in an online course on controversial issues surrounding medications and the US healthcare system. Design. The course was delivered completely online using a learning management system. Students participated in weekly small-group discussions in online forums, completed 3 reflective writing assignments, and collaborated on a peer-reviewed grant proposal project. Assessment. In a post-course survey, students reported that the course was challenging but meaningful. Final projects and peer-reviewed assignments demonstrated that primary learning goals for the course were achieved and students were empowered to engage in the healthcare debate. Conclusions. A peer-led team-learning is an effective strategy for an online course offered to a wide variety of student learners. By shifting some of the learning and grading responsibility to students, the instructor workload for the course was rendered more manageable. PMID:24052653

  20. [Lay agency and healthcare: producing healthcare maps].

    PubMed

    Cecilio, Luiz Carlos de Oliveira; Carapinheiro, Graça; Andreazza, Rosemarie; Souza, Ana Lúcia Medeiros de; Andrade, Maria da Graça Garcia; Santiago, Silvia Maria; Meneses, Consuelo Sampaio; Reis, Denizi Oliveira; Araújo, Eliane Cardoso; Pinto, Nicanor Rodrigues da Silva; Spedo, Sandra Maria

    2014-07-01

    This study aimed to characterize which regulatory logics (other than government regulation) result in healthcare output, using a two-stage qualitative study in two municipalities in the ABCD Paulista region in São Paulo State, Brazil. The first stage included interviews with strategic actors (managers and policymakers) and key health professionals. The second phase collected life histories from 18 individuals with high health-services utilization rates. An analysis of the researchers' involvement in the field allowed a better understanding of the narratives. Four regulatory systems were characterized (governmental, professional, clientelistic, and lay), indicating that regulation is a field in constant dispute, a social production. Users' action produces healthcare maps that reveal the existence of other possible health system arrangements, calling on us to test shared management of healthcare between health teams and users as a promising path to the urgent need to reinvent health.

  1. Electronics for better healthcare.

    PubMed

    Wolf, Bernhard; Herzog, Karolin

    2013-06-01

    Microelectronics and microsystem technology have changed our daily lives considerably in the past 50 years. Countless everyday objects contain microelectronic components. In healthcare up to the present, however, it has not been possible to make major alterations in introducing electronics and information technology that would lead to innovative improvements and greater transparency. This paper describes initial steps in diagnostics and oncological therapy including telematic healthcare systems which can, for example, assist patients with cardiovascular diseases and shows, through these areas, how electronics and microsystems technology can contribute to better healthcare.

  2. A novel middleware solution to improve ubiquitous healthcare systems aided by affective information.

    PubMed

    Taleb, Tarik; Bottazzi, Dario; Nasser, Nidal

    2010-03-01

    The arousal of emotion might have consequences for physical health is a broadly acknowledged idea. Therapy for depression, prevention for heart pathologies, and rehabilitation treatments for drug addiction are just a few examples of application domains that may benefit from technologies capable of monitoring, detecting, representing, and disseminating information pertaining to patients' physical and psychological/emotional states. However, the design and development of healthcare applications of this kind is a rather challenging issue that requires to integrate sensor infrastructures, which are able to detect changes in patients' physiological and emotional states, and of sharing this information to interested caregivers, such as professional medical staff, relatives, and friends. This paper proposes the Pervasive Environment for AffeCtive Healthcare (PEACH) framework, a middleware level support for affective healthcare that incarnates these ideas and describes its effective functions in a drug addiction treatment application scenario.

  3. Improving the Collection of Race, Ethnicity, and Language Data to Reduce Healthcare Disparities: A Case Study from an Academic Medical Center.

    PubMed

    Lee, Wei-Chen; Veeranki, Sreenivas P; Serag, Hani; Eschbach, Karl; Smith, Kenneth D

    2016-01-01

    Well-designed electronic health records (EHRs) must integrate a variety of accurate information to support efforts to improve quality of care, particularly equity-in-care initiatives. This case study provides insight into the challenges those initiatives may face in collecting accurate race, ethnicity, and language (REAL) information in the EHR. We present the experience of an academic medical center strengthening its EHR for better collection of REAL data with funding from the EHR Incentive Programs for meaningful use of health information technology and the Texas Medicaid 1115 Waiver program. We also present a plan to address some of the challenges that arose during the course of the project. Our experience at an academic medical center can provide guidance about the likely challenges similar institutions may expect when they implement new initiatives to collect REAL data, particularly challenges regarding scope, personnel, and other resource needs.

  4. Improving the Collection of Race, Ethnicity, and Language Data to Reduce Healthcare Disparities: A Case Study from an Academic Medical Center

    PubMed Central

    Lee, Wei-Chen; Veeranki, Sreenivas P.; Serag, Hani; Eschbach, Karl; Smith, Kenneth D.

    2016-01-01

    Well-designed electronic health records (EHRs) must integrate a variety of accurate information to support efforts to improve quality of care, particularly equity-in-care initiatives. This case study provides insight into the challenges those initiatives may face in collecting accurate race, ethnicity, and language (REAL) information in the EHR. We present the experience of an academic medical center strengthening its EHR for better collection of REAL data with funding from the EHR Incentive Programs for meaningful use of health information technology and the Texas Medicaid 1115 Waiver program. We also present a plan to address some of the challenges that arose during the course of the project. Our experience at an academic medical center can provide guidance about the likely challenges similar institutions may expect when they implement new initiatives to collect REAL data, particularly challenges regarding scope, personnel, and other resource needs. PMID:27843424

  5. Cancer Moonshot Data and Technology Team: Enabling a National Learning Healthcare System for Cancer to Unleash the Power of Data.

    PubMed

    Hsu, Elizabeth R; Klemm, Juli D; Kerlavage, Anthony R; Kusnezov, Dimitri; Kibbe, Warren A

    2017-01-31

    The Cancer Moonshot emphasizes the need to learn from the experiences of cancer patients to positively impact their outcomes, experiences, and qualities of life. To realize this vision, there has been a concerted effort to identify the fundamental building blocks required to establish a National Learning Healthcare System for Cancer, such that relevant data on all cancer patients is accessible, shareable, and contributing to the current state of knowledge of cancer care and outcomes. This article is protected by copyright. All rights reserved.

  6. Healthcare reform. Is the NHS ready for US business guru's strategy?

    PubMed

    Cavendish, Will; Edwards, Nigel; Swindells, Matthew; Henke, Nicolaus; Robinson, Edna; Smith, Richard

    2006-12-07

    The central argument of the new book by renowned US academics Michael Porter and Elizabeth Olmsted Teisberg is that the US health system is broken because rather than improving quality and efficiency, it focuses on budgetary battles. HSJ gathered together six leading healthcare insiders to discuss whether his diagnosis is applicable to the NHS. Nick Edwards was there.

  7. Constructing a positive identity: A qualitative study of the driving forces of peer workers in mental health-care systems.

    PubMed

    Vandewalle, Joeri; Debyser, Bart; Beeckman, Dimitri; Vandecasteele, Tina; Deproost, Eddy; Van Hecke, Ann; Verhaeghe, Sofie

    2017-04-01

    There is growing recognition in mental health for the perspective of individuals with lived experience of mental health problems and mental health service use. As peer workers, these individuals can use their specific experience to benefit and support peers and professional caregivers, and to participate at all levels of mental health-care systems. The aim of the present study was to develop a conceptual framework representing the driving forces of peer workers to fullfil their position in mental health-care systems. A qualitative interview approach was employed using principles of grounded theory. Over a period of 5 months in 2014-2015, semistructured interviews were conducted with 14 peer workers in residential and community mental health-care systems. The emerged conceptual framework reveals that peer workers strive towards constructing a positive identity. This process is powered by driving forces reflecting a desire for normalization and an urge for self-preservation. Peer workers realize a meaningful employment by using their lived experience perspective as an asset, liberating themselves out of restrictive role patterns, and by breaking down stigma and taboo. As a precondition to engage in these normalization processes, peer workers perceive they need to secure their self-preservation by balancing the emergence of adverse emotional fluctuations. The conceptual framework can inform the development of work contexts in which peer workers have an authentic and meaningful contribution, while being offered sufficient support and learning opportunities to manage their well-being.

  8. [Spiritual support in the spirit of current trends in the Israeli healthcare system].

    PubMed

    Ziv, Amitai; Talmi, Rachet; Gary-Cohen, Meirav; Chen, Wendy

    2014-11-01

    This editorial is in response to Bar-Sela, Bentur, Schultz and Corn's article entitled "Spiritual care in hospitals and other healthcare settings in Israel--a profession in the making", published in Harefuah in May 2014. The integration of spiritual support into hospitals marks an interesting trend in light of the current emphases in the Israeli medical system on technological advancement, financial feasibility and quantifiable quality measures. This step is evidence of the importance still attached by policy and decisionmakers to those human aspects of illness and disease, which are difficult to define and measure. "Spiritual Support" is an ancient profession based on the principle, whereby support of the spirit is considered a basic human right, in recognition of the spirit as a source of strength during times of crisis and distress. This service was introduced into the Chaim Sheba Medical Center six years ago for patients with untreatable illnesses, and through identification of commonality between their coping features and those of rehabilitation patients. It was later expanded into the orthopedic and neurological rehabilitation departments. The service is provided on an individual level for the patients and in a group formal for their caregivers. Spiritual support as an integral part of the multi-disciplinary care further ratifies the holistic approach in medical practice, as an everlasting value transcending periodical trends. The conclusion drawn is that technological advancement, the scientific approach, physical-medical treatment, emotional therapy and spiritual support can and should exist side by side to improve the welfare and coping abilities of patients dealing with adverse medical conditions.

  9. The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Cultural Competence (CC) Item Set

    PubMed Central

    Weech-Maldonado, Robert; Carle, Adam; Weidmer, Beverly; Hurtado, Margarita; Ngo-Metzger, Quyen; Hays, Ron D.

    2013-01-01

    Background There is a need for reliable and valid measures of cultural competence from the patient’s perspective. Objective This paper evaluates the reliability and validity of the Consumer Assessments of Healthcare Providers and Systems (CAHPS®) Cultural Competence (CC) item set. Research Design Using 2008 survey data, we assessed the internal consistency of the CAHPS CC scales using Cronbach alphas, and examined the validity of the measures using exploratory and confirmatory factor analysis, multitrait scaling analysis, and regression analysis. Subjects A random stratified sample (based on race/ethnicity and language) of 991 enrollees, less than 65 years old, from two Medicaid managed care plans in California and New York. Measures CAHPS CC item set after excluding screener items and ratings. Results Confirmatory factor analysis (CFI= 0.98; TLI= 0.98; RMSEA= 0.06) provided support for a seven-factor structure: Doctor Communication-Positive Behaviors; Doctor Communication-Negative Behaviors; Doctor Communication-Health Promotion; Doctor Communication-Alternative Medicine; Shared Decision Making; Equitable Treatment; and Trust. Item--total correlations (corrected for item overlap) for the 7 scales exceeded 0.40. Exploratory factor analysis showed support for one additional factor: Access to Interpreter Services. Internal consistency reliability estimates ranged from 0.58 (Alternative Medicine) to 0.92 (Positive Behaviors), and was 0.70 or higher for four of the eight composites. All composites were positively and significantly associated with the overall doctor rating. Conclusions The CAHPS CC 26-item set demonstrates adequate measurement properties, and can be used as a supplemental item set to the CAHPS Clinician and Group Surveys in assessing culturally competent care from the patient’s perspective. PMID:22895226

  10. CASALUD: an innovative health-care system to control and prevent non-communicable diseases in Mexico.

    PubMed

    Tapia-Conyer, Roberto; Gallardo-Rincón, Héctor; Saucedo-Martinez, Rodrigo

    2015-07-01

    Mexico and other Latin American countries are currently facing a dramatic increase in the number of adults suffering from non-communicable diseases (NCDs) such as diabetes, cardiovascular disease (CVD) and chronic kidney disease (CKD), which require prolonged, continuous care. This epidemiological shift has created new challenges for health-care systems. Both the World Health Organization (WHO) and the United Nations (UN) have recognised the growing human and economic costs of NCDs and outlined an action plan, recognising that NCDs are preventable, often with common preventable risk factors linked to risky health behaviours. In line with international best practices, Mexico has applied a number of approaches to tackle these diseases. However, challenges remain for the Mexican health-care system, and in planning a strategy for combating and preventing NCDs, it must consider how best to integrate these strategies with existing health-care infrastructure. Shifting the paradigm of care in Mexico from a curative, passive approach to a preventive, proactive model will require an innovative and replicable system that guarantees availability of medicines and services, strengthens human capital through ongoing professional education, expands early and continuous access to care through proactive prevention strategies and incorporates technological innovations in order to do so. Here, we describe CASALUD: an innovative model in health-care that leverages international best practices and uses innovative technology to deliver NCD care, control and prevention. In addition, we describe the lessons learned from the initial implementation of the model for its effective use in Mexico, as well as the plans for wider implementation throughout the country, in partnership with the Mexican Ministry of Health.

  11. EU-ADR healthcare database network vs. spontaneous reporting system database: preliminary comparison of signal detection.

    PubMed

    Trifirò, Gianluca; Patadia, Vaishali; Schuemie, Martijn J; Coloma, Preciosa M; Gini, Rosa; Herings, Ron; Hippisley-Cox, Julia; Mazzaglia, Giampiero; Giaquinto, Carlo; Scotti, Lorenza; Pedersen, Lars; Avillach, Paul; Sturkenboom, Miriam C J M; van der Lei, Johan; Eu-Adr Group

    2011-01-01

    The EU-ADR project aims to exploit different European electronic healthcare records (EHR) databases for drug safety signal detection. In this paper we report the preliminary results concerning the comparison of signal detection between EU-ADR network and two spontaneous reporting databases, the Food and Drug Administration and World Health Organization databases. EU-ADR data sources consist of eight databases in four countries (Denmark, Italy, Netherlands, and United Kingdom) that are virtually linked through distributed data network. A custom-built software (Jerboa©) elaborates harmonized input data that are produced locally and generates aggregated data which are then stored in a central repository. Those data are subsequently analyzed through different statistics (i.e. Longitudinal Gamma Poisson Shrinker). As potential signals, all the drugs that are associated to six events of interest (bullous eruptions - BE, acute renal failure - ARF, acute myocardial infarction - AMI, anaphylactic shock - AS, rhabdomyolysis - RHABD, and upper gastrointestinal bleeding - UGIB) have been detected via different data mining techniques in the two systems. Subsequently a comparison concerning the number of drugs that could be investigated and the potential signals detected for each event in the spontaneous reporting systems (SRSs) and EU-ADR network was made. SRSs could explore, as potential signals, a larger number of drugs for the six events, in comparison to EU-ADR (range: 630-3,393 vs. 87-856), particularly for those events commonly thought to be potentially drug-induced (i.e. BE: 3,393 vs. 228). The highest proportion of signals detected in SRSs was found for BE, ARF and AS, while for ARF, and UGIB in EU-ADR. In conclusion, it seems that EU-ADR longitudinal database network may complement traditional spontaneous reporting system for signal detection, especially for those adverse events that are frequent in general population and are not commonly thought to be drug

  12. Model of care for a changing healthcare system: are there foundational pillars for design?

    PubMed

    Booker, Catriona; Turbutt, Adam; Fox, Robyn

    2016-04-01

    Currently, healthcare organisations are being challenged to provide optimal clinical services within budget limitations while simultaneously being confronted by aging consumers and labour and skill shortages. Within this dynamic and changing environment, the ability to remain responsive to patient needs while managing these issues poses further challenges. Development or review of the model of care (MOC) may provide a possible solution to support efficiencies in service provision. Although MOC are not readily understood or appreciated as an efficiency strategy, they can be more easily explained by considering several recurring pillars when developing or redesigning an MOC. Generic and recurring foundational pillars include integrated care models, team functioning and communication, leadership, change management and lean thinking. These foundational pillars should be incorporated into the development and application of MOC in order to achieve desired outcomes. However, sustainability requires continuous review to enable improvement and must be integrated into routine business. Moreover, successful review of MOC requires collaboration and commitment by all stakeholders. Leaders are critical to motivating clinicians and stakeholders in the review process. Further, it is imperative that leaders engage stakeholders to commit to support the agreed strategies designed to provide efficient and comprehensive healthcare services. Redesign of MOC can significantly improve patient care by applying the agreed strategies. In the current healthcare environment, these strategies can favourably affect healthcare expenditure and, at the same time, improve the quality of interprofessional health services.

  13. Classical distributive justice and the European healthcare system: rethinking the foundations of European health care in an age of crises.

    PubMed

    Bauzon, Stéphane

    2015-04-01

    The state subvention and distribution of health care not only jeopardize the financial sustainability of the state, but also restrict without a conclusive rational basis the freedom of patients to decide how much health care and of what quality is worth what price. The dominant biopolitics of European health care supports a healthcare monopoly in the hands of the state and the medical profession, which health care should be (re)opened to the patient's authority to deal directly for better basic health care. In a world where it is impossible for all to receive equal access to the best of basic health care, one must critically examine the plausible scope of the authority of the state to limit access to better basic health care. Classical distributive justice affords a basis for re-examining the current European ideology of equality, human dignity, and solidarity that supports healthcare systems with unsustainable egalitarian concerns.

  14. Application of Business Process Management to drive the deployment of a speech recognition system in a healthcare organization.

    PubMed

    González Sánchez, María José; Framiñán Torres, José Manuel; Parra Calderón, Carlos Luis; Del Río Ortega, Juan Antonio; Vigil Martín, Eduardo; Nieto Cervera, Jaime

    2008-01-01

    We present a methodology based on Business Process Management to guide the development of a speech recognition system in a hospital in Spain. The methodology eases the deployment of the system by 1) involving the clinical staff in the process, 2) providing the IT professionals with a description of the process and its requirements, 3) assessing advantages and disadvantages of the speech recognition system, as well as its impact in the organisation, and 4) help reorganising the healthcare process before implementing the new technology in order to identify how it can better contribute to the overall objective of the organisation.

  15. Strategic Planning for Information Systems: The Evidence from a Successful Implementation in an Academic Setting.

    ERIC Educational Resources Information Center

    Carter, Richard B.; And Others

    1991-01-01

    Demonstrates how an information systems plan can be successfully developed and implemented within an academic setting. Six guidelines for information systems planning are provided; problems are identified and recommendations to address the problems are suggested; and information systems objectives are discussed, including business communications,…

  16. Coproduction of healthcare service

    PubMed Central

    Batalden, Maren; Batalden, Paul; Margolis, Peter; Seid, Michael; Armstrong, Gail; Opipari-Arrigan, Lisa; Hartung, Hans

    2016-01-01

    Efforts to ensure effective participation of patients in healthcare are called by many names—patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always ‘coproduced’. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services. PMID:26376674

  17. Coproduction of healthcare service.

    PubMed

    Batalden, Maren; Batalden, Paul; Margolis, Peter; Seid, Michael; Armstrong, Gail; Opipari-Arrigan, Lisa; Hartung, Hans

    2016-07-01

    Efforts to ensure effective participation of patients in healthcare are called by many names-patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always 'coproduced'. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services.

  18. Center for Healthcare Technologies

    SciTech Connect

    Carrano, A.V.

    1994-03-01

    In the U.S., we now spend about 13% of the gross domestic product (CDP) on healthcare. This figure represents nearly $3000 per year per man, woman, and child. Moreover, this expenditure is projected to grow to about 20% of the GDP by the year 2000. Medical research and development accounts for only about 3% of national healthcare spending, and technology development represents only a small fraction of that 3%. New technologies that are far more cost-effective than previous ones - such as minimally invasive surgical procedures, advanced automated diagnostics, and better information systems - could save the nation billions of dollars per year to say nothing of the potential reductions in pain and suffering. A center is described that will coordinate ongoing Laboratory research aimed at developing more cost-effective tools for use by the healthcare community. The new Center for Healthcare Technologies will have many long-term benefits for the region and the nation.

  19. At the interface of community and healthcare systems: a longitudinal cohort study on evolving health and the impact of primary healthcare from the patient's perspectiv

    PubMed Central

    2010-01-01

    Background Massive efforts in Canada have been made to renew primary healthcare. However, although early evaluations of initiatives and research on certain aspects of the reform are promising, none have examined the link between patient assessments of care and health outcomes or the impacts at a population level. The goal of this project is to examine the effect of patient-centred and effective primary healthcare on the evolution of chronic illness burden and health functioning in a population, and in particularly vulnerable groups: the multi-morbid and the poor. Methods/Design A randomly selected cohort of 2000 adults aged 25 to 75 years will be recruited within the geographic boundaries of four local healthcare networks in Quebec. At recruitment, cohort members will report on socio-demographic information, functional health and healthcare use. Two weeks, 12 months and 24 months after recruitment, cohort participants will complete a self-administered questionnaire on current health and health behaviours in order to evaluate primary healthcare received in the previous year. The dependent variables are calculated as change over time of functional health status, chronic illness burden, and health behaviours. Dimensions of patient-centred care and clinical processes are measured using sub-scales of validated instruments. We will use Poisson regression modelling to estimate the incidence rate of chronic illness burden scores and structural equation modelling to explore relationships between variables and to examine the impact of dimensions of patient-centred care and effective primary healthcare. Discussion Results will provide valuable information for primary healthcare clinicians on the course of chronic illness over time and the impact on health outcomes of accessible, patient-centred and effective care. A demonstration of impact will contribute to the promotion of continuous quality improvement activities at a clinical level. While considerable advances have been

  20. Toward a Learning Health-care System - Knowledge Delivery at the Point of Care Empowered by Big Data and NLP.

    PubMed

    Kaggal, Vinod C; Elayavilli, Ravikumar Komandur; Mehrabi, Saeed; Pankratz, Joshua J; Sohn, Sunghwan; Wang, Yanshan; Li, Dingcheng; Rastegar, Majid Mojarad; Murphy, Sean P; Ross, Jason L; Chaudhry, Rajeev; Buntrock, James D; Liu, Hongfang

    2016-01-01

    The concept of optimizing health care by understanding and generating knowledge from previous evidence, ie, the Learning Health-care System (LHS), has gained momentum and now has national prominence. Meanwhile, the rapid adoption of electronic health records (EHRs) enables the data collection required to form the basis for facilitating LHS. A prerequisite for using EHR data within the LHS is an infrastructure that enables access to EHR data longitudinally for health-care analytics and real time for knowledge delivery. Additionally, significant clinical information is embedded in the free text, making natural language processing (NLP) an essential component in implementing an LHS. Herein, we share our institutional implementation of a big data-empowered clinical NLP infrastructure, which not only enables health-care analytics but also has real-time NLP processing capability. The infrastructure has been utilized for multiple institutional projects including the MayoExpertAdvisor, an individualized care recommendation solution for clinical care. We compared the advantages of big data over two other environments. Big data infrastructure significantly outperformed other infrastructure in terms of computing speed, demonstrating its value in making the LHS a possibility in the near future.

  1. Redesigning healthcare systems to meet the health challenges associated with climate change in the twenty-first century.

    PubMed

    Phua, Kai-Lit

    2015-01-01

    In the twenty-first century, climate change is emerging as a significant threat to the health and well-being of the public through links to the following: extreme weather events, sea level rise, temperature-related illnesses, air pollution patterns, water security, food security, vector-borne infectious diseases, and mental health effects (as a result of extreme weather events and climate change-induced population displacement). This article discusses how national healthcare systems can be redesigned through changes in its components such as human resources, facilities and technology, health information system, and health policy to meet these challenges.

  2. Strengthening preventive care programs: a permanent challenge for healthcare systems; lessons from PREVENIMSS México

    PubMed Central

    2010-01-01

    challenges that this healthcare system faces. The unsolved problems such as anemia, and the emerging ones such as overweight, obesity, among others, point out the need to strength preventive care through designing and implementing innovative programs aimed to attain effective coverage for those conditions in which prevention obtains substandard results. PMID:20626913

  3. New Jersey hospitals renew their identities; part of Meridian Health. Raising awareness of the advantages of a healthcare system.

    PubMed

    Botvin, Judith D

    2005-01-01

    Meridian Health, Wall, N.J., is a three-hospital system that also includes a network of partner companies. The objectives of this branding campaign were to create a better awareness of the benefits of academic medicine, to close the physician referral loop and to improve internal morale. The objectives were realized by emphasizing the teamwork of the system's doctors and showing their actual faces and voices.

  4. Unique collaboration between a private college of pharmacy and a private academic health system.

    PubMed

    Metzger, Nicole; Paciullo, Christopher; Chesson, Melissa; Jann, Michael W; Glascock, Janice; Emamifar, Amir; Matthews, Hewitt W

    2014-07-01

    Advanced experiential education represents the culmination of a pharmacy student's training, where students can apply the knowledge they have learned in the classroom to real patients. Unfortunately, opportunities for students to provide the direct patient care recommended by pharmacy organizations and accrediting bodies are lacking. Additionally, academic health systems that can provide these experiences for students are experiencing hardships that have stalled the expansion of postgraduate training programs and services. Formal cooperation between unaffiliated colleges of pharmacies and academic health systems has the potential to increase the number of experiential students completing rotations in an academic environment, expand postgraduate education training programs, enhance the development of resident educators, increase research and scholarly opportunities, and expand clinical pharmacy services. This article describes the formation of a unique joint initiative between a private academic health system without a college of pharmacy and a private college of pharmacy without a hospital. The successful cultivation of the relationship has resulted in professional growth at both institutions and can be implemented at other sites around the country to synergize the efforts of academic health systems and colleges of pharmacy.

  5. Unique Collaboration Between a Private College of Pharmacy and a Private Academic Health System

    PubMed Central

    Metzger, Nicole; Chesson, Melissa; Jann, Michael W.; Glascock, Janice; Emamifar, Amir; Matthews, Hewitt W.

    2014-01-01

    Abstract Advanced experiential education represents the culmination of a pharmacy student’s training, where students can apply the knowledge they have learned in the classroom to real patients. Unfortunately, opportunities for students to provide the direct patient care recommended by pharmacy organizations and accrediting bodies are lacking. Additionally, academic health systems that can provide these experiences for students are experiencing hardships that have stalled the expansion of postgraduate training programs and services. Formal cooperation between unaffiliated colleges of pharmacies and academic health systems has the potential to increase the number of experiential students completing rotations in an academic environment, expand postgraduate education training programs, enhance the development of resident educators, increase research and scholarly opportunities, and expand clinical pharmacy services. This article describes the formation of a unique joint initiative between a private academic health system without a college of pharmacy and a private college of pharmacy without a hospital. The successful cultivation of the relationship has resulted in professional growth at both institutions and can be implemented at other sites around the country to synergize the efforts of academic health systems and colleges of pharmacy. PMID:25477582

  6. Palliative care is not yet a well-defined product within the Dutch healthcare insurance system.

    PubMed

    Jansen, Wim J J; Vissers, Kris C P; Zuurmond, Wouter W A; van Montfort, Guus P W P; Rhebergen, Andre; Loer, Stephan A

    2009-07-01

    In the Netherlands, the quality and availability of palliative care has improved markedly within the last decade. However, many open questions remain concerning the position of palliative care as an insurable product on the Dutch healthcare market. Therefore, we analysed the policies of all private Dutch healthcare insurance companies as well as the public insurance policy for extraordinary medical costs. We studied how and which parts of palliative care were reimbursed in 2007. We observed a huge variability in costs and reimbursement regulations reflecting a rapid turnover of products for palliative care due to various new developments on this specific field of medical care. We conclude that a better definition of the product 'palliative care' is necessary for patients, health care providers and insurance companies.

  7. Integrated Medical Information Technology System (IMITS): Information and Clinical Technologies for the Advancement of Healthcare

    DTIC Science & Technology

    2010-08-31

    Communications in Medicine ( DICOM ) standard interfaces allow communication between the DRDWA and various PACS vendors throughout the Air Force. This...Final Report: FY05 IMITS: Information and Clinical Technologies for the Advancement of Healthcare Page 15  DICOM standardization ensures...interoperability with all existing DICOM capable imaging repositories and future additions to the Air Force medical imaging initiative. The Air Force maintains a

  8. Market segmentation for multiple option healthcare delivery systems--an application of cluster analysis.

    PubMed

    Jarboe, G R; Gates, R H; McDaniel, C D

    1990-01-01

    Healthcare providers of multiple option plans may be confronted with special market segmentation problems. This study demonstrates how cluster analysis may be used for discovering distinct patterns of preference for multiple option plans. The availability of metric, as opposed to categorical or ordinal, data provides the ability to use sophisticated analysis techniques which may be superior to frequency distributions and cross-tabulations in revealing preference patterns.

  9. [Do healthcare insurers have too much power?

    PubMed

    Schut, F T; Varkevisser, M

    2016-01-01

    In the Dutch healthcare system, healthcare insurers act as purchasers of care on behalf of their insured clients. To this end, the insurers form contractual agreements with healthcare providers. In the interest of balanced negotiations regarding price and quality, it is important that neither of the two parties has a disproportionate position of power. This paper discusses whether healthy power relationships exist between healthcare insurers and healthcare providers.

  10. Evaluating Outcomes in Patients with Overactive Bladder within an Integrated Healthcare Delivery System Using a Treatment Patterns Analyzer

    PubMed Central

    Ng, Daniel B.; McCart, Melissa; Klein, Christopher; Campbell, Chelsey; Schoenhaus, Robert; Berner, Todd

    2016-01-01

    Background Overactive bladder (OAB) is a relatively common disease that has been linked to a variety of comorbidities, reductions in quality of life, and increased healthcare costs. Antimuscarinic agents are the standard of care among pharmacologic treatments for OAB, but these drugs are linked to high levels of anticholinergic burden, especially in the elderly. Objective To demonstrate how efficient data analysis can be used to identify gaps in care as a result of improvement strategies for OAB within an integrated healthcare delivery system setting. Methods We developed an OAB treatment patterns analyzer, a clinical outcomes software analysis program, to identify gaps in care, high anticholinergic burden, and potential quality improvement initiatives. Deidentified pharmacy and medical claims data from an integrated delivery network were imported into the OAB treatment patterns analyzer. Patients with a diagnosis of OAB who were continuously enrolled in the network between January 1, 2009, and December 31, 2013, were identified and were imported into the analyzer. The analyzer used National Drug Code; International Classification of Diseases, Ninth Edition, Clinical Modification; Current Procedural Terminology; and UB-92 codes to measure treatment patterns, comorbid conditions, anticholinergic burden, concomitant use with anticholinesterases, costs, and healthcare resource utilization. Results Of 157,710 members in the integrated delivery network population, 7309 patients met the study eligibility criteria. Of patients taking medications for OAB, 85% were nonadherent and 73% discontinued treatment within 1 year. Among 1147 patients in the integrated healthcare delivery system who were using medications for OAB, 39 (3.4%) patients were concomitantly taking anticholinesterase drugs and an antimuscarinic agent. The per-month plan-paid cost per member was $318.67. Of all the patients with OAB within the population, the rates of all-cause office visits, emergency

  11. An intelligent virtual human system for providing healthcare information and support.

    PubMed

    Rizzo, Albert A; Lange, Belinda; Buckwalter, John G; Forbell, Eric; Kim, Julia; Sagae, Kenji; Williams, Josh; Rothbaum, Barbara O; Difede, JoAnn; Reger, Greg; Parsons, Thomas; Kenny, Patrick

    2011-01-01

    Over the last 15 years, a virtual revolution has taken place in the use of Virtual Reality simulation technology for clinical purposes. Shifts in the social and scientific landscape have now set the stage for the next major movement in Clinical Virtual Reality with the "birth" of intelligent virtual humans. Seminal research and development has appeared in the creation of highly interactive, artificially intelligent and natural language capable virtual human agents that can engage real human users in a credible fashion. No longer at the level of a prop to add context or minimal faux interaction in a virtual world, virtual humans can be designed to perceive and act in a 3D virtual world, engage in spoken dialogues with real users and can be capable of exhibiting human-like emotional reactions. This paper will present an overview of the SimCoach project that aims to develop virtual human support agents to serve as online guides for promoting access to psychological healthcare information and for assisting military personnel and family members in breaking down barriers to initiating care. The SimCoach experience is being designed to attract and engage military Service Members, Veterans and their significant others who might not otherwise seek help with a live healthcare provider. It is expected that this experience will motivate users to take the first step--to empower themselves to seek advice and information regarding their healthcare and general personal welfare and encourage them to take the next step towards seeking more formal resources if needed.

  12. Healthcare system resiliency: The case for taking disaster plans further--Part 1.

    PubMed

    Timmins, Michael L; Bone, Eric A; Hiller, Michael

    To establish true healthcare resiliency, and to better position healthcare organisations to provide effective response, continuity, resumption and recovery of fundamental services and operations during serious incidents and disasters, the disaster planning process must evolve into an integrated approach of four contingency planning disciplines that holistically examine the end-to-end, all-hazard response continuum. This process also needs to incorporate and scale multifarious organisational levels and, when required, the health sector. This paper is the first component of two independent, but related, pieces. It will examine the typical state of disaster preparedness and plans in healthcare, examine the worth and value of honing disaster plans, and will introduce two recommended contingency planning disciplines: enterprise risk management and emergency response planning. For each discipline, a case will be made for its inclusion into the overall disaster planning process, including examination of background information, benefits, how it improves disaster planning, and other resources helpful to the reader. The second paper, in afuture issue of the Journal of Business Continuity & Emergency Planning, will introduce business continuity management--including IT disaster recovery--and crisis communications as the third and fourth contingency planning disciplines needed for a fully integrated approach. The opinions expressed in this paper are those of the authors and may not be entirely those of the organisation.

  13. The Impact of Merit-Pay Systems on the Work and Attitudes of Mexican Academics

    ERIC Educational Resources Information Center

    Galaz-Fontes, Jesús Francisco; Gil-Antón, Manuel

    2013-01-01

    The central purpose of this work is to present data that evaluates the impact and perspectives of various merit-pay systems directed at Mexican academics. To this end a brief description is provided of recent Mexican higher education evolution, including that of merit-pay programs. It is proposed that faculty merit-pay systems, in the context of…

  14. The Best System: Black Academic and Cultural Retention (Save the Children).

    ERIC Educational Resources Information Center

    Atkinson, Pansye S.; Hord, Frederick L.

    Assumptions concerning the American education system and its social structure and implications for blacks are discussed, and a Frostburg State College program that addresses academic and cultural retention issues for black students is described. This program, the Best System, includes features such as: offering black cultural history; using…

  15. The Open Academic Model for the Systems Engineering Graduate Program at Stevens Institute of Technology

    ERIC Educational Resources Information Center

    Lasfer, Kahina

    2012-01-01

    The Systems Engineering Program at Stevens Institute of Technology has developed the Open Academic Model (OAM) to guide its strategic planning and operations since its founding in 2001. Guided by OAM, the Stevens Systems Engineering Program (SSEP) has grown from inception in 2001 into one of the largest in the US. The main objectives of the…

  16. Environmental & Agricultural Systems Career Cluster ITAC for Career-Focused Education. Integrated Technical & Academic Competencies.

    ERIC Educational Resources Information Center

    Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

    Designed for Ohio educators responsible for planning programs to prepare high school students for careers in environmental and agricultural systems, this document presents an overview of Ohio's Integrated Technical and Academic Competencies (ITAC) system of career-focused education and specific information about the environmental and agricultural…

  17. MAPP (Monitoring Academic Progress Policy): Providing Advising Direction Through the Use of a Degree Auditing System.

    ERIC Educational Resources Information Center

    Severy, Lawrence J.; Slinger, Peter J.

    1996-01-01

    Describes a computerized partial degree auditing system, MAPP (Monitoring Academic Progress Policy), developed at the University of Florida to monitor students' progress into appropriate majors and apply institutional policy concerning degrees. The system generates letters directing students to advisors when needed. Discusses advantages for…

  18. Academic Teamwork among Members of the National Researchers System in Tamaulipas

    ERIC Educational Resources Information Center

    Guzman-Acuña, Teresa; Guzman-Acuña, Josefina; Sánchez-Rodriguez, Ivan

    2016-01-01

    The objective of this article is to examine the participation of Mexican researchers in the state of Tamaulipas who are members of Mexico's National Researchers System (SNI) and are working in academic groups. The paper also seeks to understand their perceptions in relation to the usefulness of this structured System to their individual research…

  19. Validation of a Statewide Teacher Evaluation System: Relationship Between Scores From Evaluation and Student Academic Progress

    ERIC Educational Resources Information Center

    Xu, Xianxuan; Grant, Leslie W.; Ward, Thomas J.

    2016-01-01

    This study examines the validity of a statewide teacher evaluation system in the Commonwealth of Virginia. Three hundred and thirty-eight teachers from 16 at-risk schools located in eight school districts participated in an evaluation system pilot during the 2011-2012 academic year. Teachers received ratings on six teacher effectiveness process…

  20. Tenure Track Career System as a Strategic Instrument for Academic Leaders

    ERIC Educational Resources Information Center

    Pietilä, Maria

    2015-01-01

    This study examines the purposes for which leaders in universities use academic career systems. It focuses on the tenure track system which is new to Finland. Tenure track represents a newly established internal career path in a situation in which Finnish universities' organizational autonomy increased via new legislation from 2010. Drawing…

  1. Healthcare Software Assurance

    PubMed Central

    Cooper, Jason G.; Pauley, Keith A.

    2006-01-01

    Software assurance is a rigorous, lifecycle phase-independent set of activities which ensure completeness, safety, and reliability of software processes and products. This is accomplished by guaranteeing conformance to all requirements, standards, procedures, and regulations. These assurance processes are even more important when coupled with healthcare software systems, embedded software in medical instrumentation, and other healthcare-oriented life-critical systems. The current Food and Drug Administration (FDA) regulatory requirements and guidance documentation do not address certain aspects of complete software assurance activities. In addition, the FDA’s software oversight processes require enhancement to include increasingly complex healthcare systems such as Hospital Information Systems (HIS). The importance of complete software assurance is introduced, current regulatory requirements and guidance discussed, and the necessity for enhancements to the current processes shall be highlighted. PMID:17238324

  2. A low-power bio-potential acquisition system with flexible PDMS dry electrodes for portable ubiquitous healthcare applications.

    PubMed

    Chen, Chih-Yuan; Chang, Chia-Lin; Chang, Chih-Wei; Lai, Shin-Chi; Chien, Tsung-Fu; Huang, Hong-Yi; Chiou, Jin-Chern; Luo, Ching-Hsing

    2013-03-04

    This work describes a bio-potential acquisition system for portable ubiquitous healthcare applications using flexible polydimethylsiloxane dry electrodes (FPDEs) and a low-power recording circuit. This novel FPDE used Au as the skin contact layer, which was made using a CO2 laser and replica method technology. The FPDE was revised from a commercial bio-potential electrode with a conductive snap using dry electrodes rather than wet electrodes that proposed reliable and robust attachment for the purpose of measurement, and attaching velcro made it wearable on the forearm for bio-potential applications. Furthermore, this study proposes a recording device to store bio-potential signal data and provides portability and low-power consumption for the proposed acquisition system. To acquire differential bio-potentials, such as electrocardiogram (ECG) signals, the proposed recording device includes a low-power front-end acquisition chip fabricated using a complementary metal-oxide-semiconductor (CMOS) process, a commercial microcontroller (MSP430F149), and a secure digital (SD) card for portable healthcare applications. The proposed system can obtain ECG signals efficiently and are comfortable to the skin. The power consumption of the system is about 85 mW for continuous working over a 3 day period with two AA batteries. It can also be used as a compact Holter ECG system.

  3. BUILDING AN ACADEMIC PEDIATRIC HEALTH SYSTEM AS THE WORLD CONTINUES TO TURN: A CASE STUDY.

    PubMed

    Ellen, Jonathan M

    2016-01-01

    In 2011, All Children's Hospital (ACH) joined the Johns Hopkins Health System (JHHS) and in so doing became a member of Johns Hopkins Medicine (JHM). The value proposition for the joining of ACH and JHHS/JHM was to transform ACH into an academic pediatric health system. This case study of the transformation provides evidence for the usefulness of a precision medicine framework to organize investments in programs and practices that further the tripartite mission of academic medical centers and may increase the value of the care they deliver.

  4. SOA governance in healthcare organisations.

    PubMed

    Koumaditis, Konstantinos; Themistocleous, Marinos; Vassilakopoulos, Georgios

    2013-01-01

    Service Oriented Architecture (SOA) is increasingly adopted by many sectors, including healthcare. Due to the nature of healthcare systems there is a need to increase SOA adoption success rates as the non integrated nature of healthcare systems is responsible for medical errors that cause the loss of tens of thousands patients per year. Following our previous research [1] we propose that SOA governance is a critical success factor for SOA success in healthcare. Literature reports multiple SOA governance models that have limitations and they are confusing. In addition to this, there is a lack of healthcare specific SOA governance models. This highlights a literature void and thus the purpose of this paper is to proposed a healthcare specific SOA governance framework.

  5. Problem-based learning: a strategic learning system design for the education of healthcare professionals in the 21st century.

    PubMed

    Gwee, Matthew Choon-Eng

    2009-05-01

    Problem-based learning (PBL) was first implemented by McMaster University medical school in 1969 as a radical, innovative, and alternative pathway to learning in medical education, thus setting a new educational trend. PBL has now spread widely across the globe and beyond the healthcare disciplines, and has prevailed for almost four decades. PBL is essentially a strategic learning system design, which combines several complementary educational principles for the delivery of instruction. PBL is specifically aimed at enhancing and optimizing the educational outcomes of learner-centered, collaborative, contextual, integrated, self-directed, and reflective learning. The design and delivery of instruction in PBL involve peer teaching and learning in small groups through the social construction of knowledge using a real-life problem case to trigger the learning process. Therefore, PBL represents a major shift in the educational paradigm from the traditional teacher-directed (teacher-centered) instruction to student-centered (learner-centered) learning. PBL is firmly underpinned by several educational theories, but problems are often encountered in practice that can affect learning outcomes. Educators contemplating implementing PBL in their institutions should have a clear understanding of its basic tenets, its practice and its philosophy, as well as the issues, challenges, and opportunities associated with its implementation. Special attention should be paid to the training and selection of PBL tutors who have a critical role in the PBL process. Furthermore, a significant change in the mindsets of both students and teachers are required for the successful implementation of PBL. Thus, effective training programs for students and teachers must precede its implementation. PBL is a highly resource-intensive learning strategy and the returns on investment (i.e. the actual versus expected learning outcomes) should be carefully and critically appraised in the decision

  6. Some thoughts about creating healthcare professionals that match what societies need.

    PubMed

    Aretz, H Thomas

    2011-01-01

    Healthcare is becoming increasingly complex across the globe; technology, delivery models, economic requirements, demographics and the epidemiology of disease are changing at a rapid pace. Despite the multiple efforts in defining common competencies and standards that all healthcare professionals should meet, it has become clear that educational and training programs have to adjust to the needs of societies they serve, and that the institutions that design and deliver those programs need to be accountable to society for the products they produce. Academic institutions that educate healthcare professionals will have to interact differently with the many stakeholders needed to create effective and efficient, and culturally appropriate healthcare systems. Present day medical education has its roots in the European university which traditionally valued academic freedom, autonomy and independent research over serving society and the job market; future efforts will require a fundamental shift in the outlook and measures of success for academic institutions. The recent outcomes and competency movement is a first step in that direction but more will need to be done. Rather than being one participant, possibly a reluctant one, academia should become the catalyst for change, the hub for stakeholder interactions, and the breeding ground for the new healthcare workforce.

  7. The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms.

    PubMed

    Intaranongpai, Siranee; Hughes, David; Leethongdee, Songkramchai

    2012-01-01

    This paper examines the implementation of Thailand's universal coverage healthcare reforms in a rural province, using data from field studies undertaken in 2003-2005 and 2008-2011. We focus on the strand of policy that aimed to develop primary care by allocating funds to contracting units for primary care (CUPs) responsible for managing local service networks. The two studies document a striking change in the balance of power in the local healthcare system over the 8-year period. Initially, the newly formed CUPs gained influence as 'power followed the money', and the provincial health offices (PHOs), which had commanded the service units, were left with a weaker co-ordination role. However, the situation changed as a new insurance purchaser, the National Health Security Office, took financial control and established regional outposts. National Health Security Office outposts worked with PHOs to develop rationalised management tools-strategic plans, targets, KPIs and benchmarking-that installed the PHOs as performance managers of local healthcare systems. New lines of accountability and changed budgetary systems reduced the power of the CUPs to control resource allocation and patterns of services within CUP networks. Whereas some CUPs fought to retain limited autonomy, the PHO has been able to regain much of its former control. We suggest that implementation theory needs to take a long view to capture the complexity of a major reform initiative and argue for an analysis that recognises the key role of policy networks and advocacy coalitions that span national and local levels and realign over time.

  8. XML technologies for the Omaha System: a data model, a Java tool and several case studies supporting home healthcare.

    PubMed

    Vittorini, Pierpaolo; Tarquinio, Antonietta; di Orio, Ferdinando

    2009-03-01

    The eXtensible markup language (XML) is a metalanguage which is useful to represent and exchange data between heterogeneous systems. XML may enable healthcare practitioners to document, monitor, evaluate, and archive medical information and services into distributed computer environments. Therefore, the most recent proposals on electronic health records (EHRs) are usually based on XML documents. Since none of the existing nomenclatures were specifically developed for use in automated clinical information systems, but were adapted to such use, numerous current EHRs are organized as a sequence of events, each represented through codes taken from international classification systems. In nursing, a hierarchically organized problem-solving approach is followed, which hardly couples with the sequential organization of such EHRs. Therefore, the paper presents an XML data model for the Omaha System taxonomy, which is one of the most important international nomenclatures used in the home healthcare nursing context. Such a data model represents the formal definition of EHRs specifically developed for nursing practice. Furthermore, the paper delineates a Java application prototype which is able to manage such documents, shows the possibility to transform such documents into readable web pages, and reports several case studies, one currently managed by the home care service of a Health Center in Central Italy.

  9. The Academic Medical System: Reinvention to Survive the Revolution in Health Care.

    PubMed

    Konstam, Marvin A; Hill, Joseph A; Kovacs, Richard J; Harrington, Robert A; Arrighi, James A; Khera, Amit

    2017-03-14

    Academic medical centers (AMCs) are presently facing enormous challenges arising from a prospective decline in government funding for research and education, shifting payment models emphasizing efficiency and value, and increasing competition. Left unabated, these challenges will drive many AMCs to de-emphasize or forsake their core missions in an effort to survive. Stemming from a symposium held at the 2015 Scientific Sessions of the American College of Cardiology titled, "The Academic Medical Center of the Future," we propose a series of changes, including internal restructuring, system-wide partnership, and novel approaches to support research and education, that are designed to better position AMCs to compete and face their growing challenges in a manner that preserves their essential missions. In aggregate, these changes will facilitate establishing the academic medical system of the future.

  10. New Jersey Children's Behavioral Healthcare System: cross service delivery planning for transitional population of youth (ages 16 and 18+ years).

    PubMed

    McGill, Kenneth; McGill, Scott A

    2011-08-01

    The continued need for improvement within a 'system of care' is essential as the need for mental health services by those 'youth' within the child welfare system continually grows. This article outlines the statewide reform of New Jersey's Children's Behavioral Healthcare System, which began in 2000, as well as including the recommendations of the University of South Florida as part of their 'Final Report: Independent Assessment of New Jersey's Child Behavioral Health Services' on continued changes within the system of care. Successful outcomes have resulted from this welfare reform initiative, which include most notably the significant caseload decrease of the Division of Youth and Family Services (DYFS) and the creation of a new cabinet entity, the Department of Children and Families (DCF). This article specifically outlines systemic recommendations to best serve the target population of 'transitional' youth between the ages of 16 to 18+ years utilizing interagency cooperation based upon 'theory of change' and Total Clinical Outcomes Management (TCOM) strategies.

  11. [Dental orthopedic service for retirees from MD RF in medical institutions of state and municipal system of healthcare].

    PubMed

    Malykh, A B; Grebnev, G A; Butsenko, S A; Pastukhov, A G

    2012-04-01

    Financial feasibility study of dental orthopedic service for retirees of Ministry of Defence is analyzed, suggestions about the organization of dental orthopedic service for contingent in medical institution of state and municipal system of healthcare. Information about the number of retirees, index of needs in dental orthopedic service which was 40,29%, information about 2806 prosthodontics oders for retirees in military medical institution, data about the average price of production of dental in different subjects of Russian Federation is the basis of the given research. Algorithm of dental orthopedic service for retirees by stomatologies is suggested.

  12. The utilization of mobile devices for telemedicine services in a South African public healthcare system.

    PubMed

    Hartmann, André; Van Dyk, Liezl

    2014-01-01

    The purpose of this study is to develop an understanding in the use of mobile devices in administering telemedicine services within the public health care sector of South Africa. An online questionnaire was developed and distributed amongst medical officers, specialists, students and medical staff of one of the health districts of South Africa. This paper describes the design of the questionnaire as well as the most significant outcomes. Results are presented in terms of reasons why healthcare workers use mobile devices, as well as perceptions in terms of transmission security and quality of transmitted information.

  13. A Healthcare System Perspective on Implementing Genomic Medicine: Pediatric Acute Lymphoblastic Leukemia as a Paradigm

    PubMed Central

    Evans, William E.; Crews, Kristine R.; Pui, Ching-Hon

    2013-01-01

    The promise of genomic medicine has received great attention over the past decade, projecting how genomics will soon guide the prevention, diagnosis, and treatment of human diseases. However, this evolution has been slower than forecast, even where evidence is often strong (e.g., pharmacogenomics). Reasons include the requirement for institutional resources and the need for the will to push beyond barriers impeding health-care changes. Here, we illustrate how genomics has been deployed to advance the treatment of childhood leukemia. PMID:23462885

  14. E-prescription as a tool for improving services and the financial viability of healthcare systems: the case of the Greek national e-prescription system.

    PubMed

    Pangalos, G; Sfyroeras, V; Pagkalos, I

    2014-01-01

    E-prescription systems can help improve patient service, safety and quality of care. They can also help achieve better compliance for the patients and better alignment with the guidelines for the practitioners. The recently implemented national e-prescription system in Greece already covers approximately 85% of all prescriptions prescribed in Greece today (approximately 5.5 million per month). The system has not only contributed already in significant changes towards improving services and better monitoring and planning of public health, but also substantially helped to contain unnecessary expenditure related to medication use and improve transparency and administrative control. Such issues have gained increasing importance not only for Greece but also for many other national healthcare systems that have to cope with the continuous rise of medication expenditure. Our implementation has, therefore, shown that besides their importance for improving services, national e-prescription systems can also provide a valuable tool for better utilisation of resources and for containing unnecessary healthcare costs, thus contributing to the improvement of the financial stability and viability of the overall healthcare system.

  15. Evidence-based decision-making in healthcare: exploring the issues though the lens of complex, adaptive systems theory.

    PubMed

    Lindstrom, Ronald R

    2003-01-01

    Browman, Snider and Ellis have articulated several reasons as to why and how managers should address the implementation of evidence-based decision-making (EBDM) in healthcare. While their observations are acknowledged to be from the unique perspective of an oncology setting, this is a timely and welcome lead article with significance in other settings. The authors invite opinions on transferability, thus forming the basis of this commentary. In response, this commentary offers a number of supportive and differing views. Complex, adaptive systems (CAS) theory is first addressed as an appropriate lens to reframe our conceptualization of the health system. Then, in contrast to negotiation, dialogue through participatory planning and decision-making is introduced. Evidence-based decision-making (EBDM) and knowledge translation (KT) are expanded upon in the context of CAS and participatory environments. Finally, concrete suggestions are offered on how to structure multiple-stakeholder involvement in the decision-making process, including the growing role of consumers in the new complex, adaptive systems reality of healthcare.

  16. Developing an electronic nursing record system for clinical care and nursing effectiveness research in a korean home healthcare setting.

    PubMed

    Lee, Eun Joo; Lee, Mikyoung; Moorhead, Sue

    2009-01-01

    Increased accountability requirements for the cost and quality of healthcare force nurses to clearly define and verify nursing's contributions to patient outcomes. This demand necessitates documentation of nursing care in a precise manner. An electronic nursing record system is considered a key element that enhances nurses' ability not only to record nursing care provided to patients but also to measure, report, and monitor quality and effectiveness. Home care is a growing field as nurses attempt to meet the demand for long-term care. The development of an electronic record system for home care nursing was the immediate focus of this study. We identified the nursing content required for home care nursing using standardized nursing languages and designed linkages among medical diagnoses, nursing diagnoses, nursing interventions, and nursing-sensitive outcomes within the system. Equipping an electronic nursing record system with nursing standards is particularly critical for enhancing nursing practice and for creating refined data to verify nursing effectiveness.

  17. National Initiatives to Improve Healthcare Outcomes: A Comparative Study of Health Delivery Systems in Slovakia and the United States.

    PubMed

    Curtis, Robert; Caplanova, Anetta; Novak, Marcel

    2015-01-01

    While the United States and Slovakia offer different healthcare delivery systems, each country faces the same challenges of improving the health status of their populations. The authors explore the impact of their respective systems on the health of their populations and compare the health outcomes of both nations. They point out that socioeconomic factors play a far more important role in determining population health outcomes than do the structures of the systems surrounding the care delivery. The authors illustrate this finding through a comparison of the poverty and education levels of a selected minority group from each country in relation to the health outcomes for each population group. The comparison reveals that education is a more influential determinant in a population's health outcomes, than the improved access to care offered by a universal system.

  18. Beyond feedback control: the interactive use of performance management systems. Implications for process innovation in Italian healthcare organizations.

    PubMed

    Demartini, Chiara; Mella, Piero

    2014-01-01

    This paper shows how the use of performance management systems affects managers' perception of satisfaction, the effectiveness of the control system and the performance related to process innovation. An exploratory empirical research has been conducted on 85 managers operating in Italian healthcare organizations. Empirical findings put forward that the interactive--as opposed to diagnostic--use of performance management systems enhances managerial satisfaction with the control system and managerial perception of effectiveness. The present study then showed that it is not the control itself that is an obstacle to innovation in organizations in general (and in health organizations in particular) but the diagnostic use of the control mechanisms, which impedes the interaction between the control personnel and those subject to the control. Finally, this paper addresses managerial implications and further research avenues.

  19. Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need

    PubMed Central

    Hanssens, Lise; Vyncke, Veerle; De Maeseneer, Jan; Willems, Sara

    2017-01-01

    Access to healthcare is inequitably distributed across different socioeconomic groups. Several vulnerable groups experience barriers in accessing healthcare, compared to their more wealthier counterparts. In response to this, many countries use resources to strengthen their primary care (PC) system, because in many European countries PC is the first entry-point to the healthcare system and plays a central role in the coordination of patients through the healthcare system. However it is unclear whether this strengthening of PC leads to less inequity in access to the whole healthcare system. This study investigates the association between strength indicators of PC and inequity in unmet need by merging data from the European Union Statistics on Income and Living Conditions database (2013) and the Primary Healthcare Activity Monitor for Europe (2010). The analyses reveal a significant association between the Gini coefficient for income inequality and inequity in unmet need. When the Gini coefficient of a country is one SD higher, the social inequity in unmet need in that particular country will be 4.960 higher. Furthermore, the accessibility and the workforce development of a country’s PC system is inverse associated with the social inequity of unmet need. More specifically, when the access- and workforce development indicator of a country PC system are one standard deviation higher, the inequity in unmet healthcare needs are respectively 2.200 and 4.951 lower. Therefore, policymakers should focus on reducing income inequality to tackle inequity in access, and strengthen PC (by increasing accessibility and better-developing its workforce) as this can influence inequity in unmet need. PMID:28046051

  20. A multinational study to develop universal standardization of whole-body bone density and composition using GE Healthcare Lunar and Hologic DXA systems.

    PubMed

    Shepherd, John A; Fan, Bo; Lu, Ying; Wu, Xiao P; Wacker, Wynn K; Ergun, David L; Levine, Michael A

    2012-10-01

    Dual-energy x-ray absorptiometry (DXA) is used to assess bone mineral density (BMD) and body composition, but measurements vary among instruments from different manufacturers. We sought to develop cross-calibration equations for whole-body bone density and composition derived using GE Healthcare Lunar and Hologic DXA systems. This multinational study recruited 199 adult and pediatric participants from a site in the US (n = 40, ages 6 through 16 years) and one in China (n = 159, ages 5 through 81 years). The mean age of the participants was 44.2 years. Each participant was scanned on both GE Healthcare Lunar and Hologic Discovery or Delphi DXA systems on the same day (US) or within 1 week (China) and all scans were centrally analyzed by a single technologist using GE Healthcare Lunar Encore version 14.0 and Hologic Apex version 3.0. Paired t-tests were used to test the results differences between the systems. Multiple regression and Deming regressions were used to derive the cross-conversion equations between the GE Healthcare Lunar and Hologic whole-body scans. Bone and soft tissue measures were highly correlated between the GE Healthcare Lunar and Hologic and systems, with r ranging from 0.96 percent fat [PFAT] to 0.98 (BMC). Significant differences were found between the two systems, with average absolute differences for PFAT, BMC, and BMD of 1.4%, 176.8 g and 0.013 g/cm(2) , respectively. After cross-calibration, no significant differences remained between GE Healthcare Lunar measured results and the results converted from Hologic. The equations we derived reduce differences between BMD and body composition as determined by GE Healthcare Lunar and Hologic systems and will facilitate combining study results in clinical or epidemiological studies.

  1. Facilitating Metacognitive Processes of Academic Genre-Based Writing Using an Online Writing System

    ERIC Educational Resources Information Center

    Yeh, Hui-Chin

    2015-01-01

    Few studies have investigated how metacognitive processes foster the application of genre knowledge to students' academic writing. This is largely due to its internal and unobservable characteristics. To bridge this gap, an online writing system based on metacognition, involving the stages of planning, monitoring, evaluating, and revising, was…

  2. A Complex Systems Framework for Research on Leadership and Organizational Dynamics in Academic Libraries

    ERIC Educational Resources Information Center

    Gilstrap, Donald L.

    2009-01-01

    This article provides a historiographical analysis of major leadership and organizational development theories that have shaped our thinking about how we lead and administrate academic libraries. Drawing from behavioral, cognitive, systems, and complexity theories, this article discusses major theorists and research studies appearing over the past…

  3. The Relationship between Academic Support Systems and Intended Persistence in Doctoral Education

    ERIC Educational Resources Information Center

    Cockrell, Casey N.; Shelley, Kyna

    2011-01-01

    This study investigated the relationship of formal academic support systems and stage of doctoral study on persistence, satisfaction, and knowledge of resources, expectations, and customs in doctoral education. Doctoral students (N = 141) enrolled in four public institutions in a southeastern state were surveyed. An online questionnaire, adapted…

  4. Measure for Measure: How Proficiency-Based Accountability Systems Affect Inequality in Academic Achievement

    ERIC Educational Resources Information Center

    Jennings, Jennifer; Sohn, Heeju

    2014-01-01

    How do proficiency-based accountability systems affect inequality in academic achievement? This article reconciles mixed findings in the literature by demonstrating that three factors jointly determine accountability's impact. First, by analyzing student-level data from a large urban school district, we find that when educators face accountability…

  5. Computerized Assessment System for Academic Satisfaction (ASAS) for First-Year University Student

    ERIC Educational Resources Information Center

    Medrano, Leonardo Adrian; Liporace, Mercedes Fernandez; Perez, Edgardo

    2014-01-01

    Introduction: Computerized tests have become one of the most widely used and efficient educational assessment methods. Increasing efforts to generate computerized assessment systems to identify students at risk for drop out have been recently noted. An important variable influencing student retention is academic satisfaction. Accordingly, the…

  6. Free text databases in an Integrated Academic Information System (IAIMS) at Columbia Presbyterian Medical Center.

    PubMed

    Clark, A S; Shea, S

    1991-01-01

    The use of Folio Views, a PC DOS based product for free text databases, is explored in three applications in an Integrated Academic Information System (IAIMS): (1) a telephone directory, (2) a grants and contracts newsletter, and (3) nursing care plans.

  7. The Genealogy Project: Tracing Academic Roots in the History and Systems Course.

    ERIC Educational Resources Information Center

    Goodwin, C. James; Dingus, Michelle; Petterson, Stephanie

    2002-01-01

    Describes an assignment in a history and systems of psychology course where students traced the genealogy of psychologists in terms of their academic roots. Explains that the students learned about bibliographic resources during the project. Discusses assignment outcomes as discovered through a student survey. (CMK)

  8. Enforced Cultural Change in Academe. A Practical Case Study: Implementing Management Systems in Higher Education.

    ERIC Educational Resources Information Center

    Spencer-Matthews, Sarah

    2001-01-01

    An action research project sought to implement a quality management system in an academic department in an Australian higher education institution. The case study revealed that technical change was attained, but adoption of a quality culture achieved only token acceptance. (EV)

  9. Screening for Early Learning Problems within an Urban Population: The Brief Academic Competence Evaluation Screening System

    ERIC Educational Resources Information Center

    Kettler, Ryan J.

    2007-01-01

    The Brief Academic Competence Evaluation Screening System (BACESS; Elliott, DiPerna, & Huai, 2003) is a multi-phase instrument designed to assist educators in the identification of students who are likely to experience early learning problems. The BACESS was used in eight elementary classrooms (n=71) in southern California. Each phase of the…

  10. After the Fall: The Use of Surplus Capacity in an Academic Library Automation System.

    ERIC Educational Resources Information Center

    Wright, A. J.

    The possible uses of excess central processing unit capacity in an integrated academic library automation system discussed in this draft proposal include (1) in-house services such as word processing, electronic mail, management decision support using PERT/CPM techniques, and control of physical plant operation; (2) public services such as the…

  11. Effects of an Intelligent Web-Based English Instruction System on Students' Academic Performance

    ERIC Educational Resources Information Center

    Jia, J.; Chen, Y.; Ding, Z.; Bai, Y.; Yang, B.; Li, M.; Qi, J.

    2013-01-01

    This research conducted quasi-experiments in four middle schools to evaluate the long-term effects of an intelligent web-based English instruction system, Computer Simulation in Educational Communication (CSIEC), on students' academic attainment. The analysis of regular examination scores and vocabulary test validates the positive impact of CSIEC,…

  12. Academic Language, English Language Learners, and Systemic Functional Linguistics: Connecting Theory and Practice in Teacher Education

    ERIC Educational Resources Information Center

    Schulze, Joshua

    2015-01-01

    Teacher educators need linguistic tools to help preservice teachers develop a deeper understanding of the academic language demands of the literacy practices required by the Common Core State Standards (CCSS). Systemic functional linguistics (SFL) serves as a tool for developing teachers' knowledge of content-area language. Teachers' increased…

  13. Using Systemic Functional Linguistics in Academic Writing Development: An Example from Film Studies

    ERIC Educational Resources Information Center

    Donohue, James P.

    2012-01-01

    On film studies courses, students are asked to treat as objects of study the same films which they may more commonly experience as entertainment. To explore the role of academic writing in this, an action research project was carried out on a university film studies course using a systemic functional linguistics approach. This paper presents a key…

  14. The Relationship of a Systemic Student Support Intervention to Academic Achievement in Urban Catholic Schools

    ERIC Educational Resources Information Center

    Shields, Katherine A.; Walsh, Mary E.; Lee-St. John, Terrence J.

    2016-01-01

    Much of the achievement gap between rich and poor students can be attributed to out-of-school factors, yet few schools have a comprehensive, coordinated system for addressing students' nonacademic needs. Within a group of Catholic schools located in one city, this study examined academic achievement on the Stanford Achievement Test battery in…

  15. Perceived Usefulness of a Strategy-Based Peer Annotation System for Improving Academic Reading Comprehension

    ERIC Educational Resources Information Center

    Chen, I-Jung; Chen, Wen-Chun

    2016-01-01

    This study examines the enhancing effect of peer annotation on the academic English reading of nonnative-Englishspeaking graduate students. To facilitate peer collaboration, the present study included the development of a strategybased online reading system. Through peer annotation, the students not only achieved enhanced reading comprehension but…

  16. Academic Staff Views of Quality Systems for Teaching and Learning: A Hong Kong Case Study

    ERIC Educational Resources Information Center

    Jones, John; Saram, Don Darshi De

    2005-01-01

    The "Teaching and Learning Quality Process Review" (TLQPR) recently completed in Hong Kong had an emphasis on education quality work. This paper analyses how, from the perspective of academic staff in one university in Hong Kong, the good intentions embedded in that idea are enhanced or subverted by the broader ?quality system setting in…

  17. A Systemic Functional Contribution to Planning Academic Genre Teaching in a Bilingual Education Context

    ERIC Educational Resources Information Center

    Walker, Elizabeth

    2010-01-01

    Commencing study through a foreign language in senior secondary school brings huge challenges because of the cognitive-linguistic demands of academic subjects. This paper argues for the need to blend sociocultural and systemic functional linguistic (SFL) perspectives to address this enormous task. Firstly, readers' attention is drawn to the less…

  18. Virtual Tutee System: A Potential Tool for Enhancing Academic Reading Engagement

    ERIC Educational Resources Information Center

    Park, SeungWon; Kim, ChanMin

    2014-01-01

    This article reports on evaluation studies of the Virtual Tutee System (VTS) designed to enhance students' engagement in academic reading. The VTS is a web-based peer-tutoring environment in which students teach a virtual tutee about the content in course readings that students have been assigned to learn. With the VTS, students interact with…

  19. Geographic Information Systems Librarianship: Suggestions for Entry-Level Academic Professionals

    ERIC Educational Resources Information Center

    Martindale, Jaime

    2004-01-01

    Future Geographic Information Systems (GIS) librarians face a number of challenges that other Library and Information Studies (LIS) graduates may not when preparing for a career in academic librarianship. This article discusses these challenges and offers suggestions to help entry-level GIS librarians begin successful and rewarding careers.

  20. [Surgeons' hope: expanding the professional role of co-medical staff and introducing the nurse practitioner/physician assistant and team approach to the healthcare system].

    PubMed

    Maehara, Tadaaki; Nishida, Hiroshi; Watanabe, Takashi; Tominaga, Ryuji; Tabayashi, Koichi

    2010-07-01

    The healthcare system surrounding surgeons is collapsing due to Japan's policy of limiting health expenditure, market fundamentalism, shortage of healthcare providers, unfavorable working environment for surgeons, increasing risk of malpractice suits, and decreasing number of those who desire to pursue the surgery specialty. In the USA, nonphysician and mid-level clinicians such as nurse practitioners (NPs) and physician assistants (PAs) have been working since the 1960s, and the team approach to medicine which benefits patients is functioning well. One strategy to avoid the collapse of the Japanese surgical healthcare system is introducing the NP/PA system. The division of labor in medicine can provide high-quality, safe healthcare and increase the confidence of the public by contributing to: reduced postoperative complications; increased patient satisfaction; decreased length of postoperative hospital stay: and economic benefits. We have requested that the Ministry of Health, Labor and Welfare establish a Japanese NP/PA system to care for patients more efficiently perioperatively. The ministry has decided to launch a trial profession called "tokutei (specifically qualified) nurse" in February 2010. These nurses will be trained and educated at the Master's degree level and allowed to practice several predetermined skill sets under physician supervision. We hope that all healthcare providers will assist in transforming the tokutei nurse system into a Japanese NP/PA system.