Developing an Index to Measure Health System Performance: Measurement for Districts of Nepal.

PubMed

Kandel, N; Fric, A; Lamichhane, J

2014-01-01

Various frameworks for measuring health system performance have been proposed and discussed. The scope of using performance indicators are broad, ranging from examining national health system to individual patients at various levels of health system. Development of innovative and easy index is essential to measure multidimensionality of health systems. We used indicators, which also serve as proxy to the set of activities, whose primary goal is to maintain and improve health. We used eleven indicators of MDGs, which represent all dimensions of health to develop index. These indicators are computed with similar methodology that of human development index. We used published data of Nepal for computation of the index for districts of Nepal as an illustration. To validate our finding, we compared the indices of these districts with other development indices of Nepal. An index for each district has been computed from eleven indicators. Then indices are compared with that of human development index, socio-economic and infrastructure development indices and findings has shown the similarity on distribution of districts. Categories of low and high performing districts on health system performance are also having low and high human development, socio-economic, and infrastructure indices respectively. This methodology of computing index from various indicators could assist policy makers and program managers to prioritize activities based on their performance. Validation of the findings with that of other development indicators show that this can be one of the tools, which can assist on assessing health system performance for policy makers, program managers and others.

Principles of Assessment of Rehabilitation Services in Health Systems: Learning from experiences.

PubMed

Gutenbrunner, Christoph; Nugraha, Boya

2018-04-18

Strengthening of health-related rehabilitation services must start from the needs of persons with health conditions experiencing disability and should be implemented within health systems. The implementation of rehabilitation services in health systems should be planned and realized according to the World Health Organization's 6 constituents of health systems (i.e. health service delivery; health workforce; health information systems; essential medicines; financing; and leadership and governance). The development of recommendations based on situation analysis and best-available data is crucial. In order to facilitate such data collection at a national level, a checklist and a related questionnaire (Rehabilitation Service Assessment Tool (RSAT)) were developed and implemented. The following steps were followed to develop a checklist for implementation of rehabilitation services: a literature search, drafting, checking and testing the list, and development of the RSAT. The RSAT comprises 8 sections derived from 5 main domains of the most important areas of information (i.e. country profile; health system; disability and rehabilitation; national policies, laws, and responsibilities; and relevant non-governmental stakeholders). The implementation of RSAT in different missions has shown that the principles are working well and that RSAT is feasible and helpful. Further field testing is important and the development of an internationally agreed tool should be promoted.

Propulsion Health Management System Development for Affordable and Reliable Operation of Space Exploration Systems

NASA Technical Reports Server (NTRS)

Melcher, Kevin J.; Maul, William A.; Garg, Sanjay

2007-01-01

The constraints of future Exploration Missions will require unique integrated system health management capabilities throughout the mission. An ambitious launch schedule, human-rating requirements, long quiescent periods, limited human access for repair or replacement, and long communication delays, all require an integrated approach to health management that can span distinct, yet interdependent vehicle subsystems, anticipate failure states, provide autonomous remediation and support the Exploration Mission from beginning to end. Propulsion is a critical part of any space exploration mission, and monitoring the health of the propulsion system is an integral part of assuring mission safety and success. Health management is a somewhat ubiquitous technology that encompasses a large spectrum of physical components and logical processes. For this reason, it is essential to develop a systematic plan for propulsion health management system development. This paper provides a high-level perspective of propulsion health management systems, and describes a logical approach for the future planning and early development that are crucial to planned space exploration programs. It also presents an overall approach, or roadmap, for propulsion health management system development and a discussion of the associated roadblocks and challenges.

Health region development from the perspective of system theory - an empirical cross-regional case study.

PubMed

Volgger, Michael; Mainil, Tomas; Pechlaner, Harald; Mitas, Ondrej

2015-01-01

Governments are increasingly establishing health regions to deal with current challenges of public health service. These regions are seen as instruments to balance public and private stakeholders, and offer health care to regional citizens as well as to medical/health tourists. However, it is still unclear how the development of such health regions as well as their governance may be conceptualized. We apply Luhmann's system theory approach in the context of a cross-regional case study that compares health region developments in the Autonomous Province of Bolzano-South Tyrol (Italy) with particular regard to the Eastern Dolomites and in the province of Zeeland (the Netherlands). We suggest that Luhmann's system theory provides a useful set of criteria to evaluate and judge health region development. Fully developed health regions can be understood as auto-poietic systems. By emphasizing programs, personnel, and communication channels, these case studies illustrate the suitability of the system theory toolset to analyze the governance and spatial embeddedness of health regions. Additionally, the study contributes to literature by indicating that health regions are closely related to identity issues and to decision making in regions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Public Health Platforms: An Emerging Informatics Approach to Health Professional Learning and Development

PubMed Central

Gray, Kathleen

2016-01-01

Health informatics has a major role to play in optimising the management and use of data, information and knowledge in health systems. As health systems undergo digital transformation, it is important to consider informatics approaches not only to curriculum content but also to the design of learning environments and learning activities for health professional learning and development. An example of such an informatics approach is the use of large-scale, integrated public health platforms on the Internet as part of health professional learning and development. This article describes selected examples of such platforms, with a focus on how they may influence the direction of health professional learning and development. Significance for public health The landscape of healthcare systems, public health systems, health research systems and professional education systems is fragmented, with many gaps and silos. More sophistication in the management of health data, information, and knowledge, based on public health informatics expertise, is needed to tackle key issues of prevention, promotion and policy-making. Platform technologies represent an emerging large-scale, highly integrated informatics approach to public health, combining the technologies of Internet, the web, the cloud, social technologies, remote sensing and/or mobile apps into an online infrastructure that can allow more synergies in work within and across these systems. Health professional curricula need updating so that the health workforce has a deep and critical understanding of the way that platform technologies are becoming the foundation of the health sector. PMID:27190977

[Health services research for the public health service (PHS) and the public health system].

PubMed

Hollederer, A; Wildner, M

2015-03-01

There is a great need for health services research in the public health system and in the German public health service. However, the public health service is underrepresented in health services research in Germany. This has several structural, historical and disciplinary-related reasons. The public health service is characterised by a broad range of activities, high qualification requirements and changing framework conditions. The concept of health services research is similar to that of the public health service and public health system, because it includes the principles of multidisciplinarity, multiprofessionalism and daily routine orientation. This article focuses on a specified system theory based model of health services research for the public health system and public health service. The model is based on established models of the health services research and health system research, which are further developed according to specific requirements of the public health service. It provides a theoretical foundation for health services research on the macro-, meso- and microlevels in public health service and the public health system. Prospects for public health service are seen in the development from "old public health" to "new public health" as well as in the integration of health services research and health system research. There is a significant potential for development in a better linkage between university research and public health service as is the case for the "Pettenkofer School of Public Health Munich". © Georg Thieme Verlag KG Stuttgart · New York.

Advancing the application of systems thinking in health: managing rural China health system development in complex and dynamic contexts.

PubMed

Zhang, Xiulan; Bloom, Gerald; Xu, Xiaoxin; Chen, Lin; Liang, Xiaoyun; Wolcott, Sara J

2014-08-26

This paper explores the evolution of schemes for rural finance in China as a case study of the long and complex process of health system development. It argues that the evolution of these schemes has been the outcome of the response of a large number of agents to a rapidly changing context and of efforts by the government to influence this adaptation process and achieve public health goals. The study draws on several sources of data including a review of official policy documents and academic papers and in-depth interviews with key policy actors at national level and at a sample of localities. The study identifies three major transition points associated with changes in broad development strategy and demonstrates how the adaptation of large numbers of actors to these contextual changes had a major impact on the performance of the health system. Further, it documents how the Ministry of Health viewed its role as both an advocate for the interests of health facilities and health workers and as the agency responsible for ensuring that government health system objectives were met. It is argued that a major reason for the resilience of the health system and its ability to adapt to rapid economic and institutional change was the ability of the Ministry to provide overall strategy leadership. Additionally, it postulates that a number of interest groups have emerged, which now also seek to influence the pathway of health system development. This history illustrates the complex and political nature of the management of health system development and reform. The paper concludes that governments will need to increase their capacity to analyze the health sector as a complex system and to manage change processes.

Development and deployment of a health information system in transitional countries (croatian experience).

PubMed

Stevanovic, Ranko; Pristas, Ivan; Ivicevic Uhernik, Ana; Stanic, Arsen

2005-01-01

Croatian Primary Health Care Information System pilot project, conducted between 2001 and 2003, aimed to develop and deploy a health information system based on the latest technologies which would improve the quality of primary health care and rationalise the consumption. 60 primary health care teams (physician and nurse) were equipped with PCs and connected via central server to the main national health insurer, state treasury and public health institute. Developed information system enabled rapid retrieval of documents, replacement of manual data input and a real-time insight into needed information as well as prompt interventions within the system. The project also introduced electronic smart cards for physicians and nurses, so that at each medical check-up the information system verified both the ensuree's and the physician's or nurse's status and rights.Based on the experiences from the pilot project, plan has been made for comprehensive health information system at national level which would connect primary health care teams, hospitals, laboratories, dentistries, health insurance companies, state treasury, public health institutes and electronic health records database. Its major goals are more rapid diagnostics, accuracy in prescribing therapy, standardisation of the good practice as well as better utilisation of capacities, shorter waiting times and shorter stays in hospitals, which would lead to improvement in overall health care quality and better control over the health care consumption. Estimated 5-year investment for installing such system would be 125 million EUR. However, information system could save substantially more and yield a return of investment in only two years.As information system for primary health care should be a strategic component of every health care reform and development plan, we can recommend our model, based on the results of the pilot project, to other transitional countries.

Strengthening public health surveillance and response using the health systems strengthening agenda in developing countries.

PubMed

Nsubuga, Peter; Nwanyanwu, Okey; Nkengasong, John N; Mukanga, David; Trostle, Murray

2010-12-03

There is increased interest in strengthening health systems for developing countries. However, at present, there is common uncertainty about how to accomplish this task. Specifically, several nations are faced with an immense challenge of revamping an entire system. To accomplish this, it is essential to first identify the components of the system that require modification. The World Health Organization (WHO) has proposed health system building blocks, which are now widely recognized as essential components of health systems strengthening.With increased travel and urbanization, the threat of emerging diseases of pandemic potential is increasing alongside endemic diseases such as human immunodeficiency virus (HIV), tuberculosis (TB), malaria, and hepatitis virus infections. At the same time, the epidemiologic patterns are shifting, giving rise to a concurrent increase in disease burden due to non-communicable diseases. These diseases can be addressed by public health surveillance and response systems that are operated by competent public health workers in core public health positions at national and sub-national levels with a focus on disease prevention.We describe two ways that health ministries in developing countries could leverage President Obama's Global Health Initiative (GHI) to build public health surveillance and response systems using proven models for public health systems strengthening and to create the public health workforce to operate those systems. We also offer suggestions for how health ministries could strengthen public health systems within the broad health systems strengthening agenda. Existing programs (e.g., the Global Vaccine Alliance [GAVI] and the Global Fund Against Tuberculosis, AIDS, and Malaria [GFTAM]) can also adapt their current health systems strengthening programs to build sustainable public health systems.

[The need of transforming the health system in Mexico].

PubMed

López-Cervantes, Malaquías; Durán Arenas, Juan Luis; Villanueva Lozano, Marcia

2011-01-01

In this article we review the need for the transformation of the Mexican health care system given the deformities that the system developed in the last 60 years. We start by the discussion of two main deformities: the segmented answer to the health right, and the development of a segmented health care system based on the method of payment (formal workers contributions); and the development of a health care model based on specialties and hospital care. These deformities have resulted in a health care system characterized by high costs and low effectiveness. Even though the correction of the deformities imply complex modifications that involve political economic and legal aspects, in the short term we have the conditions in Mexico for the creation of a universal primary health care system, given the human and financial resources available in the country.

Using a participatory evaluation design to create an online data collection and monitoring system for New Mexico's Community Health Councils.

PubMed

Andrews, M L; Sánchez, V; Carrillo, C; Allen-Ananins, B; Cruz, Y B

2014-02-01

We present the collaborative development of a web-based data collection and monitoring plan for thirty-two county councils within New Mexico's health council system. The monitoring plan, a key component in our multiyear participatory statewide evaluation process, was co-developed with the end users: representatives of the health councils. Guided by the Institute of Medicine's Community, Health Improvement Process framework, we first developed a logic model that delineated processes and intermediate systems-level outcomes in council development, planning, and community action. Through the online system, health councils reported data on intermediate outcomes, including policy changes and funds leveraged. The system captured data that were common across the health council system, yet was also flexible so that councils could report their unique accomplishments at the county level. A main benefit of the online system was that it provided the ability to assess intermediate, outcomes across the health council system. Developing the system was not without challenges, including creating processes to ensure participation across a large rural state; creating shared understanding of intermediate outcomes and indicators; and overcoming technological issues. Even through the challenges, however, the benefits of committing to using participatory processes far outweighed the challenges. Copyright © 2013 Elsevier Ltd. All rights reserved.

Building capacity in health research in the developing world.

PubMed Central

Lansang, Mary Ann; Dennis, Rodolfo

2004-01-01

Strong national health research systems are needed to improve health systems and attain better health. For developing countries to indigenize health research systems, it is essential to build research capacity. We review the positive features and weaknesses of various approaches to capacity building, emphasizing that complementary approaches to human resource development work best in the context of a systems and long-term perspective. As a key element of capacity building, countries must also address issues related to the enabling environment, in particular: leadership, career structure, critical mass, infrastructure, information access and interfaces between research producers and users. The success of efforts to build capacity in developing countries will ultimately depend on political will and credibility, adequate financing, and a responsive capacity-building plan that is based on a thorough situational analysis of the resources needed for health research and the inequities and gaps in health care. Greater national and international investment in capacity building in developing countries has the greatest potential for securing dynamic and agile knowledge systems that can deliver better health and equity, now and in the future. PMID:15643798

Building capacity in health research in the developing world.

PubMed

Lansang, Mary Ann; Dennis, Rodolfo

2004-10-01

Strong national health research systems are needed to improve health systems and attain better health. For developing countries to indigenize health research systems, it is essential to build research capacity. We review the positive features and weaknesses of various approaches to capacity building, emphasizing that complementary approaches to human resource development work best in the context of a systems and long-term perspective. As a key element of capacity building, countries must also address issues related to the enabling environment, in particular: leadership, career structure, critical mass, infrastructure, information access and interfaces between research producers and users. The success of efforts to build capacity in developing countries will ultimately depend on political will and credibility, adequate financing, and a responsive capacity-building plan that is based on a thorough situational analysis of the resources needed for health research and the inequities and gaps in health care. Greater national and international investment in capacity building in developing countries has the greatest potential for securing dynamic and agile knowledge systems that can deliver better health and equity, now and in the future.

Capacity building in the health sector to improve care for child nutrition and development.

PubMed

Yousafzai, Aisha K; Rasheed, Muneera A; Daelmans, Bernadette; Manji, Sheila; Arnold, Caroline; Lingam, Raghu; Muskin, Joshua; Lucas, Jane E

2014-01-01

The effectiveness of interventions promoting healthy child growth and development depends upon the capacity of the health system to deliver a high-quality intervention. However, few health workers are trained in providing integrated early child-development services. Building capacity entails not only training the frontline worker, but also mobilizing knowledge and support to promote early child development across the health system. In this paper, we present the paradigm shift required to build effective partnerships between health workers and families in order to support children's health, growth, and development, the practical skills frontline health workers require to promote optimal caregiving, and the need for knowledge mobilization across multiple institutional levels to support frontline health workers. We present case studies illustrating challenges and success stories around capacity development. There is a need to galvanize increased commitment and resources to building capacity in health systems to deliver early child-development services. © 2014 New York Academy of Sciences.

Development of a web-based epidemiological surveillance system with health system response for improving maternal and newborn health: Field-testing in Thailand.

PubMed

Liabsuetrakul, Tippawan; Prappre, Tagoon; Pairot, Pakamas; Oumudee, Nurlisa; Islam, Monir

2017-06-01

Surveillance systems are yet to be integrated with health information systems for improving the health of pregnant mothers and their newborns, particularly in developing countries. This study aimed to develop a web-based epidemiological surveillance system for maternal and newborn health with integration of action-oriented responses and automatic data analysis with results presentations and to assess the system acceptance by nurses and doctors involved in various hospitals in southern Thailand. Freeware software and scripting languages were used. The system can be run on different platforms, and it is accessible via various electronic devices. Automatic data analysis with results presentations in the forms of graphs, tables and maps was part of the system. A multi-level security system was incorporated into the program. Most doctors and nurses involved in the study felt the system was easy to use and useful. This system can be integrated into country routine reporting system for monitoring maternal and newborn health and survival.

Health information systems: a survey of frameworks for developing countries.

PubMed

Marcelo, A B

2010-01-01

The objective of this paper is to perform a survey of excellent research on health information systems (HIS) analysis and design, and their underlying theoretical frameworks. It classifies these frameworks along major themes, and analyzes the different approaches to HIS development that are practical in resource-constrained environments. Literature review based on PubMed citations and conference proceedings, as well as Internet searches on information systems in general, and health information systems in particular. The field of health information systems development has been studied extensively. Despite this, failed implementations are still common. Theoretical frameworks for HIS development are available that can guide implementers. As awareness, acceptance, and demand for health information systems increase globally, the variety of approaches and strategies will also follow. For developing countries with scarce resources, a trial-and-error approach can be very costly. Lessons from the successes and failures of initial HIS implementations have been abstracted into theoretical frameworks. These frameworks organize complex HIS concepts into methodologies that standardize techniques in implementation. As globalization continues to impact healthcare in the developing world, demand for more responsive health systems will become urgent. More comprehensive frameworks and practical tools to guide HIS implementers will be imperative.

Population aging and its impacts: strategies of the health-care system in Taipei.

PubMed

Lin, Ming-Hsien; Chou, Ming-Yueh; Liang, Chih-Kuang; Peng, Li-Ning; Chen, Liang-Kung

2010-11-01

Taiwan is one of the fastest aging countries in the world. As such, the government has developed various strategies to promote an age-friendly health-care system. Health services are supported by National Health Insurance (NHI), which insures over 97% of citizens and over 99% of health-care institutes. The current health-care system has difficulties in caring for older patients with multiple comorbidities, complex care needs, functional impairments, and post-acute care needs. Taipei, an international metropolis with a well-preserved tradition of filial piety in Chinese societies, has developed various strategies to overcome the aforementioned barriers to an age-friendly health-care system. These include an emphasis on general medical care and a holistic approach in all specialties, development of a geriatrics specialty training program, development of post-acute services, and strengthening of linkages between health and social care services. Despite achievements thus far, challenges still include creating a more extensive integration between medical specialties, promotion of an interdisciplinary care model across specialties and health-care settings, and integration of health and social care services. The experiences of Taipei in developing an age-friendly health-care service system may be a culturally appropriate model for other Chinese and Asian communities. Copyright © 2010 Elsevier B.V. All rights reserved.

Development of a Maternal, Newborn and Child mHealth Intervention in Thai Nguyen Province, Vietnam: Protocol for the mMom Project

PubMed Central

McBride, Bronwyn; Nguyen, Liem Thanh; Wiljer, David; Vu, Nguyen C; Nguyen, Cuong K

2018-01-01

Background Ethnic minority women (EMW) living in mountainous areas of northern Vietnam have disproportionately high infant and maternal mortality rates as a result of low maternal health knowledge, poverty, and remoteness from low-capacity health centers. Objective The objective of this study was to describe the protocol for the development and evaluation of the mMom intervention, which is an integrated mobile health (mHealth) system designed to improve maternal and infant health knowledge, and behavior among women in remote areas of Thai Nguyen, Vietnam. Methods This project featured the following four phases: (1) development of an mHealth platform integrated into the existing health management information system in partnership with the provincial health department; (2) ethnographic fieldwork and intervention content development; (3) intervention piloting and implementation; and (4) evaluation of the intervention’s impact on participants’ maternal health knowledge, behavior, and interactions with the health system. Results The mMom project development process resulted in the following: (1) the successful development of the mMom system, including the mHealth platform hardware and integration, the intervention plan and content, and the monitoring and evaluation framework; (2) the piloting and implementation of the intervention as planned; and (3) the implementation of the monitoring and evaluation framework components. Conclusions This protocol outlines the development of the mMom intervention and describes critical next steps in understanding the impact of the intervention on participants and the wider health system in Thai Nguyen province, Vietnam. PMID:29326095

Operationalising and piloting the IUHPE European accreditation system for health promotion.

PubMed

Battel-Kirk, Barbara; Barry, Margaret M; van der Zanden, Gerard; Contu, Paolo; Gallardo, Carmen; Martinez, Ana; Speller, Viv; Debenedetti, Sara

2015-09-01

The International Union for Health Promotion and Education (IUHPE) European Accreditation System for Health Promotion aims to promote quality assurance in health promotion practice, education and training. The System is designed to be flexible and sensitive to the different contexts for health promotion practice, education and training in Europe, while maintaining robust criteria. These competency-based criteria were developed in the CompHP Project (2009-2012) that developed core competencies, professional standards and an accreditation framework for health promotion practice, education and training in the context of workforce capacity development in Europe.This paper describes how consultations undertaken with the health promotion community informed the structure and processes of the IUHPE Accreditation System. An overview of its development, key functions and the piloting of its implementation, which was co-funded by the European Union in the context of the EU Health Programme, is presented.Feedback from consultations with key health promotion stakeholders in Europe indicated overall support for the development of an accreditation system for health promotion. However, a number of potential barriers to its implementation were noted including: absence of dedicated practitioners and professional bodies in some countries; lack of clarity about professional boundaries; lack of financial resources required to facilitate capacity building; and concerns about the costs, objectivity and transparency of the system. Feedback from the consultations shaped and informed the process of designing an operational accreditation system to ensure that it would be responsive to potential users' needs and concerns.Based on the agreed structures and processes, a web-based application system was developed and managed at IUHPE headquarters. A governance structure was established together with agreed policies and procedures for the System. During the pilot period, applications from 20 health promotion practitioners, two health promotion education programmes and one national accreditation organisation were processed. Feedback from the piloting stage will inform further refinement of the system.While recognising the challenges, the overall positive feedback and the commitment demonstrated by the health promotion community form a constructive platform for the implementation of the IUHPE Accreditation System in Europe and internationally. © The Author(s) 2014.

Space and place for WHO health development dialogues in the African Region.

PubMed

Kirigia, Joses Muthuri; Nabyonga-Orem, Juliet; Dovlo, Delanyo Yao Tsidi

2016-07-18

Majority of the countries in the World Health Organization (WHO) African Region are not on track to achieve the health-related Millennium Development Goals, yet even more ambitious Sustainable Development Goals (SDGs), including SDG 3 on heath, have been adopted. This paper highlights the challenges - amplified by the recent Ebola virus disease (EVD) outbreak in West Africa - that require WHO and other partners' dialogue in support of the countries, and debate on how WHO can leverage the existing space and place to foster health development dialogues in the Region. To realise SDG 3 on ensuring healthy lives and promoting well-being for all at all ages, the African Region needs to tackle the persistent weaknesses in its health systems, systems that address the social determinants of health and national health research systems. The performance of the third item is crucial for the development and innovation of systems, products and tools for promoting, maintaining and restoring health in an equitable manner. Under its new leadership, the WHO Regional Office for Africa is transforming itself to galvanise existing partnerships, as well as forging new ones, with a view to accelerating the provision of timely and quality support to the countries in pursuit of SDG 3. WHO in the African Region engages in dialogues with various stakeholders in the process of health development. The EVD outbreak in West Africa accentuated the necessity for optimally exploiting currently available space and place for health development discourse. There is urgent need for the WHO Regional Office for Africa to fully leverage the space and place arenas of the World Health Assembly, WHO Regional Committee for Africa, African Union, Regional economic communities, Harmonization for Health in Africa, United Nations Economic Commission for Africa, African Development Bank, professional associations, and WHO African Health Forum, when it is created, for dialogues to mobilise the required resources to give the African Region the thrust it needs to attain SDG 3. The pursuit of SDG 3 amidst multiple challenges related to political leadership and governance, weak health systems, sub-optimal systems for addressing the socioeconomic determinants of health, and weak national health research systems calls for optimum use of all the space and place available for regional health development dialogues to supplement Member States' efforts.

Tunable Laser Development for In-Flight Fiber Optic Based Structural Health Monitoring Systems

NASA Technical Reports Server (NTRS)

Richards, Lance; Parker, Allen; Chan, Patrick

2013-01-01

Briefing based on tunable laser development for in flight fiber optic based structural health monitoring systems. The objective of this task is to investigate, develop, and demonstrate a low-cost swept lasing light source for NASA DFRC's fiber optics sensing system (FOSS) to perform structural health monitoring on current and future aerospace vehicles.

School Health Connection Goes Electronic: Developing a Health Information Management System for New Orleans' School-Based Health Centers. Program Results Report

ERIC Educational Resources Information Center

Rastorfer, Darl

2011-01-01

From February 2008 through April 2011, School Health Connection, a program of the Louisiana Public Health Institute, developed an electronic health information management system for newly established school-based health centers in Greater New Orleans. School Health Connection was established as part of a broader effort to restore community health…

An object-oriented mobile health system with usability features.

PubMed

Escarfullet, Krystle; Moore, Cantera; Tucker, Shari; Wei, June

2012-01-01

Mobile health (m-health) comprises the concept of utilising mobile devices to carry out the task of viewing electronic medical records, reserving medical appointments with a patient's medical provider and electronically refilling prescriptions. This paper aims at developing a m-health system to improve usability from a user's perspective. Specifically, it first developed a m-health model by logically linking characteristics of the m-health system together based on information flows. Then, the system requirements were collected by using a developed questionnaire. These requirements were structured and further in-depth analysis was conducted by using an object-oriented approach based on unified modelling language, such as use-case, sequence and analysis class diagrams. This research will be beneficial to decision makers and developers in the mobile healthcare industry.

Value-Added Clinical Systems Learning Roles for Medical Students That Transform Education and Health: A Guide for Building Partnerships Between Medical Schools and Health Systems.

PubMed

Gonzalo, Jed D; Lucey, Catherine; Wolpaw, Terry; Chang, Anna

2017-05-01

To ensure physician readiness for practice and leadership in changing health systems, an emerging three-pillar framework for undergraduate medical education integrates the biomedical and clinical sciences with health systems science, which includes population health, health care policy, and interprofessional teamwork. However, the partnerships between medical schools and health systems that are commonplace today use health systems as a substrate for learning. Educators need to transform the relationship between medical schools and health systems. One opportunity is the design of authentic workplace roles for medical students to add relevance to medical education and patient care. Based on the experiences at two U.S. medical schools, the authors describe principles and strategies for meaningful medical school-health system partnerships to engage students in value-added clinical systems learning roles. In 2013, the schools began large-scale efforts to develop novel required longitudinal, authentic health systems science curricula in classrooms and workplaces for all first-year students. In designing the new medical school-health system partnerships, the authors combined two models in an intersecting manner-Kotter's change management and Kern's curriculum development steps. Mapped to this framework, they recommend strategies for building mutually beneficial medical school-health system partnerships, including developing a shared vision and strategy and identifying learning goals and objectives; empowering broad-based action and overcoming barriers in implementation; and generating short-term wins in implementation. Applying this framework can lead to value-added clinical systems learning roles for students, meaningful medical school-health system partnerships, and a generation of future physicians prepared to lead health systems change.

An approach to health system strengthening in the Democratic Peoples Republic of Korea (North Korea).

PubMed

Grundy, John; Moodie, Rob

2009-01-01

The Democratic Peoples Republic of Korea (DPRK), under the leadership of the Ministry of Public Health (MOPH), undertook the development of a Health System Strengthening (HSS) proposal through the support of the Global Alliance for Vaccines and Immunization (GAVI). The aim of this paper is to outline the approach to the development of the HSS strategy in DPRK, and describe opportunities and challenges associated with its development and future implementation. Sources of information for this review have included national programme plans, in country social sector reviews, information generated through HSS proposal developments and the international literature. Updated assessments in DPRK indicate some recent improvements in the health situation for women and children, but there remain ongoing concerns regarding health management, human resource and physical infrastructure barriers to health services access. In response to this situation, the DPRK developed a health system strengthening strategy, the main elements of which are the strengthening of health management and service delivery systems at the implementing agency levels of county (district) and Ri (sub district). Three success factors were associated with the reaching of consensus on HSS strategy in DPRK. These were partnerships formed between system planners and programme planners, the identification of an overall health sector strategic framework, and high-level leadership of the MOPH. Although DPRK is in the very early stages of health system reconstruction, there are significant and new opportunities to alleviate the health conditions of women and children in DPRK, through implementation of health system strengthening strategies that are nationally coordinated and internationally supported.

OOMM--Object-Oriented Matrix Modelling: an instrument for the integration of the Brasilia Regional Health Information System.

PubMed

Cammarota, M; Huppes, V; Gaia, S; Degoulet, P

1998-01-01

The development of Health Information Systems is widely determined by the establishment of the underlying information models. An Object-Oriented Matrix Model (OOMM) is described which target is to facilitate the integration of the overall health system. The model is based on information modules named micro-databases that are structured in a three-dimensional network: planning, health structures and information systems. The modelling tool has been developed as a layer on top of a relational database system. A visual browser facilitates the development and maintenance of the information model. The modelling approach has been applied to the Brasilia University Hospital since 1991. The extension of the modelling approach to the Brasilia regional health system is considered.

Expanding the scope of health information systems. Challenges and developments.

PubMed

Kuhn, K A; Wurst, S H R; Bott, O J; Giuse, D A

2006-01-01

To identify current challenges and developments in health information systems. Reports on HIS, eHealth and process support were analyzed, core problems and challenges were identified. Health information systems are extending their scope towards regional networks and health IT infrastructures. Integration, interoperability and interaction design are still today's core problems. Additional problems arise through the integration of genetic information into the health care process. There are noticeable trends towards solutions for these problems.

The right to health, health systems development and public health policy challenges in Chad.

PubMed

Azétsop, Jacquineau; Ochieng, Michael

2015-02-15

There is increasing consensus that the right to health can provide ethical, policy and practical groundings for health systems development. The goals of the right to health are congruent with those of health systems development, which are about strengthening health promotion organizations and actions so as to improve public health. The poor shape and performance of health systems in Chad question the extent of realization of the right to health. Due to its comprehensiveness and inclusiveness, the right to health has the potential of being an organizational and a normative backbone for public health policy and practice. It can then be understood and studied as an integral component of health systems development. This paper uses a secondary data analysis of existing documents by the Ministry of Public Health, Institut National de la Statistique, des Etudes Economiques et Démographiques (INSEED), the Ministry of Economy and Agence Française de Cooperation to analyze critically the shape and performance of health systems in Chad based on key concepts and components of the right to health contained in article 12 of the International Covenant on Economic, Social and Cultural Rights, and on General Comment 14. The non-realization of the right to health, even in a consistently progressive manner, raises concerns about the political commitment of state officials to public health, about the justice of social institutions in ensuring social well-being and about individual and public values that shape decision-making processes. Social justice, democratic rule, transparency, accountability and subsidiarity are important groundings for ensuring community participation in public affairs and for monitoring the performance of public institutions. The normative ideals of health systems development are essentially democratic in nature and are rooted in human rights and in ethical principles of human dignity, equality, non-discrimination and social justice. These ideals are grounded in an integrated vision of society as a place for multi-level interactions, where government plays its role by equitably providing institutions and services that ensure people's welfare. Inter-sectoral collaboration, which calls for a conceptual shift in health and public policy, can be instrumental in improving health systems through concerted efforts of various governmental institutions and civil society.

Defining Health Research for Development: The perspective of stakeholders from an international health research partnership in Ghana and Tanzania.

PubMed

Ward, Claire Leonie; Shaw, David; Anane-Sarpong, Evelyn; Sankoh, Osman; Tanner, Marcel; Elger, Bernice

2017-05-03

The study uses a qualitative empirical method to define Health Research for Development. This project explores the perspectives of stakeholders in an international health research partnership operating in Ghana and Tanzania. We conducted 52 key informant interviews with major stakeholders in an international multicenter partnership between GlaxoSmithKline (GSK, Vaccine Developer) and the global health nonprofit organisation PATH and its Malaria Vaccine Initiative program (PATH/MVI, Funder-Development Partner), (RTS, S) (NCT00866619). The respondents included teams from four clinical research centres (two centres in Ghana and two in Tanzania) and various collaborating partners. This paper analyses responses to the question: What is Health Research for Development? Based on the stakeholders' experience the respondents offered many ways of defining Health Research for Development. The responses fell into four broad themes: i) Equitable Partnerships; ii) System Sustainability; iii) Addressing Local Health Targets, and iv) Regional Commitment to Benefit Sharing. Through defining Health Research for Development six key learning points were generated from the four result themes: 1) Ensure there is local research leadership working with the collaborative partnership, and local healthcare system, to align the project agenda and activities with local research and health priorities; 2) Know the country-specific context - map the social, health, legislative and political setting; 3) Define an explicit development component and plan of action in a research project; 4) Address the barriers and opportunities to sustain system capacity. 5) Support decentralised health system decision-making to facilitate the translation pathway; 6) Govern, monitor and evaluate the development components of health research partnerships. Overall, equity and unity between partners are required to deliver health research for development. © 2017 John Wiley & Sons Ltd.

PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health information systems

PubMed Central

Aqil, Anwer; Lippeveld, Theo; Hozumi, Dairiku

2009-01-01

The utility and effectiveness of routine health information systems (RHIS) in improving health system performance in developing countries has been questioned. This paper argues that the health system needs internal mechanisms to develop performance targets, track progress, and create and manage knowledge for continuous improvement. Based on documented RHIS weaknesses, we have developed the Performance of Routine Information System Management (PRISM) framework, an innovative approach to design, strengthen and evaluate RHIS. The PRISM framework offers a paradigm shift by putting emphasis on RHIS performance and incorporating the organizational, technical and behavioural determinants of performance. By describing causal pathways of these determinants, the PRISM framework encourages and guides the development of interventions for strengthening or reforming RHIS. Furthermore, it conceptualizes and proposes a methodology for measuring the impact of RHIS on health system performance. Ultimately, the PRISM framework, in spite of its challenges and competing paradigms, proposes a new agenda for building and sustaining information systems, for the promotion of an information culture, and for encouraging accountability in health systems. PMID:19304786

Tuberculosis in Asia and the pacific: the role of socioeconomic status and health system development.

PubMed

Wu, Jie; Dalal, Koustuv

2012-01-01

To identify the relationship between socioeconomic status, health system development and the incidence, prevalence and mortality of tuberculosis in Asia and the Pacific. Incidence, prevalence and mortality rates of tuberculosis and 20 variables of socioeconomic, health system and biological-behavioral issues were included in the study involving all 46 countries of the Asian Development Bank region (2007 data). Both univariate and multivariate linear regressions were used. The worst three tuberculosis affected countries were Cambodia, India and Indonesia, while the least affected was Australia. Tuberculosis incidence, prevalence and mortality rate were higher in countries with lower human development index, corruption perception index, gross domestic product (GDP) per capita and countries with more people under minimum food supplements. Among the health system variables, total health expenditure per capita, governmental health expenditure per capita, hospital beds, and access to improved water and sanitation were strongly associated with tuberculosis. Socioeconomic determinants and health system development have significant effect on the control of tuberculosis in Asia and the Pacific region. The study has some policy implications by means of lowering the corruption and improving the sanitation.

Development of village doctors in China: financial compensation and health system support.

PubMed

Hu, Dan; Zhu, Weiming; Fu, Yaqun; Zhang, Minmin; Zhao, Yang; Hanson, Kara; Martinez-Alvarez, Melisa; Liu, Xiaoyun

2017-07-01

Since 1968, China has trained about 1.5 million barefoot doctors in a few years' time to provide basic health services to 0.8 billion rural population. China's Ministry of Health stopped using the term of barefoot doctor in 1985, and changed policy to develop village doctors. Since then, village doctors have kept on playing an irreplaceable role in China's rural health, even though the number of village doctors has fluctuated over the years and they face serious challenges. United Nations declared Sustainable Development Goals in 2015 to achieve universal health coverage by 2030. Under this context, development of Community Health workers (CHWs) has become an emerging policy priority in many resource-poor developing countries. China's experiences and lessons learnt in developing and maintaining village doctors may be useful for these developing countries. This paper aims to synthesis lessons learnt from the Chinese CHW experiences. It summarizes China's experiences in exploring and using strategic partnership between the community and the formal health system to develop CHWs in the two stages, the barefoot doctor stage (1968 -1985) and the village doctor stage (1985-now). Chinese and English literature were searched from PubMed, CNKI and Wanfang. The information extracted from the selected articles were synthesized according to the four partnership strategies for communities and health system to support CHW development, namely 1) joint ownership and design of CHW programmes; 2) collaborative supervision and constructive feedback; 3) a balanced package of incentives, both financial and non-financial; and 4) a practical monitoring system incorporating data from the health system and community. The study found that the townships and villages provided an institutional basis for barefoot doctor policy, while the formal health system, including urban hospitals, county health schools, township health centers, and mobile medical teams provided training to the barefoot doctors. But After 1985, the formal health system played a more dominant role in the CHW system including both selection and training of village doctors. China applied various mechanisms to compensate village doctors in different stages. During 1960s and 1970s, the main income source of barefoot doctors was from their villages' collective economy. After 1985 when the rural collective economy collapsed and barefoot doctors were transformed to village doctors, they depended on user fees, especially from drug sale revenues. In the new century, especially after the new round of health system reform in 2009, government subsidy has become an increasing source of village doctors' income. The barefoot doctor policy has played a significant role in providing basic human resources for health and basic health services to rural populations when rural area had great shortages of health resources. The key experiences for this great achievement are the intersection between the community and the formal health system, and sustained and stable financial compensation to the community health workers.

Exploring a model-driven architecture (MDA) approach to health care information systems development.

PubMed

Raghupathi, Wullianallur; Umar, Amjad

2008-05-01

To explore the potential of the model-driven architecture (MDA) in health care information systems development. An MDA is conceptualized and developed for a health clinic system to track patient information. A prototype of the MDA is implemented using an advanced MDA tool. The UML provides the underlying modeling support in the form of the class diagram. The PIM to PSM transformation rules are applied to generate the prototype application from the model. The result of the research is a complete MDA methodology to developing health care information systems. Additional insights gained include development of transformation rules and documentation of the challenges in the application of MDA to health care. Design guidelines for future MDA applications are described. The model has the potential for generalizability. The overall approach supports limited interoperability and portability. The research demonstrates the applicability of the MDA approach to health care information systems development. When properly implemented, it has the potential to overcome the challenges of platform (vendor) dependency, lack of open standards, interoperability, portability, scalability, and the high cost of implementation.

Building a widespread public health education system for developing countries in Africa.

PubMed

Wiesner, Martin; Pfeifer, Daniel

2013-01-01

Many developing countries struggle to move their health care system into the information age. Millions of people in Africa do not have any access to online resources to satisfy their need for adequate individual health information. Access to high quality content available in public spots could have an immense impact on people's daily life. Our browser-based health education application might help to provide a better understanding of diseases for people in developing countries. We encourage other researchers to adopt our vision for a widespread public health education system in Africa.

[Assessment system for watershed ecological health in the United States: development and application].

PubMed

Zhang, Hua; Luo, Yong-Ming

2013-07-01

To meet the water quality goals of the Clean Water Act, the environmental agencies in the United States (U.S.) have developed a comprehensive ecological assessment system of watershed health in the last two decades. The system employs a watershed approach, and includes a large set of hydrological, chemical, and biological indices, having become an essential part of the watershed water quality management system in the U.S. and provided strong support for the protection of water environment and the restoration of aquatic system. In this paper, the development and application of the ecological assessment system of watershed health by the U.S. environmental regulators, especially the U.S. Environmental Protection Agency (US EPA), were overviewed from the aspects of related laws and regulations, ecosystem function analysis, ecological health indicators, comprehensive assessment system, and monitoring and data management systems, and the health assessment systems for the rivers, lakes, estuaries, coasts, and wetlands adopted by the National$t1-1-1 Aquatic Resource Surveys (NARS) were introduced. Some suggestions for the future development of the scientific ecological assessment system of watershed health in China were put forward based on the understanding of the protection and remediation practices of our water environment.

Tunable Laser Development for In-flight Fiber Optic Based Structural Health Monitoring Systems

NASA Technical Reports Server (NTRS)

Richards, Lance; Parker, Allen; Chan, Patrick

2014-01-01

The objective of this task is to investigate, develop, and demonstrate a low-cost swept lasing light source for NASA DFRC's fiber optics sensing system (FOSS) to perform structural health monitoring on current and future aerospace vehicles. This is the regular update of the Tunable Laser Development for In-flight Fiber Optic Based Structural Health Monitoring Systems website.

Enhancing Leadership and Governance Competencies to Strengthen Health Systems in Nigeria: Assessment of Organizational Human Resources Development

PubMed Central

Uneke, Chigozie J.; Ezeoha, Abel E.; Ndukwe, Chinwendu D.; Oyibo, Patrick G.; Onwe, Fri Day

2012-01-01

The lack of effective leadership and governance in the health sector has remained a major challenge in Nigeria and contributes to the failure of health systems and poor development of human resources. In this cross-sectional intervention study, leadership and governance competencies of policy makers were enhanced through a training workshop, and an assessment was conducted of organizational activities designed to promote evidence-informed leadership and governance to improve human resources for health (HRH). The training workshop increased the understanding of policy makers with regard to leadership and governance factors that ensure the functionality of health systems and improve human resources development, including policy guidance, intelligence and oversight, collaboration and coalition building, regulation, system design and accountability. Findings indicated that systems for human resources development exist in all participants' organizations, but the functionality of these systems was suboptimal. More systematic and standardized processes are required to improve competencies of leadership and governance for better human resources development in low-income settings. PMID:23372582

The path dependence of district manager decision-space in Ghana

PubMed Central

Kwamie, Aku; van Dijk, Han; Ansah, Evelyn K; Agyepong, Irene Akua

2016-01-01

The district health system in Ghana today is characterized by high resource-uncertainty and narrow decision-space. This article builds a theory-driven historical case study to describe the influence of path-dependent administrative, fiscal and political decentralization processes on development of the district health system and district manager decision-space. Methods included a non-exhaustive literature review of democratic governance in Ghana, and key informant interviews with high-level health system officials integral to the development of the district health system. Through our analysis we identified four periods of district health system progression: (1) development of the district health system (1970–85); (2) Strengthening District Health Systems Initiative (1986–93); (3) health sector reform planning and creation of the Ghana Health Service (1994–96) and (4) health sector reform implementation (1997–2007). It was observed that district manager decision-space steadily widened during periods (1) and (2), due to increases in managerial profile, and concerted efforts at managerial capacity strengthening. Periods (3) and (4) saw initial augmentation of district health system financing, further widening managerial decision-space. However, the latter half of period 4 witnessed district manager decision-space contraction. Formalization of Ghana Health Service structures influenced by self-reinforcing tendencies towards centralized decision-making, national and donor shifts in health sector financing, and changes in key policy actors all worked to the detriment of the district health system, reversing early gains from bottom-up development of the district health system. Policy feedback mechanisms have been influenced by historical and contemporary sequencing of local government and health sector decentralization. An initial act of administrative decentralization, followed by incomplete political and fiscal decentralization has ensured that the balance of power has remained at national level, with strong vertical accountabilities and dependence of the district on national level. This study demonstrates that the rhetoric of decentralization does not always mirror actual implementation, nor always result in empowered local actors. PMID:26318537

Analyzing the Historical Development and Transition of the Korean Health Care System.

PubMed

Lee, Sang-Yi; Kim, Chul-Woung; Seo, Nam-Kyu; Lee, Seung Eun

2017-08-01

Many economically advanced countries have attempted to minimize public expenditures and pursue privatization based on the principles of neo-liberalism. However, Korea has moved contrary to this global trend. This study examines why and how the Korean health care system was formed, developed, and transformed into an integrated, single-insurer, National Health Insurance (NHI) system. We describe the transition in the Korean health care system using an analytical framework that incorporates such critical variables as government economic development strategies and the relationships among social forces, state autonomy, and state power. This study focuses on how the relationships among social forces can change as a nation's economic development or governing strategy changes in response to changes in international circumstances such as globalization. The corporatist Social Health Insurance (SHI) system (multiple insurers) introduced in 1977 was transformed into the single-insurer NHI in July 2000. These changes were influenced externally by globalization and internally by political democratization, keeping Korea's private-dominant health care provision system unchanged over several decades. Major changes such as integration reform occurred, when high levels of state autonomy were ensured. The state's power (its policy capability), based on health care infrastructures, acts to limit the direction of any change in the health care system because it is very difficult to build the infrastructure for a health care system in a short timeframe.

Analyzing the Historical Development and Transition of the Korean Health Care System

PubMed Central

Lee, Sang-Yi; Kim, Chul-Woung; Seo, Nam-Kyu; Lee, Seung Eun

2017-01-01

Objectives Many economically advanced countries have attempted to minimize public expenditures and pursue privatization based on the principles of neo-liberalism. However, Korea has moved contrary to this global trend. This study examines why and how the Korean health care system was formed, developed, and transformed into an integrated, single-insurer, National Health Insurance (NHI) system. Methods We describe the transition in the Korean health care system using an analytical framework that incorporates such critical variables as government economic development strategies and the relationships among social forces, state autonomy, and state power. This study focuses on how the relationships among social forces can change as a nation’s economic development or governing strategy changes in response to changes in international circumstances such as globalization. Results The corporatist Social Health Insurance (SHI) system (multiple insurers) introduced in 1977 was transformed into the single-insurer NHI in July 2000. These changes were influenced externally by globalization and internally by political democratization, keeping Korea’s private-dominant health care provision system unchanged over several decades. Conclusion Major changes such as integration reform occurred, when high levels of state autonomy were ensured. The state’s power (its policy capability), based on health care infrastructures, acts to limit the direction of any change in the health care system because it is very difficult to build the infrastructure for a health care system in a short timeframe. PMID:28904846

Health care in China: improvement, challenges, and reform.

PubMed

Wang, Chen; Rao, Keqin; Wu, Sinan; Liu, Qian

2013-02-01

Over the past 2 decades, significant progress has been made in improving the health-care system and people's health conditions in China. Following rapid economic growth and social development, China's health-care system is facing new challenges, such as increased health-care demands and expenditure, inefficient use of health-care resources, unsatisfying implementation of disease management guidelines, and inadequate health-care insurance. Facing these challenges, the Chinese government carried out a national health-care reform in 2009. A series of policies were developed and implemented to improve the health-care insurance system, the medical care system, the public health service system, the pharmaceutical supply system, and the health-care institution management system in China. Although these measures have shown promising results, further efforts are needed to achieve the ultimate goal of providing affordable and high-quality care for both urban and rural residents in China. This article not only covers the improvement, challenges, and reform of health care in general in China, but also highlights the status of respiratory medicine-related issues.

Reconceptualizing children's complex discharge with health systems theory: novel integrative review with embedded expert consultation and theory development.

PubMed

Noyes, Jane; Brenner, Maria; Fox, Patricia; Guerin, Ashleigh

2014-05-01

To report a novel review to develop a health systems model of successful transition of children with complex healthcare needs from hospital to home. Children with complex healthcare needs commonly experience an expensive, ineffectual and prolonged nurse-led discharge process. Children gain no benefit from prolonged hospitalization and are exposed to significant harm. Research to enable intervention development and process evaluation across the entire health system is lacking. Novel mixed-method integrative review informed by health systems theory. DATA  CINAHL, PsychInfo, EMBASE, PubMed, citation searching, personal contact. REVIEW  Informed by consultation with experts. English language studies, opinion/discussion papers reporting research, best practice and experiences of children, parents and healthcare professionals and purposively selected policies/guidelines from 2002-December 2012 were abstracted using Framework synthesis, followed by iterative theory development. Seven critical factors derived from thirty-four sources across five health system levels explained successful discharge (new programme theory). All seven factors are required in an integrated care pathway, with a dynamic communication loop to facilitate effective discharge (new programme logic). Current health system responses were frequently static and critical success factors were commonly absent, thereby explaining ineffectual discharge. The novel evidence-based model, which reconceptualizes 'discharge' as a highly complex longitudinal health system intervention, makes a significant contribution to global knowledge to drive practice development. Research is required to develop process and outcome measures at different time points in the discharge process and future trials are needed to determine the effectiveness of integrated health system discharge models. © 2013 John Wiley & Sons Ltd.

Linking Primary Care Information Systems and Public Health Vertical Programs in the Philippines: An Open-source Experience

PubMed Central

Tolentino, Herman; Marcelo, Alvin; Marcelo, Portia; Maramba, Inocencio

2005-01-01

Community-based primary care information systems are one of the building blocks for national health information systems. In the Philippines, after the devolution of health care to local governments, we observed “health information system islands” connected to national vertical programs being implemented in devolved health units. These structures lead to a huge amount of “information work” in the transformation of health information at the community level. This paper describes work done to develop and implement the open-source Community Based Health Information Tracking System (CHITS) Project, which was implemented to address this information management problem and its outcomes. Several lessons learned from the field as well as software development strategies are highlighted in building community level information systems that link to national level health information systems. PMID:16779052

[Health Statistics in Senegal: between political stakes and role playing].

PubMed

Hane, Fatoumata

2017-01-01

Many countries have developed disease surveillance systems to deal with epidemics, but although health information systems have existed for more than two decades, constraints and biases in data collection limit the relevance of policy decisions and strategies in the field of health, as priority has been given to education and health in developing countries. Donor support has led to the development of systems for the production of statistics, designed, among other things, to more clearly target interventions in terms of educational objectives, action and credibility and enable health systems to continue to benefit from external funding. We used a classical anthropology approach based on observations and in-depth interviews with local and national health system actors. The aim of this article is to analyse the real effects of the production of health statistics in health care systems and to determine the relevance of these figures in the context in which they apply. Health priorities defined by international organizations and technical and financial partners focus on diseases considered to be ?priorities? to the detriment of neglected diseases, which are perceived as being more important at the local level due to their impact on the already limited health systems. We describe how health actors within healthcare structures adjust and adapt to public health requirements.

75 FR 7651 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-22

... Administration Leadership and Workforce Development--VA'' (161VA10A2). DATES: Comments on this new system of.... Description of Proposed Systems of Records Veterans Health Administration Leadership and Workforce Development... Affairs. 161VA10A2 SYSTEM NAME: Veterans Health Administration Leadership and Workforce Development--VA...

Contribution of the Japan International Cooperation Agency health-related projects to health system strengthening

PubMed Central

2013-01-01

Background The Japan International Cooperation Agency (JICA) has focused its attention on appraising health development assistance projects and redirecting efforts towards health system strengthening. This study aimed to describe the type of project and targets of interest, and assess the contribution of JICA health-related projects to strengthening health systems worldwide. Methods We collected a web-based Project Design Matrix (PDM) of 105 JICA projects implemented between January 2005 and December 2009. We developed an analytical matrix based on the World Health Organization (WHO) health system framework to examine the PDM data and thereby assess the projects’ contributions to health system strengthening. Results The majority of JICA projects had prioritized workforce development, and improvements in governance and service delivery. Conversely, there was little assistance for finance or medical product development. The vast majority (87.6%) of JICA projects addressed public health issues, for example programs to improve maternal and child health, and the prevention and treatment of infectious diseases such as AIDS, tuberculosis and malaria. Nearly 90% of JICA technical healthcare assistance directly focused on improving governance as the most critical means of accomplishing its goals. Conclusions Our study confirmed that JICA projects met the goals of bilateral cooperation by developing workforce capacity and governance. Nevertheless, our findings suggest that JICA assistance could be used to support financial aspects of healthcare systems, which is an area of increasing concern. We also showed that the analytical matrix methodology is an effective means of examining the component of health system strengthening to which the activity and output of a project contributes. This may help policy makers and practitioners focus future projects on priority areas. PMID:24053583

Contribution of the Japan International Cooperation Agency health-related projects to health system strengthening.

PubMed

Yuasa, Motoyuki; Yamaguchi, Yoshie; Imada, Mihoko

2013-09-22

The Japan International Cooperation Agency (JICA) has focused its attention on appraising health development assistance projects and redirecting efforts towards health system strengthening. This study aimed to describe the type of project and targets of interest, and assess the contribution of JICA health-related projects to strengthening health systems worldwide. We collected a web-based Project Design Matrix (PDM) of 105 JICA projects implemented between January 2005 and December 2009. We developed an analytical matrix based on the World Health Organization (WHO) health system framework to examine the PDM data and thereby assess the projects' contributions to health system strengthening. The majority of JICA projects had prioritized workforce development, and improvements in governance and service delivery. Conversely, there was little assistance for finance or medical product development. The vast majority (87.6%) of JICA projects addressed public health issues, for example programs to improve maternal and child health, and the prevention and treatment of infectious diseases such as AIDS, tuberculosis and malaria. Nearly 90% of JICA technical healthcare assistance directly focused on improving governance as the most critical means of accomplishing its goals. Our study confirmed that JICA projects met the goals of bilateral cooperation by developing workforce capacity and governance. Nevertheless, our findings suggest that JICA assistance could be used to support financial aspects of healthcare systems, which is an area of increasing concern. We also showed that the analytical matrix methodology is an effective means of examining the component of health system strengthening to which the activity and output of a project contributes. This may help policy makers and practitioners focus future projects on priority areas.

Assessing health system performance in developing countries: a review of the literature.

PubMed

Kruk, Margaret Elizabeth; Freedman, Lynn P

2008-03-01

With the setting of ambitious international health goals and an influx of additional development assistance for health, there is growing interest in assessing the performance of health systems in developing countries. This paper proposes a framework for the assessment of health system performance and reviews the literature on indicators currently in use to measure performance using online medical and public health databases. This was complemented by a review of relevant books and reports in the grey literature. The indicators were organized into three categories: effectiveness, equity, and efficiency. Measures of health system effectiveness were improvement in health status, access to and quality of care and, increasingly, patient satisfaction. Measures of equity included access and quality of care for disadvantaged groups together with fair financing, risk protection and accountability. Measures of efficiency were appropriate levels of funding, the cost-effectiveness of interventions, and effective administration. This framework and review of indicators may be helpful to health policy makers interested in assessing the effects of different policies, expenditures, and organizational structures on health outputs and outcomes in developing countries.

Emergency preparedness and public health systems lessons for developing countries.

PubMed

Kruk, Margaret E

2008-06-01

Low- and middle-income countries, where emerging diseases often make their debut, are also likely to bear the harshest consequences of a potential influenza pandemic. Yet public health systems in developing countries are underfunded, understaffed, and in many cases struggling to deal with the existing burden of disease. As a result, developed countries are beginning to expand assistance for emergency preparedness to the developing world. Given developing countries' weak infrastructure and many competing public health priorities, it is not clear how to best direct these resources. Evidence from the U.S. and other developed countries suggests that some investments in bioterror and pandemic emergency preparedness, although initially implemented as vertical programs, have the potential to strengthen the general public health infrastructure. This experience may hold some lessons for how global funds for emergency preparedness could be invested in developing countries to support struggling public health systems in responding to current health priorities as well as potential future public health threats.

Moving towards Universal Health Coverage through the Development of Integrated Service Delivery Packages for Primary Health Care in the Solomon Islands

PubMed Central

Whiting, Stephen; Postma, Sjoerd; Jamshaid de Lorenzo, Ayesha; Aumua, Audrey

2016-01-01

The Solomon Islands Government is pursuing integrated care with the goal of improving the quality of health service delivery to rural populations. Under the auspices of Universal Health Coverage, integrated service delivery packages were developed which defined the clinical and public health services that should be provided at different levels of the health system. The process of developing integrated service delivery packages helped to identify key policy decisions the government needed to make in order to improve service quality and efficiency. The integrated service delivery packages have instigated the revision of job descriptions and are feeding into the development of a human resource plan for health. They are also being used to guide infrastructure development and health system planning and should lead to better management of resources. The integrated service delivery packages have become a key tool to operationalise the government’s policy to move towards a more efficient, equitable, quality and sustainable health system. PMID:28321177

Electronic health record - public health (EHR-PH) system prototype for interoperability in 21st century healthcare systems.

PubMed

Orlova, Anna O; Dunnagan, Mark; Finitzo, Terese; Higgins, Michael; Watkins, Todd; Tien, Allen; Beales, Steven

2005-01-01

Information exchange, enabled by computable interoperability, is the key to many of the initiatives underway including the development of Regional Health Information Exchanges, Regional Health Information Organizations, and the National Health Information Network. These initiatives must include public health as a full partner in the emerging transformation of our nation's healthcare system through the adoption and use of information technology. An electronic health record - public health (EHR-PH)system prototype was developed to demonstrate the feasibility of electronic data transfer from a health care provider, i.e. hospital or ambulatory care settings, to multiple customized public health systems which include a Newborn Metabolic Screening Registry, a Newborn Hearing Screening Registry, an Immunization Registry and a Communicable Disease Registry, using HL7 messaging standards. Our EHR-PH system prototype can be considered a distributed EHR-based RHIE/RHIO model - a principal element for a potential technical architecture for a NHIN.

Development and implementation of a clinical and business intelligence system for the Florida health data warehouse.

PubMed

AlHazme, Raed H; Rana, Arif M; De Lucca, Michael

2014-01-01

To develop and implement a Clinical and Business Intelligence (CBI) system for the Florida Health Data Warehouse (FHDW) in order to bridge the gap between Florida's healthcare stakeholders and the health data archived in FHWD. A gap analysis study has been conducted to evaluate the technological divide between the relevant users and FHWD health data, which is maintained by the Broward Regional Health Planning Council (BRHPC). The study revealed a gap between the health care data and the decision makers that utilize the FHDW data. To bridge the gap, a CBI system was proposed, developed and implemented by BRHPC as a viable solution to address this issue, using the System Development Life Cycle methodology. The CBI system was successfully implemented and yielded a number of positive outcomes. In addition to significantly shortening the time required to analyze the health data for decision-making processes, the solution also provided end-users with the ability to automatically track public health parameters. A large amount of data is collected and stored by various health care organizations at the local, state, and national levels. If utilized properly, such data can go a long way in optimizing health care services. CBI systems provide health care organizations with valuable insights for improving patient care, tracking trends for medical research, and for controlling costs. The CBI system has been found quite effective in bridging the gap between Florida's healthcare stake holders and FHDW health data. Consequently, the solution has improved in the planning and coordination of health care services for the state of Florida.

New solutions for personalised health management: citizens' needs, healthcare changes, and market perspectives round table debate.

PubMed

Olsson, Silas; Hofmann, Isa; Brambilla, Piero Maria; Jacobsson, Ulf; Kennedy, Paul; Roca, Josep; Schmitt, Karl-Jürgen; Wyke, Alexandra

2004-01-01

The aim with the round table was to give additional inputs and views to the specific technology oriented presentations focusing on issues dealing with the need, patients' view, the use and the business opportunities relating to wearable eHealth systems for personalised health management. Wearable eHealth systems for personalised health management are targeting citizens, patients at health risks and patients enrolled in open care or home care for monitoring, treatment or follow up. The developments so far show promises for these group categories, and in addition, could support developments in health care organisations and systems. However, the ethical issues and data privacy nature have to be seriously taken into account. The market is not yet developed, and this is the situation both in Europe and in the US. To be able to give the customers solid product information a standardised test bed for new equipment and services might speed up the market development. In the round table discussion it was highlighted that one has to differ between needs and demands. Needs are related to the prevalence of the diseases, the health risks, etc. Demands are more related to market developments and customers' willingness to pay for the new products and services. Further, technical interoperability was seen as a fundamental prerequisite for market acceptance. As wearable eHealth systems for personalised health management differ completely from traditional way of deliver healthcare, new reimbursement systems have to be developed and implemented.

Applications of Electronic Health Information in Public Health: Uses, Opportunities & Barriers

PubMed Central

Tomines, Alan; Readhead, Heather; Readhead, Adam; Teutsch, Steven

2013-01-01

Electronic health information systems can reshape the practice of public health including public health surveillance, disease and injury investigation and control, decision making, quality assurance, and policy development. While these opportunities are potentially transformative, and the federal program for the Meaningful Use (MU) of electronic health records (EHRs) has included important public health components, significant barriers remain. Unlike incentives in the clinical care system, scant funding is available to public health departments to develop the necessary information infrastructure and workforce capacity to capitalize on EHRs, personal health records, or Big Data. Current EHR systems are primarily built to serve clinical systems and practice rather than being structured for public health use. In addition, there are policy issues concerning how broadly the data can be used by public health officials. As these issues are resolved and workable solutions emerge, they should yield a more efficient and effective public health system. PMID:25848571

Human rights, health and the state in Bangladesh

PubMed Central

Rahman, Redwanur M

2006-01-01

Background This paper broadly discusses the role of the State of Bangladesh in the context of the health system and human rights. The interrelation between human rights, health and development are well documented. The recognition of health as a fundamental right by WHO and subsequent approval of health as an instrument of welfare by the Universal Declaration of Human Rights (UDHR) and the International Covenant on Social, Economic and Cultural Rights (ICSECR) further enhances the idea. Moreover, human rights are also recognized as an expedient of human development. The state is entrusted to realize the rights enunciated in the ICSECR. Discussion In exploring the relationship of the human rights and health situation in Bangladesh, it is argued, in this paper, that the constitution and major policy documents of the Bangladesh government have recognized the health rights and development. Bangladesh has ratified most of the international treaties and covenants including ICCPR, ICESCR; and a signatory of international declarations including Alma-Ata, ICPD, Beijing declarations, and Millennium Development Goals. However the implementation of government policies and plans in the development of health institutions, human resources, accessibility and availability, resource distribution, rural-urban disparity, the male-female gap has put the health system in a dismal state. Neither the right to health nor the right to development has been established in the development of health system or in providing health care. Summary The development and service pattern of the health system have negative correlation with human rights and contributed to the underdevelopment of Bangladesh. The government should take comprehensive approach in prioritizing the health rights of the citizens and progressive realization of these rights. PMID:16611360

Health systems frameworks in their political context: framing divergent agendas

PubMed Central

2012-01-01

Background Despite the mounting attention for health systems and health systems theories, there is a persisting lack of consensus on their conceptualisation and strengthening. This paper contributes to structuring the debate, presenting landmarks in the development of health systems thinking against the backdrop of the policy context and its dominant actors. We argue that frameworks on health systems are products of their time, emerging from specific discourses. They are purposive, not neutrally descriptive, and are shaped by the agendas of their authors. Discussion The evolution of thinking over time does not reflect a progressive accumulation of insights. Instead, theories and frameworks seem to develop in reaction to one another, partly in line with prevailing paradigms and partly as a response to the very different needs of their developers. The reform perspective considering health systems as projects to be engineered is fundamentally different from the organic view that considers a health system as a mirror of society. The co-existence of health systems and disease-focused approaches indicates that different frameworks are complementary but not synthetic. The contestation of theories and methods for health systems relates almost exclusively to low income countries. At the global level, health system strengthening is largely narrowed down to its instrumental dimension, whereby well-targeted and specific interventions are supposed to strengthen health services and systems or, more selectively, specific core functions essential to programmes. This is in contrast to a broader conceptualization of health systems as social institutions. Summary Health systems theories and frameworks frame health, health systems and policies in particular political and public health paradigms. While there is a clear trend to try to understand the complexity of and dynamic relationships between elements of health systems, there is also a demand to provide frameworks that distinguish between health system interventions, and that allow mapping with a view of analysing their returns. The choice for a particular health system model to guide discussions and work should fit the purpose. The understanding of the underlying rationale of a chosen model facilitates an open dialogue about purpose and strategy. PMID:22971107

Strengthening the public health system.

PubMed

Roper, W L; Baker, E L; Dyal, W W; Nicola, R M

1992-01-01

Although the American public health system has made major contributions to life expectancy for residents of this country over the past century, the system now faces more complex health problems that require comprehensive approaches and increased capacity, particularly in local and State public health agencies. To strengthen the public health system, concerted action is needed to meet these five critical needs: First, the knowledge base of public health workers needs to be supplemented through on-the-job training and continuing education programs. To this end, self-study courses will be expanded, and a network of regional training centers will be established throughout the country. Second, communities need dynamic leadership from public health officials and their agencies. To enhance leadership skills and expand the leadership role of public health agencies, focused personal leadership development activities, including a Public Health Leadership Institute, and national conferences will provide a vision of the future role of public health agencies. Third, local and State public health agencies need access to data on the current health status of the people in their communities and guidance from the nation's public health experts. To improve access to information resources, state-of-the-art technologies will be deployed to create integrated information and communication systems linking all components of the public health system. Fourth, local and State agencies need disease prevention and health promotion plans that target problems and develop strategies and the capacity to address them. To provide communities with structured approaches to this process, planning tools have been developed and distributed, and technical assistance will be provided to local and State health agencies to involve each community in planning,priority setting, and constituency building.Finally, public health agencies need adequate resources to fund prevention programs. To improve the use of existing Federal support and enhance the availability of new community resources, grant programs will be modified, and innovative approaches to local resource enhancement will be developed and shared.Activities in these five key areas are designed to improve the infrastructure of the public health system and its capacity to carry out effectively the core functions of public health assessment, policy development, and assurance of the availability of the benefits of public health. If the nation is to achieve the health objectives for the year 2000, the public health system-the individuals and institutions that, when working effectively together, promote and protect the health of the people-must be strengthened.

Developing a health information network within an integrated delivery system: a case study.

PubMed

Wager, K A; Heda, S; Austin, C J

1997-05-01

Changes in the health care environment, such as the growth of integrated delivery systems and the proliferation of managed care, are having a profound impact on the way in which health care organizations manage both clinical and financial information. Health information networks (HINs) are emerging to support the goals and internal needs of integrated delivery systems. In this environment, health care managers must assume a leadership role in planning for the development of HINs. The article provides an overview of the principal issues that should be addressed in an organization's information systems plan when a HIN is being developed and includes a case study that illustrates the key points discussed.

Towards responsible system development in health services: a discourse analysis study of design conflict resolution tactics.

PubMed

Irestig, Magnus; Timpka, Toomas

2010-02-01

We set out to examine design conflict resolution tactics used in development of large information systems for health services and to outline the design consequences for these tactics. Discourse analysis methods were applied to data collected from meetings conducted during the development of a web-based system in a public health context. We found that low risk tactics were characterized by design issues being managed within the formal mandate and competences of the design group. In comparison, high risk tactics were associated with irresponsible compromises, i.e. decisions being passed on to others or to later phases of the design process. The consequence of this collective disregard of issues such as responsibility and legitimacy is that the system design will be impossible to implement in factual health service contexts. The results imply that downstream responsibility issues have to be continuously dealt with in system development in health services.

A Lean Approach to Improving SE Visibility in Large Operational Systems Evolution

DTIC Science & Technology

2013-06-01

large health care system of systems. To enhance both visibility and flow, the approach utilizes visualization techniques, pull-scheduling processes...development processes. This paper describes an example implementation of the concept in a large health care system of systems. To enhance both visibility...and then provides the results to the requestor as soon as available. Hospital System Information Support Development The health care SoS is a set

Development of informational-communicative system, created to improve medical help for family medicine doctors.

PubMed

Smiianov, Vladyslav A; Dryha, Natalia O; Smiianova, Olha I; Obodyak, Victor K; Zudina, Tatyana O

2018-01-01

Introduction: Today mobile health`s protection service has no concrete meaning. As an research object it was called mHealth and named by Global observatory of electronic health`s protection as "Doctor and social health practice that can be supported by any mobile units (mobile phones or smartphones), units for patient`s health control, personal computers and other units of non-wired communication". An active usage of SMS in programs for patients` cure regimen keeping was quiet predictable. Mobile and electronic units only begin their development in medical sphere. Thus, to solve all health`s protection system reformation problems a special memorandum about cooperation in creating E-Health system in Ukraine was signed. The aim: Development of ICS for monitoring and non-infection ill patients` informing system optimization as a first level of medical help. Materials and methods: During research, we used systematical approach, meta-analysis, informational-analytical systems` schemes projection, expositive modeling. Developing the backend (server part of the site), we used next technologies: 1) the Apache web server; 2) programming language PHP; 3) Yii 2 PHP Framework. In the frontend developing were used the following technologies (client part of the site): 1) Bootstrap 3; 2) Vue JS Framework. Results and conclusions: Created duo-channel system "doctor-patient" and "patient-doctor" will allow usual doctors of family medicine (DFM) take the interactive dispensary cure and avoid uncontrolled illness progress. Doctor will monitor basic physical data of patient`s health and curing process. The main goal is to create automatic system to allow doctor regularly write periodical or non-periodical notifications, get patients` questioning answers and spread information between doctor and patient; that will optimize work of DFMs.

Tuberculosis in Asia and the Pacific: The Role of Socioeconomic Status and Health System Development

PubMed Central

Wu, Jie; Dalal, Koustuv

2012-01-01

Objective: To identify the relationship between socioeconomic status, health system development and the incidence, prevalence and mortality of tuberculosis in Asia and the Pacific. Methods: Incidence, prevalence and mortality rates of tuberculosis and 20 variables of socioeconomic, health system and biological–behavioral issues were included in the study involving all 46 countries of the Asian Development Bank region (2007 data). Both univariate and multivariate linear regressions were used. Results: The worst three tuberculosis affected countries were Cambodia, India and Indonesia, while the least affected was Australia. Tuberculosis incidence, prevalence and mortality rate were higher in countries with lower human development index, corruption perception index, gross domestic product (GDP) per capita and countries with more people under minimum food supplements. Among the health system variables, total health expenditure per capita, governmental health expenditure per capita, hospital beds, and access to improved water and sanitation were strongly associated with tuberculosis. Conclusions: Socioeconomic determinants and health system development have significant effect on the control of tuberculosis in Asia and the Pacific region. The study has some policy implications by means of lowering the corruption and improving the sanitation. PMID:22355472

Development and Application of a Portable Health Algorithms Test System

NASA Technical Reports Server (NTRS)

Melcher, Kevin J.; Fulton, Christopher E.; Maul, William A.; Sowers, T. Shane

2007-01-01

This paper describes the development and initial demonstration of a Portable Health Algorithms Test (PHALT) System that is being developed by researchers at the NASA Glenn Research Center (GRC). The PHALT System was conceived as a means of evolving the maturity and credibility of algorithms developed to assess the health of aerospace systems. Comprising an integrated hardware-software environment, the PHALT System allows systems health management algorithms to be developed in a graphical programming environment; to be tested and refined using system simulation or test data playback; and finally, to be evaluated in a real-time hardware-in-the-loop mode with a live test article. In this paper, PHALT System development is described through the presentation of a functional architecture, followed by the selection and integration of hardware and software. Also described is an initial real-time hardware-in-the-loop demonstration that used sensor data qualification algorithms to diagnose and isolate simulated sensor failures in a prototype Power Distribution Unit test-bed. Success of the initial demonstration is highlighted by the correct detection of all sensor failures and the absence of any real-time constraint violations.

Developing Workforce Capacity in Public Health Informatics: Core Competencies and Curriculum Design

PubMed Central

Wholey, Douglas R.; LaVenture, Martin; Rajamani, Sripriya; Kreiger, Rob; Hedberg, Craig; Kenyon, Cynthia

2018-01-01

We describe a master’s level public health informatics (PHI) curriculum to support workforce development. Public health decision-making requires intensive information management to organize responses to health threats and develop effective health education and promotion. PHI competencies prepare the public health workforce to design and implement these information systems. The objective for a Master’s and Certificate in PHI is to prepare public health informaticians with the competencies to work collaboratively with colleagues in public health and other health professions to design and develop information systems that support population health improvement. The PHI competencies are drawn from computer, information, and organizational sciences. A curriculum is proposed to deliver the competencies and result of a pilot PHI program is presented. Since the public health workforce needs to use information technology effectively to improve population health, it is essential for public health academic institutions to develop and implement PHI workforce training programs. PMID:29770321

Developing Workforce Capacity in Public Health Informatics: Core Competencies and Curriculum Design.

PubMed

Wholey, Douglas R; LaVenture, Martin; Rajamani, Sripriya; Kreiger, Rob; Hedberg, Craig; Kenyon, Cynthia

2018-01-01

We describe a master's level public health informatics (PHI) curriculum to support workforce development. Public health decision-making requires intensive information management to organize responses to health threats and develop effective health education and promotion. PHI competencies prepare the public health workforce to design and implement these information systems. The objective for a Master's and Certificate in PHI is to prepare public health informaticians with the competencies to work collaboratively with colleagues in public health and other health professions to design and develop information systems that support population health improvement. The PHI competencies are drawn from computer, information, and organizational sciences. A curriculum is proposed to deliver the competencies and result of a pilot PHI program is presented. Since the public health workforce needs to use information technology effectively to improve population health, it is essential for public health academic institutions to develop and implement PHI workforce training programs.

The Role of Health Systems Factors in Facilitating Access to Psychotropic Medicines: A Cross-Sectional Analysis of the WHO-AIMS in 63 Low- and Middle-Income Countries

PubMed Central

McBain, Ryan; Norton, Daniel J.; Morris, Jodi; Yasamy, M. Taghi; Betancourt, Theresa S.

2012-01-01

Background Neuropsychiatric conditions comprise 14% of the global burden of disease and 30% of all noncommunicable disease. Despite the existence of cost-effective interventions, including administration of psychotropic medicines, the number of persons who remain untreated is as high as 85% in low- and middle-income countries (LAMICs). While access to psychotropic medicines varies substantially across countries, no studies to date have empirically investigated potential health systems factors underlying this issue. Methods and Findings This study uses a cross-sectional sample of 63 LAMICs and country regions to identify key health systems components associated with access to psychotropic medicines. Data from countries that completed the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) were included in multiple regression analyses to investigate the role of five major mental health systems domains in shaping medicine availability and affordability. These domains are: mental health legislation, human rights implementations, mental health care financing, human resources, and the role of advocacy groups. Availability of psychotropic medicines was associated with features of all five mental health systems domains. Most notably, within the domain of mental health legislation, a comprehensive national mental health plan was associated with 15% greater availability; and in terms of advocacy groups, the participation of family-based organizations in the development of mental health legislation was associated with 17% greater availability. Only three measures were related with affordability of medicines to consumers: level of human resources, percentage of countries' health budget dedicated to mental health, and availability of mental health care in prisons. Controlling for country development, as measured by the Human Development Index, health systems features were associated with medicine availability but not affordability. Conclusions Results suggest that strengthening particular facets of mental health systems might improve availability of psychotropic medicines and that overall country development is associated with affordability. Please see later in the article for the Editors' Summary PMID:22303288

A Cryogenic Fluid System Simulation in Support of Integrated Systems Health Management

NASA Technical Reports Server (NTRS)

Barber, John P.; Johnston, Kyle B.; Daigle, Matthew

2013-01-01

Simulations serve as important tools throughout the design and operation of engineering systems. In the context of sys-tems health management, simulations serve many uses. For one, the underlying physical models can be used by model-based health management tools to develop diagnostic and prognostic models. These simulations should incorporate both nominal and faulty behavior with the ability to inject various faults into the system. Such simulations can there-fore be used for operator training, for both nominal and faulty situations, as well as for developing and prototyping health management algorithms. In this paper, we describe a methodology for building such simulations. We discuss the design decisions and tools used to build a simulation of a cryogenic fluid test bed, and how it serves as a core technology for systems health management development and maturation.

Developing a national health research system: participatory approaches to legislative, institutional and networking dimensions in Zambia.

PubMed

Chanda-Kapata, Pascalina; Campbell, Sandy; Zarowsky, Christina

2012-06-06

For many sub-Saharan African countries, a National Health Research System (NHRS) exists more in theory than in reality, with the health system itself receiving the majority of investments. However, this lack of attention to NHRS development can, in fact, frustrate health systems in achieving their desired goals. In this case study, we discuss the ongoing development of Zambia's NHRS. We reflect on our experience in the ongoing consultative development of Zambia's NHRS and offer this reflection and process documentation to those engaged in similar initiatives in other settings. We argue that three streams of concurrent activity are critical in developing an NHRS in a resource-constrained setting: developing a legislative framework to determine and define the system's boundaries and the roles all actors will play within it; creating or strengthening an institution capable of providing coordination, management and guidance to the system; and focusing on networking among institutions and individuals to harmonize, unify and strengthen the overall capacities of the research community.

The role of health system governance in strengthening the rural health insurance system in China.

PubMed

Yuan, Beibei; Jian, Weiyan; He, Li; Wang, Bingyu; Balabanova, Dina

2017-05-23

Systems of governance play a key role in the operation and performance of health systems. In the past six decades, China has made great advances in strengthening its health system, most notably in establishing a health insurance system that enables residents of rural areas to achieve access to essential services. Although there have been several studies of rural health insurance schemes, these have focused on coverage and service utilization, while much less attention has been given to the role of governance in designing and implementing these schemes. Information from publications and policy documents relevant to the development of two rural health insurance policies in China was obtained, analysed, and synthesise. 92 documents on CMS (Cooperative Medical Scheme) or NCMS (New Rural Cooperative Medical Scheme) from four databases searched were included. Data extraction and synthesis of the information were guided by a framework that drew on that developed by the WHO to describe health system governance and leadership. We identified a series of governance practices that were supportive of progress, including the prioritisation by the central government of health system development and certain health policies within overall national development; strong government commitment combined with a hierarchal administrative system; clear policy goals coupled with the ability for local government to adopt policy measures that take account of local conditions; and the accumulation and use of the evidence generated from local practices. However these good practices were not seen in all governance domains. For example, poor collaboration between different government departments was shown to be a considerable challenge that undermined the operation of the insurance schemes. China's success in achieving scale up of CMS and NCMS has attracted considerable interest in many low and middle income countries (LMICs), especially with regard to the schemes' designs, coverage, and funding mechanisms. However, this study demonstrates that health systems governance may be critical to enable the development and operation of such schemes. Given that many LMICs are expanding health financing system to cover populations in rural areas or the informal sectors, we argue that strengthening specific practices in each governance domain could inform the adaptation of these schemes to other settings.

Sustainable health systems: addressing three key areas.

PubMed

Chhanabhai, Prajesh N; Holt, Alec; Benwell, George

2007-01-01

In the modern context sustainable health systems are being developed using the newest technological and communication technologies. This is proving to be a great success for the growth of Health Informatics and healthcare improvement. However this revolution is not being reached by a lot of the world population. This paper will address the importance of closing the Digital Divide, Empowerment of health consumers and the importance of converging communications. Key areas in the development of a truly sustainable health system.

Aligning leadership across systems and organizations to develop a strategic climate for evidence-based practice implementation.

PubMed

Aarons, Gregory A; Ehrhart, Mark G; Farahnak, Lauren R; Sklar, Marisa

2014-01-01

There has been a growing impetus to bridge the gap between basic science discovery, development of evidence-based practices (EBPs), and the availability and delivery of EBPs in order to improve the public health impact of such practices. To capitalize on factors that support implementation and sustainment of EBPs, it is important to consider that health care is delivered within the outer context of public health systems and the inner context of health care organizations and work groups. Leaders play a key role in determining the nature of system and organizational contexts. This article addresses the role of leadership and actions that leaders can take at and across levels in developing a strategic climate for EBP implementation within the outer (i.e., system) and inner (i.e., organization, work group) contexts of health care. Within the framework of Edgar Schein's "climate embedding mechanisms," we describe strategies that leaders at the system, organization, and work group levels can consider and apply to develop strategic climates that support the implementation and sustainment of EBP in health care and allied health care settings.

A theory for classification of health care organizations in the new economy.

PubMed

Vimarlund, Vivian; Sjöberg, Cecilia; Timpka, Toomas

2003-10-01

Most of the available studies into information technology (IT) have been limited to investigating specific issues, such as how IT can support decision makers distributing the information throughout health care organization, or how technology impacts organizational performance. In this study, for use in the planning of information system development projects, a theoretical model for the classification of health care organizations is proposed. We try to reflect the development in the contemporary digital economy by theoretically classifying health care organizations into three types, namely traditional, developing, and flexible. We describe traditional health care organizations as organizations with a centralized system for management and control. In developing health care organizations, IT is spread over the horizontal dimension and is used for coordinating the different parties throughout the organization. Finally, flexible health care organizations are those which work actively with the design of new health care organizational structure while they are designing the information system.

Central Asian Post-Soviet health systems in transition: has different aid engagement produced different outcomes?

PubMed Central

Ulikpan, Anar; Mirzoev, Tolib; Jimenez, Eliana; Malik, Asmat; Hill, Peter S.

2014-01-01

Background The collapse of the Soviet Union in 1991 resulted in a transition from centrally planned socialist systems to largely free-market systems for post-Soviet states. The health systems of Central Asian Post-Soviet (CAPS) countries (Kyrgyzstan, Mongolia, Tajikistan, Turkmenistan, and Uzbekistan) have undergone a profound revolution. External development partners have been crucial to this reorientation through financial and technical support, though both relationships and outcomes have varied. This research provides a comparative review of the development assistance provided in the health systems of CAPS countries and proposes future policy options to improve the effectiveness of development. Design Extensive documentary review was conducted using Pubmed, Medline/Ovid, Scopus, and Google scholar search engines, local websites, donor reports, and grey literature. The review was supplemented by key informant interviews and participant observation. Findings The collapse of the Soviet dominance of the region brought many health system challenges. Donors have played an essential role in the reform of health systems. However, as new aid beneficiaries, neither CAPS countries’ governments nor the donors had the experience of development collaboration in this context. The scale of development assistance for health in CAPS countries has been limited compared to other countries with similar income, partly due to their limited history with the donor community, lack of experience in managing donors, and a limited history of transparency in international dealings. Despite commonalities at the start, two distinctive trajectories formed in CAPS countries, due to their differing politics and governance context. Conclusions The influence of donors, both financially and technically, remains crucial to health sector reform, despite their relatively small contribution to overall health budgets. Kyrgyzstan, Mongolia, and Tajikistan have demonstrated more effective development cooperation and improved health outcomes; arguably, Uzbekistan and Turkmenistan have made slower progress in their health and socio-economic indices because of their resistance to open and accountable development relationships. PMID:25231098

TPS In-Flight Health Monitoring Project Progress Report

NASA Technical Reports Server (NTRS)

Kostyk, Chris; Richards, Lance; Hudston, Larry; Prosser, William

2007-01-01

Progress in the development of new thermal protection systems (TPS) is reported. New approaches use embedded lightweight, sensitive, fiber optic strain and temperature sensors within the TPS. Goals of the program are to develop and demonstrate a prototype TPS health monitoring system, develop a thermal-based damage detection algorithm, characterize limits of sensor/system performance, and develop ea methodology transferable to new designs of TPS health monitoring systems. Tasks completed during the project helped establish confidence in understanding of both test setup and the model and validated system/sensor performance in a simple TPS structure. Other progress included complete initial system testing, commencement of the algorithm development effort, generation of a damaged thermal response characteristics database, initial development of a test plan for integration testing of proven FBG sensors in simple TPS structure, and development of partnerships to apply the technology.

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 develop a socio-physical model of systemic seismic vulnerability that enhances the further understanding of societal seismic risk by taking into account social vulnerability impacts for health and health-care system, shelter, and transportation.

Achieving value for money in health: a comparative analysis of OECD countries and regional countries.

PubMed

Çelik, Yusuf; Khan, Mahmud; Hikmet, Neşet

2017-10-01

To measure efficiency gains in health sector over the years 1995 to 2013 in OECD, EU, non-member European countries. An output-oriented DEA model with variable return to scale, and residuals estimated by regression equations were used to estimate efficiencies of health systems. Slacks for health care outputs and inputs were calculated by using DEA multistage method of estimating country efficiency scores. Better health outcomes of countries were related with higher efficiency. Japan, France, or Sweden were found to be peer-efficient countries when compared to other developed countries like Germany and United States. Increasing life expectancy beyond a certain high level becomes very difficult to achieve. Despite declining marginal productivity of inputs on health outcomes, some developed countries and developing countries were found to have lowered their inefficiencies in the use of health inputs. Although there was no systematic relationship between political system of countries and health system efficiency, the objectives of countries on social and health policy and the way of achieving these objectives might be a factor increasing the efficiency of health systems. Economic and political stability might be as important as health expenditure in improving health system goals. A better understanding of the value created by health expenditures, especially in developed countries, will require analysis of specific health interventions that can increase value for money in health. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

The Professional Development Plan of a Health Care Workforce as a Qualitative Indicator of the Health Care System's Well-Being

ERIC Educational Resources Information Center

Saiti, Anna; Mylona, Vasiliki

2015-01-01

The quality of a health care system is heavily dependent on a capable and skillful health care workforce so as to guarantee the delivery of quality health care services to its user groups. Hence, only through continuous training and development can the health care workforce follow rapid scientific progress while equitably balancing investment…

Analysis Of The Health Care System Of Pakistan: Lessons Learnt And Way Forward.

PubMed

Kurji, Zohra; Premani, Zahra Shaheen; Mithani, Yasmin

2016-01-01

Pakistani health care system is in progress and since last year, Pakistan has tried to make much improvement in its health care delivery system and has brought out many reforms. A systematic search of national and international literature was looked from peerreviewed databases form MEDLINE, CINAHL, and PubMed. There is little strength in health care delivery system in Pakistan like making health policies, participating in Millennium Development Goals program, initiating vertical programs and introducing Public Private Partnership, improving human resource development and infrastructure by making Basic Health Unit and Rural Health Centres. However, these all programs are very limited in its scope and that is the reason that Pakistan's healthcare system is still not very efficient. There are numerous weaknesses like poor governance, lack of access and unequal resources, poor quality of Health Information Management System, corruption in health system, lack of monitoring in health policy and health planning and lack of trained staff. Pakistan is improving very slowly in the health sector for the last five decades as is evident by its health indicators and above mentioned strengths and weaknesses. Therefore, the Government needs to take strong initiatives to change the current health care system.

Reflections on the role of open source in health information system interoperability.

PubMed

Sfakianakis, S; Chronaki, C E; Chiarugi, F; Conforti, F; Katehakis, D G

2007-01-01

This paper reflects on the role of open source in health information system interoperability. Open source is a driving force in computer science research and the development of information systems. It facilitates the sharing of information and ideas, enables evolutionary development and open collaborative testing of code, and broadens the adoption of interoperability standards. In health care, information systems have been developed largely ad hoc following proprietary specifications and customized design. However, the wide deployment of integrated services such as Electronic Health Records (EHRs) over regional health information networks (RHINs) relies on interoperability of the underlying information systems and medical devices. This reflection is built on the experiences of the PICNIC project that developed shared software infrastructure components in open source for RHINs and the OpenECG network that offers open source components to lower the implementation cost of interoperability standards such as SCP-ECG, in electrocardiography. Open source components implementing standards and a community providing feedback from real-world use are key enablers of health care information system interoperability. Investing in open source is investing in interoperability and a vital aspect of a long term strategy towards comprehensive health services and clinical research.

The development of the U.S. Health Care System and the contemporary role of the public health department.

PubMed

Grott, Catherine J

2006-01-01

The absence of national health care reform and the growing number of uninsured individuals in the United States have prompted states to develop plans to provide medical care for the low income and the indigent. Many local health departments are not only responsible for the core public health functions; but they are increasingly called upon to provide person health care services for those who cannot afford it. This article chronicles the development of the health care system in the United States and describes the contemporary role of the local public health department.

Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study

PubMed Central

Magare, Steve; Monda, Jonathan; Kamau, Onesmus; Houston, Stuart; Fraser, Hamish; Powell, John; English, Mike; Paton, Chris

2018-01-01

Background The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. Objective We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. Methods We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. Results This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. Conclusions Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa. PMID:29669709

Development of the Learning Health System Researcher Core Competencies.

PubMed

Forrest, Christopher B; Chesley, Francis D; Tregear, Michelle L; Mistry, Kamila B

2017-08-04

To develop core competencies for learning health system (LHS) researchers to guide the development of training programs. Data were obtained from literature review, expert interviews, a modified Delphi process, and consensus development meetings. The competencies were developed from August to December 2016 using qualitative methods. The literature review formed the basis for the initial draft of a competency domain framework. Key informant semi-structured interviews, a modified Delphi survey, and three expert panel (n = 19 members) consensus development meetings produced the final set of competencies. The iterative development process yielded seven competency domains: (1) systems science; (2) research questions and standards of scientific evidence; (3) research methods; (4) informatics; (5) ethics of research and implementation in health systems; (6) improvement and implementation science; and (7) engagement, leadership, and research management. A total of 33 core competencies were prioritized across these seven domains. The real-world milieu of LHS research, the embeddedness of the researcher within the health system, and engagement of stakeholders are distinguishing characteristics of this emerging field. The LHS researcher core competencies can be used to guide the development of learning objectives, evaluation methods, and curricula for training programs. © Health Research and Educational Trust.

Integrated Systems Health Management (ISHM) Toolkit

NASA Technical Reports Server (NTRS)

Venkatesh, Meera; Kapadia, Ravi; Walker, Mark; Wilkins, Kim

2013-01-01

A framework of software components has been implemented to facilitate the development of ISHM systems according to a methodology based on Reliability Centered Maintenance (RCM). This framework is collectively referred to as the Toolkit and was developed using General Atomics' Health MAP (TM) technology. The toolkit is intended to provide assistance to software developers of mission-critical system health monitoring applications in the specification, implementation, configuration, and deployment of such applications. In addition to software tools designed to facilitate these objectives, the toolkit also provides direction to software developers in accordance with an ISHM specification and development methodology. The development tools are based on an RCM approach for the development of ISHM systems. This approach focuses on defining, detecting, and predicting the likelihood of system functional failures and their undesirable consequences.

Open source cardiology electronic health record development for DIGICARDIAC implementation

NASA Astrophysics Data System (ADS)

Dugarte, Nelson; Medina, Rubén.; Huiracocha, Lourdes; Rojas, Rubén.

2015-12-01

This article presents the development of a Cardiology Electronic Health Record (CEHR) system. Software consists of a structured algorithm designed under Health Level-7 (HL7) international standards. Novelty of the system is the integration of high resolution ECG (HRECG) signal acquisition and processing tools, patient information management tools and telecardiology tools. Acquisition tools are for management and control of the DIGICARDIAC electrocardiograph functions. Processing tools allow management of HRECG signal analysis searching for indicative patterns of cardiovascular pathologies. Telecardiology tools incorporation allows system communication with other health care centers decreasing access time to the patient information. CEHR system was completely developed using open source software. Preliminary results of process validation showed the system efficiency.

Japan's advanced medicine.

PubMed

Sho, Ri; Narimatsu, Hiroto; Murakami, Masayasu

2013-10-01

Like health care systems in other developed countries, Japan's health care system faces significant challenges due to aging of the population and economic stagnation. Advanced medicine (Senshin Iryou) is a unique system of medical care in Japan offering highly technology-driven medical care that is not covered by public health insurance. Advanced medicine has recently developed and expanded as part of health care reform. Will it work? To answer this question, we briefly trace the historical development of advanced medicine and describe the characteristics and current state of advanced medical care in Japan. We then offer our opinions on the future of advanced medicine with careful consideration of its pros and cons. We believe that developing advanced medicine is an attempt to bring health care reform in line rather than the goal of health care reform.

The Centre for International Mental Health Approach to Mental Health System Development

PubMed Central

Minas, Harry

2012-01-01

Although mental disorders are a major public health problem, the development of mental health services has been a low priority everywhere, particularly in low- and middle-income countries. Recent years have seen a growing understanding of the importance of population mental health and increased attention to the need to developmental health systems for responding to population mental health service needs. In countries and regions where mental health services are all but nonexistent, and in postconflict and postdisaster settings, there are many impediments to establishing or scaling up mental health services. It is frequently necessary to act simultaneously on multiple fronts: generating local evidence that will inform decision makers; developing a policy framework; securing investment; determining the most appropriate service model for the context; training and supporting mental health workers; establishing or expanding existing services; putting in place systems for monitoring and evaluation; and strengthening leadership and governance capabilities. This article presents the approach of the Centre for International Mental Health in the Melbourne School of Population Health to mental health system development, and illustrates the way in which the elements of the program are integrated by giving a brief case example from Sri Lanka. (harv rev psychiatry 2012;20:37–46.) PMID:22335181

Development of Mental Health Indicators in Korea

PubMed Central

Han, Hyeree; Ahn, Dong Hyun; Song, Jinhee; Hwang, Tae Yeon

2012-01-01

Objective Promoting mental health and preventing mental health problems are important tasks for international organizations and nations. Such goals entail the establishment of active information networks and effective systems and indicators to assess the mental health of populations. This being said, there is a need in Korea develop ways to measure the state of mental health in Korea. Methods This paper reviews the mental health indicator development policies and practices of seven organizations, countries, and regions: WHO, OECD, EU, United States, Australia, UK, and Scotland. Using Delphi method, we conducted two surveys of mental health indicators for experts in the field of mental health. The survey questionnaire included 5 domains: mental health status, mental health factor, mental health system, mental health service, and quality of mental health services. We considered 124 potential mental health indicators out of more than 600 from indicators of international organizations and foreign countries. Results We obtained the top 30 mental health indicators from the surveys. Among them, 10 indicators belong to the mental health system. The most important five mental health indicators are suicide rate, rate of increase in mental disorder treatment, burden caused by mental disorders, adequacy of identifying problems of mental health projects and deriving solutions, and annual prevalence of mental disorders. Conclusion Our study provides information about the process for indicator development and the use of survey results to measure the mental health status of the Korean population. The aim of mental health indicator development is to improve the mental health system by better grasping the current situation. We suggest these mental health indicators can monitor progress in efforts to implement reform policies, provide community services, and involve users, families and other stakeholders in mental health promotion, prevention, care and rehabilitation. PMID:23251193

Development and Implementation of a Clinical and Business Intelligence System for the Florida Health Data Warehouse

PubMed Central

AlHazme, Raed H.; Rana, Arif M.; De Lucca, Michael

2014-01-01

Objective To develop and implement a Clinical and Business Intelligence (CBI) system for the Florida Health Data Warehouse (FHDW) in order to bridge the gap between Florida’s healthcare stakeholders and the health data archived in FHWD. Materials and Methods A gap analysis study has been conducted to evaluate the technological divide between the relevant users and FHWD health data, which is maintained by the Broward Regional Health Planning Council (BRHPC). The study revealed a gap between the health care data and the decision makers that utilize the FHDW data. To bridge the gap, a CBI system was proposed, developed and implemented by BRHPC as a viable solution to address this issue, using the System Development Life Cycle methodology. Results The CBI system was successfully implemented and yielded a number of positive outcomes. In addition to significantly shortening the time required to analyze the health data for decision-making processes, the solution also provided end-users with the ability to automatically track public health parameters. Discussion A large amount of data is collected and stored by various health care organizations at the local, state, and national levels. If utilized properly, such data can go a long way in optimizing health care services. CBI systems provide health care organizations with valuable insights for improving patient care, tracking trends for medical research, and for controlling costs. Conclusion The CBI system has been found quite effective in bridging the gap between Florida’s healthcare stake holders and FHDW health data. Consequently, the solution has improved in the planning and coordination of health care services for the state of Florida. PMID:25379128

The path dependence of district manager decision-space in Ghana.

PubMed

Kwamie, Aku; van Dijk, Han; Ansah, Evelyn K; Agyepong, Irene Akua

2016-04-01

The district health system in Ghana today is characterized by high resource-uncertainty and narrow decision-space. This article builds a theory-driven historical case study to describe the influence of path-dependent administrative, fiscal and political decentralization processes on development of the district health system and district manager decision-space. Methods included a non-exhaustive literature review of democratic governance in Ghana, and key informant interviews with high-level health system officials integral to the development of the district health system. Through our analysis we identified four periods of district health system progression: (1) development of the district health system (1970-85); (2) Strengthening District Health Systems Initiative (1986-93); (3) health sector reform planning and creation of the Ghana Health Service (1994-96) and (4) health sector reform implementation (1997-2007). It was observed that district manager decision-space steadily widened during periods (1) and (2), due to increases in managerial profile, and concerted efforts at managerial capacity strengthening. Periods (3) and (4) saw initial augmentation of district health system financing, further widening managerial decision-space. However, the latter half of period 4 witnessed district manager decision-space contraction. Formalization of Ghana Health Service structures influenced by self-reinforcing tendencies towards centralized decision-making, national and donor shifts in health sector financing, and changes in key policy actors all worked to the detriment of the district health system, reversing early gains from bottom-up development of the district health system. Policy feedback mechanisms have been influenced by historical and contemporary sequencing of local government and health sector decentralization. An initial act of administrative decentralization, followed by incomplete political and fiscal decentralization has ensured that the balance of power has remained at national level, with strong vertical accountabilities and dependence of the district on national level. This study demonstrates that the rhetoric of decentralization does not always mirror actual implementation, nor always result in empowered local actors. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Health research systems: promoting health equity or economic competitiveness?

PubMed

Pratt, Bridget; Loff, Bebe

2012-01-01

International collaborative health research is justifiably expected to help reduce global health inequities. Investment in health policy and systems research in developing countries is essential to this process but, currently, funding for international research is mainly channelled towards the development of new medical interventions. This imbalance is largely due to research legislation and policies used in high-income countries. These policies have increasingly led these countries to invest in health research aimed at boosting national economic competitiveness rather than reducing health inequities. In the United States of America and the United Kingdom of Great Britain and Northern Ireland, the regulation of research has encouraged a model that: leads to products that can be commercialized; targets health needs that can be met by profitable, high-technology products; has the licensing of new products as its endpoint; and does not entail significant research capacity strengthening in other countries. Accordingly, investment in international research is directed towards pharmaceutical trials and product development public-private partnerships for neglected diseases. This diverts funding away from research that is needed to implement existing interventions and to strengthen health systems, i.e. health policy and systems research. Governments must restructure their research laws and policies to increase this essential research in developing countries.

Fundamental Technology Development for Gas-Turbine Engine Health Management

NASA Technical Reports Server (NTRS)

Mercer, Carolyn R.; Simon, Donald L.; Hunter, Gary W.; Arnold, Steven M.; Reveley, Mary S.; Anderson, Lynn M.

2007-01-01

Integrated vehicle health management technologies promise to dramatically improve the safety of commercial aircraft by reducing system and component failures as causal and contributing factors in aircraft accidents. To realize this promise, fundamental technology development is needed to produce reliable health management components. These components include diagnostic and prognostic algorithms, physics-based and data-driven lifing and failure models, sensors, and a sensor infrastructure including wireless communications, power scavenging, and electronics. In addition, system assessment methods are needed to effectively prioritize development efforts. Development work is needed throughout the vehicle, but particular challenges are presented by the hot, rotating environment of the propulsion system. This presentation describes current work in the field of health management technologies for propulsion systems for commercial aviation.

The financial performance of hospitals belonging to health networks and systems.

PubMed

Bazzoli, G J; Chan, B; Shortell, S M; D'Aunno, T

2000-01-01

The U.S. health industry is experiencing substantial restructuring through ownership consolidation and development of new forms of interorganizational relationships. Using an established taxonomy of health networks and systems, this paper develops and tests four hypotheses related to hospital financial performance. Consistent with our predictions, we find that hospitals in health systems that had unified ownership generally had better financial performance than hospitals in contractually based health networks. Among health network hospitals, those belonging to highly centralized networks had better financial performance than those belonging to more decentralized networks. However, health system hospitals in moderately centralized systems performed better than those in highly centralized systems. Finally, hospitals in networks or systems with little differentiation or centralization experienced the poorest financial performance. These results are consistent with resource dependence, transaction cost economics, and institutional theories of organizational behavior, and provide a conceptual and empirical baseline for future research.

Developing Indicators for the Child and Youth Mental Health System in Ontario.

PubMed

Yang, Julie; Kurdyak, Paul; Guttmann, Astrid

2016-01-01

When the Government of Ontario launched a comprehensive mental health and addictions strategy, the Institute for Clinical Evaluative Sciences (ICES) was tasked with developing a scorecard for ongoing monitoring of the child and youth mental health system. Using existing administrative and survey-based healthcare and education data, researchers at ICES developed a scorecard consisting of 25 indicators that described at-risk populations, child and youth mental healthcare and relevant outcomes. This scorecard is the first in Canada to report on performance indicators for the child and youth mental health system and provides a model for monitoring child and youth mental health using routinely collected administrative data.

Technological and social innovation: a unifying new paradigm for global health.

PubMed

Gardner, Charles A; Acharya, Tara; Yach, Derek

2007-01-01

This paper highlights the growing capacity for innovation in some developing countries. To maximize the potential of this phenomenon for global health, countries and donors need to link two disparate schools of thought: (1) a search for technological solutions exemplified by global public-private product development partnerships, and (2) a focus on systemic solutions exemplified by health policy and systems research. A strong capacity for both technological and social innovation in developing countries represents the only truly sustainable means of improving the effectiveness of health systems. Local public-private research and development partnerships, implementation research, and individual leadership are needed to achieve this goal.

An Electronic Health Record - Public Health (EHR-PH) System Prototype for Interoperability in 21st Century Healthcare Systems

PubMed Central

Orlova, Anna O.; Dunnagan, Mark; Finitzo, Terese; Higgins, Michael; Watkins, Todd; Tien, Allen; Beales, Steven

2005-01-01

Information exchange, enabled by computable interoperability, is the key to many of the initiatives underway including the development of Regional Health Information Exchanges, Regional Health Information Organizations, and the National Health Information Network. These initiatives must include public health as a full partner in the emerging transformation of our nation’s healthcare system through the adoption and use of information technology. An electronic health record - public health (EHR-PH) system prototype was developed to demonstrate the feasibility of electronic data transfer from a health care provider, i.e. hospital or ambulatory care settings, to multiple customized public health systems which include a Newborn Metabolic Screening Registry, a Newborn Hearing Screening Registry, an Immunization Registry and a Communicable Disease Registry, using HL7 messaging standards. Our EHR-PH system prototype can be considered a distributed EHR-based RHIE/RHIO model - a principal element for a potential technical architecture for a NHIN. PMID:16779105

Private health insurance: a role model for European health systems.

PubMed

Arentz, Christine; Eekhoff, Johann; Kochskämper, Susanna

2012-10-01

European health care systems will face major challenges in the near future. Demographic change and technological progress induce rising costs. In order to deal with these developments and to preserve the current level of health care provision, health care systems need to be highly efficient. Yet existing health care systems show a lot of inefficiencies that result in waste of scarce resources. Therefore, improvements in performance are necessary. In this article, we argue that a change in financing health care accompanied by the liberalisation of the market for health care service providers offers a promising solution. We develop a market-based model for financing health care and show how it can be put into practice without generating additional costs for society while meeting social equity criteria.

Developing a ubiquitous health management system with healthy diet control for metabolic syndrome healthcare in Taiwan.

PubMed

Kan, Yao-Chiang; Chen, Kai-Hong; Lin, Hsueh-Chun

2017-06-01

Self-management in healthcare can allow patients managing their health data anytime and everywhere for prevention of chronic diseases. This study established a prototype of ubiquitous health management system (UHMS) with healthy diet control (HDC) for people who need services of metabolic syndrome healthcare in Taiwan. System infrastructure comprises of three portals and a database tier with mutually supportive components to achieve functionality of diet diaries, nutrition guides, and health risk assessments for self-health management. With the diet, nutrition, and personal health database, the design enables the analytical diagrams on the interactive interface to support a mobile application for diet diary, a Web-based platform for health management, and the modules of research and development for medical care. For database integrity, dietary data can be stored at offline mode prior to transformation between mobile device and server site at online mode. The UHMS-HDC was developed by open source technology for ubiquitous health management with personalized dietary criteria. The system integrates mobile, internet, and electronic healthcare services with the diet diary functions to manage healthy diet behaviors of users. The virtual patients were involved to simulate the self-health management procedure. The assessment functions were approved by capturing the screen snapshots in the procedure. The proposed system development was capable for practical intervention. This approach details the expandable framework with collaborative components regarding the self-developed UHMS-HDC. The multi-disciplinary applications for self-health management can support the healthcare professionals to reduce medical resources and improve healthcare effects for the patient who requires monitoring personal health condition with diet control. The proposed system can be practiced for intervention in the hospital. Copyright © 2017 Elsevier B.V. All rights reserved.

Teleradiology as a foundation for an enterprise-wide health care delivery system.

PubMed

Dionisio, J D; Taira, R K; Sinha, U; Johnson, D B; Dai, B Y; Tashima, G H; Blythe, S; Johnson, R; Kangarloo, H

2000-01-01

An effective, integrated telemedicine system has been developed that allows (a) teleconsultation between local primary health care providers (primary care physicians and general radiologists) and remote imaging subspecialists and (b) active patient participation related to his or her medical condition and patient education. The initial stage of system development was a traditional teleradiology consultation service between general radiologists and specialists; this established system was expanded to include primary care physicians and patients. The system was developed by using a well-defined process model, resulting in three integrated modules: a patient module, a primary health care provider module, and a specialist module. A middle agent layer enables tailoring and customization of the modules for each specific user type. Implementation by using Java and the Common Object Request Broker Architecture standard facilitates platform independence and interoperability. The system supports (a) teleconsultation between a local primary health care provider and an imaging subspecialist regardless of geographic location and (b) patient education and online scheduling. The developed system can potentially form a foundation for an enterprise-wide health care delivery system. In such a system, the role of radiologist specialists is enhanced from that of a diagnostician to the management of a patient's process of care.

Is health systems integration being advanced through Local Health District planning?

PubMed

Saunders, Carla; Carter, David J

2017-05-01

Objective Delivering genuine integrated health care is one of three strategic directions in the New South Wales (NSW) Government State Health Plan: Towards 2021. This study investigated the current key health service plan of each NSW Local Health District (LHD) to evaluate the extent and nature of health systems integration strategies that are currently planned. Methods A scoping review was conducted to identify common key principles and practices for successful health systems integration to enable the development of an appraisal tool to content assess LHD strategic health service plans. Results The strategies that are planned for health systems integration across LHDs focus most often on improvements in coordination, health care access and care delivery for complex at-risk patients across the care continuum by both state- and commonwealth-funded systems, providers and agencies. The most common reasons given for integrated activities were to reduce avoidable hospitalisation, avoid inappropriate emergency department attendance and improve patient care. Conclusions Despite the importance of health systems integration and finding that all NSW LHDs have made some commitment towards integration in their current strategic health plans, this analysis suggests that health systems integration is in relatively early development across NSW. What is known about the topic? Effective approaches to managing complex chronic diseases have been found to involve health systems integration, which necessitates sound communication and connection between healthcare providers across community and hospital settings. Planning based on current health systems integration knowledge to ensure the efficient use of scarce resources is a responsibility of all health systems. What does this paper add? Appropriate planning and implementation of health systems integration is becoming an increasingly important expectation and requirement of effective health systems. The present study is the first of its kind to assess the planned activity in health systems integration in the NSW public health system. NSW health districts play a central role in health systems integration; each health service plan outlines the strategic directions for the development and delivery of all state-funded services across each district for the coming years, equating to hundreds of millions of dollars in health sector funding. The inclusion of effective health systems integration strategies allows Local Health Districts to lay the foundation for quality patient outcomes and long-term financial sustainability despite projected increases in demand for health services. What are the implications for practice? Establishing robust ongoing mechanisms for effective health systems integration is now a necessary part of health planning. The present study identifies several key areas and strategies that are wide in scope and indicative of efforts towards health systems integration, which may support Local Health Districts and other organisations in systematic planning and implementation.

Developing family practice to respond to global health challenges

PubMed Central

Arya, Neil; Dahlman, Bruce; Gibson, Christine; Ponka, David; Haq, Cynthia; Rouleau, Katherine; Hansel, Stephanie

2017-01-01

Abstract Objective To assess family medicine’s role in developing strong, coordinated, community-based, integrated health care systems in low-resource settings globally. Composition of the committee A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with selected international colleagues with expertise in international family medicine practice, health systems and capacity building, and teaching to map family medicine globally and give a bird’s eye view of family medicine internationally. Methods Following a background literature review, the authors collectively reflected on their substantial international experience to attempt to describe best practices for various contexts. Report With the failure of vertical, disease-oriented models to provide sustained improvements in health outcomes, the need to develop integrated primary care involving the most appropriate health professionals for differing contexts is becoming apparent worldwide. Health system planning is required to develop policies on health professional training to achieve this. Advocating and offering appropriate incentives for, and coordination of, local opportunities within the health system also becomes paramount. The adaptability and generalist nature of family medicine allows it to respond to the unique needs of a given population. Family physicians with adequate financial and physical resources can function most effectively as members of interdisciplinary teams, thus providing valuable, comprehensive health services in any area of the world. PMID:28807953

NIMH Prototype Management Information System for Community Mental Health Centers

PubMed Central

Wurster, Cecil R.; Goodman, John D.

1980-01-01

Various approaches to centralized support of computer applications in health care are described. The NIMH project to develop a prototype Management Information System (MIS) for community mental health centers is presented and discussed as a centralized development of an automated data processing system for multiple user organizations. The NIMH program is summarized, the prototype MIS is characterized, and steps taken to provide for the differing needs of the mental health centers are highlighted.

[Development and application of a web-based expert system using artificial intelligence for management of mental health by Korean emigrants].

PubMed

Bae, Jeongyee

2013-04-01

The purpose of this project was to develop an international web-based expert system using principals of artificial intelligence and user-centered design for management of mental health by Korean emigrants. Using this system, anyone can access the system via computer access to the web. Our design process utilized principles of user-centered design with 4 phases: needs assessment, analysis, design/development/testing, and application release. A survey was done with 3,235 Korean emigrants. Focus group interviews were also conducted. Survey and analysis results guided the design of the web-based expert system. With this system, anyone can check their mental health status by themselves using a personal computer. The system analyzes facts based on answers to automated questions, and suggests solutions accordingly. A history tracking mechanism enables monitoring and future analysis. In addition, this system will include intervention programs to promote mental health status. This system is interactive and accessible to anyone in the world. It is expected that this management system will contribute to Korean emigrants' mental health promotion and allow researchers and professionals to share information on mental health.

A model for dental hygiene education concerning the relationship between periodontal health and systemic health.

PubMed

Bush, Barbara Crafton; Donley, Timothy G

2002-01-01

To develop a format for educating the appropriate health care professionals as to the relationships between periodontal inflammation and increased risks for poor diabetes control, cardiovascular disease, cerebrovascular disease, pre-term low birth weight, pneumonia and gastric ulcer reinfection. Dental hygiene students in the Advanced Periodontology curriculum were instructed to review current literature regarding the increased risk for systemic health problems when periodontal inflammation is present. Abstracts of the reviewed material were then presented in group setting to all course participants. For each systemic entity (diabetes, cardio/cerebrovascular disease, adverse pregnancy outcome, pneumonia, gastric ulcer) literature-based evidence of periodontal disease's association, affect, pathogenesis, validity and clinical significance was determined. Consensus statements for each entity were developed and used as a basis for clinical interpretation. Following this, patient health-history materials were developed to obtain the necessary information from patients while educating them about the increased risk for systemic health problems when periodontal inflammation is present. Lastly, correspondence materials were developed to alert managing physicians and medical auxiliaries about the increased risk for systemic problems in their patients who may present with periodontal inflammation. A methodology which medical personnel can use to quickly screen for the presence of periodontal inflammation in at-risk patients was also developed in these correspondences. An educational model and clinical materials were developed which are aimed at alerting patients, dental and medical personnel to the increased risk for systemic health problems when inflammatory periodontal disease is present.

Application of system thinking concepts in health system strengthening in low-income settings: a proposed conceptual framework for the evaluation of a complex health system intervention: the case of the BHOMA intervention in Zambia.

PubMed

Mutale, Wilbroad; Balabanova, Dina; Chintu, Namwinga; Mwanamwenge, Margaret Tembo; Ayles, Helen

2016-02-01

The current drive to strengthen health systems provides an opportunity to develop new strategies that will enable countries to achieve targets for millennium development goals. In this paper, we present a proposed framework for evaluating a new health system strengthening intervention in Zambia known as Better Health Outcomes through Mentoring and Assessment. We briefly describe the intervention design and focus on the proposed evaluation approach through the lens of systems thinking. In this paper, we present a proposed framework to evaluate a complex health system intervention applying systems thinking concepts. We hope that lessons learnt from this process will help to adapt the intervention and limit unintended negative consequences while promoting positive effects. Emphasis will be paid to interaction and interdependence between health system building blocks, context and the community. © 2014 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

Open Source, Open Standards, and Health Care Information Systems

PubMed Central

2011-01-01

Recognition of the improvements in patient safety, quality of patient care, and efficiency that health care information systems have the potential to bring has led to significant investment. Globally the sale of health care information systems now represents a multibillion dollar industry. As policy makers, health care professionals, and patients, we have a responsibility to maximize the return on this investment. To this end we analyze alternative licensing and software development models, as well as the role of standards. We describe how licensing affects development. We argue for the superiority of open source licensing to promote safer, more effective health care information systems. We claim that open source licensing in health care information systems is essential to rational procurement strategy. PMID:21447469

Open source, open standards, and health care information systems.

PubMed

Reynolds, Carl J; Wyatt, Jeremy C

2011-02-17

Recognition of the improvements in patient safety, quality of patient care, and efficiency that health care information systems have the potential to bring has led to significant investment. Globally the sale of health care information systems now represents a multibillion dollar industry. As policy makers, health care professionals, and patients, we have a responsibility to maximize the return on this investment. To this end we analyze alternative licensing and software development models, as well as the role of standards. We describe how licensing affects development. We argue for the superiority of open source licensing to promote safer, more effective health care information systems. We claim that open source licensing in health care information systems is essential to rational procurement strategy.

Integrating Continuing Professional Development With Health System Reform: Building Pillars of Support.

PubMed

Davis, David A; Rayburn, William F

2016-01-01

Clinical failures sparked a widespread desire for health system reform at the beginning of the 21st century, but related efforts have resulted in changes that are either slow or nonexistent. In response, academic medicine has moved in two directions: (1) system-wide reform using electronic health records, practice networks, and widespread data applications (a macro pathway); and (2) professional development of individual clinicians through continuous performance improvement (a micro pathway). Both pathways exist to improve patient care and population health, yet each suffers from limitations in widespread implementation. The authors call for a better union between these two parallel pathways through four pillars of support: (1) an acknowledgment that both pathways are essential to each other and to the final outcome they intend to achieve, (2) a strong faculty commitment to educate about quality improvement and patient safety at all education levels, (3) a reengineering of tools for professional development to serve as effective change agents, and (4) the development of standards to sustain this alignment of pathways. With these pillars of support integrating continuing professional development with health system reform, the authors envision a better functioning system, with improved metrics and value to enhance patient care and population health.

Development goals in the post-2015 world: whither Canada?

PubMed

Labonté, Ronald

2014-05-29

A new set of post-2015 development goals for the world is being negotiated. Several potential goals relating to sustainable development, poverty, the economy and health have been identified. Many of them have potential public health gains, although there are inadequacies in how several of them have been defined. In participating in finalization of these goals, Canada should strengthen its commitments to maternal/child health; promote its publicly funded health system as an important model for universal health coverage; incorporate stronger protections for public health in trade and investment treaties; use its foreign aid to help low- and middle-income countries build the transparent and progressive tax systems to mobilize domestic revenues for health; and promote global systems of taxation to prevent tax evasion and illicit capital flight.

Population Health Measurement: Applying Performance Measurement Concepts in Population Health Settings

PubMed Central

Stoto, Michael A.

2014-01-01

Introduction: Whether the focus of population-health improvement efforts, the measurement of health outcomes, risk factors, and interventions to improve them are central to achieving collective impact in the population health perspective. And because of the importance of a shared measurement system, appropriate measures can help to ensure the accountability of and ultimately integrate the efforts of public health, the health care delivery sector, and other public and private entities in the community to improve population health. Yet despite its importance, population health measurement efforts in the United States are poorly developed and uncoordinated. Collaborative Measurement Development: To achieve the potential of the population health perspective, public health officials, health system leaders, and others must work together to develop sets of population health measures that are suitable for different purposes yet are harmonized so that together they can help to improve a community’s health. This begins with clearly defining the purpose of a set of measures, distinguishing between outcomes for which all share responsibility and actions to improve health for which the health care sector, public health agencies, and others should be held accountable. Framework for Population Health Measurement: Depending on the purpose of the analysis, then, measurement systems should clearly specify what to measure—in particular the population served (the denominator), what the critical health dimensions are in a measurement framework, and how the measures can be used to ensure accountability. Building on a clear understanding of the purpose and dimensions of population health that must be measured, developers can then choose specific measures using existing data or developing new data sources if necessary, with established validity, reliability, and other scientific characteristics. Rather than indiscriminately choosing among the proliferating data streams, this systematic approach to measure development can yield measurement systems that are more appropriate and useful for improving population health. PMID:25995988

[The Tallinn Charter: health systems for health and wealth].

PubMed

Piotrowicz, Maria; Cianciara, Dorota; Wysocki, Mirosław J

2009-01-01

The article presents main issues of Tallinn Charter (2008) that concerns functioning health systems, theirs influence on health and wealth of society. Health systems are diverse, but share common set of functions. Theirs effective performance contribute, not only to improving health, but also to participation in labour market and socioeconomical development of country.

Connections Matter: Social Networks and Lifespan Health in Primate Translational Models

PubMed Central

McCowan, Brenda; Beisner, Brianne; Bliss-Moreau, Eliza; Vandeleest, Jessica; Jin, Jian; Hannibal, Darcy; Hsieh, Fushing

2016-01-01

Humans live in societies full of rich and complex relationships that influence health. The ability to improve human health requires a detailed understanding of the complex interplay of biological systems that contribute to disease processes, including the mechanisms underlying the influence of social contexts on these biological systems. A longitudinal computational systems science approach provides methods uniquely suited to elucidate the mechanisms by which social systems influence health and well-being by investigating how they modulate the interplay among biological systems across the lifespan. In the present report, we argue that nonhuman primate social systems are sufficiently complex to serve as model systems allowing for the development and refinement of both analytical and theoretical frameworks linking social life to health. Ultimately, developing systems science frameworks in nonhuman primate models will speed discovery of the mechanisms that subserve the relationship between social life and human health. PMID:27148103

Stakeholder driven indicators for eHealth performance management.

PubMed

Vedlūga, Tomas; Mikulskienė, Birutė

2017-08-01

The goal of the present article is to compile a corpus of indicators of eHealth development evaluation that would essentially reflect stakeholder approaches and complement technical indicators of assessment of an eHealth system. Consequently, the assessment of the development of an eHealth system would reflect stakeholder approaches and become an innovative solution in attempting to improve productivity of IT projects in the field of health care. The compiled minimum set of indicators will be designed to monitor implementation of the national eHealth information system. To ensure reliability of the quality research, the respondents were grouped in accordance to the geographical distribution and diversity of the levels and types of the represented jobs and institutions. The applied analysis implies several managerial insights on the hierarchy of eHealth indicators. These insights may be helpful in recommending priority activities in implementation of an eHealth data system on the national or international level. The research is practically useful as it is the first to deal with the topic in Lithuania and its theoretical and practical aspect are particularly relevant in implementation of an eHealth data system in Lithuania. The eHealth assessment indicators presented in the article may be practically useful in two aspects: (1) as key implementation guidelines facilitating the general course of eHealth system development and (2) as a means to evaluate eHealth outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Report on the International Conference on Emergency Health Care Development.

PubMed Central

Dines, G B

1990-01-01

Emergency medical services (EMS) provide rescue, field stabilization, transportation to medical facilities, and definitive care for persons experiencing medical emergencies. In order to advance worldwide development and refinement of EMS systems, and their integration with emergency preparedness and response programs, the International Conference on Emergency Health Care Development was held in Crystal City, Arlington, VA, August 15-19, 1989. The conference was supported by the Department of Health and Human Services and its Health Resources and Services Administration; the Department of Transportation and its National Highway Traffic and Safety Administration; and the Pan American Health Organization. Objectives of the conference were to clarify linkages between various levels of emergency response, to present methods for developing or improving EMS systems within societies with different resources, to demonstrate processes by which EMS systems have been developed, and to propose international emergency health care development goals. Topics included development of services in developing nations, case studies of underdeveloped countries' responses to natural disasters, and a method for updating disaster response through use of available medical resources. PMID:1968669

Comparison of the Determinants of the Health Service System and the Health Status of the People in the Greater Mekong Subregion (GMS).

PubMed

Phanphairoj, Kanjanee; Loa, Ritzmond

2017-12-01

Health is influenced by numerous factors that affect the health service system and health status of the people in every country. This article aims to compare the determinants of the health service system and the health status of the people in Thailand, the Lao PDR, Vietnam, and Cambodia; and to recommend policies that impact the population's health and the country's development. Methods: A comprehensive search of the literature from a variety of online search and academic databases, and synthesis of previous study was used in this paper. Data on country indicators were taken from published online databases of the Ministry of Public Health of Cambodia, Lao PDR, Thailand,and Vietnam; the World Health Organization, and the World Bank. In Thailand, the determinants of the health service system and health status of the people are medical information and technology because of the government initiatives to improve the quality of healthcare services through the use of modern technology. In Vietnam, the society and culture, and the strengths and weaknesses of the hospital significantly affect the health status and health service system there because of the religious beliefs of the people. However, in Cambodia, the strengths and weaknesses of the hospital are the primary determinant of the health service system and health status of the people due to the condition of the hospitals, the availability of new medical devices, and the number of healthcare professionals. In the Lao PDR, trade and investment, and medical information and technology, significantly influence the health service system and health status of the people because of the government efforts to outsource capital expenditures and medical technology. The strengths and weaknesses of the hospital are the key determinants of the health service system and health status of the people in all GMS countries. Understanding the determinants of health is essential in order to develop policies and programs that impact the population's health and the country's development.

Thinking about complexity in health: A systematic review of the key systems thinking and complexity ideas in health.

PubMed

Rusoja, Evan; Haynie, Deson; Sievers, Jessica; Mustafee, Navonil; Nelson, Fred; Reynolds, Martin; Sarriot, Eric; Swanson, Robert Chad; Williams, Bob

2018-01-30

As the Sustainable Development Goals are rolled out worldwide, development leaders will be looking to the experiences of the past to improve implementation in the future. Systems thinking and complexity science (ST/CS) propose that health and the health system are composed of dynamic actors constantly evolving in response to each other and their context. While offering practical guidance for steering the next development agenda, there is no consensus as to how these important ideas are discussed in relation to health. This systematic review sought to identify and describe some of the key terms, concepts, and methods in recent ST/CS literature. Using the search terms "systems thinkin * AND health OR complexity theor* AND health OR complex adaptive system* AND health," we identified 516 relevant full texts out of 3982 titles across the search period (2002-2015). The peak number of articles were published in 2014 (83) with journals specifically focused on medicine/healthcare (265) and particularly the Journal of Evaluation in Clinical Practice (37) representing the largest number by volume. Dynamic/dynamical systems (n = 332), emergence (n = 294), complex adaptive system(s) (n = 270), and interdependent/interconnected (n = 263) were the most common terms with systems dynamic modelling (58) and agent-based modelling (43) as the most common methods. The review offered several important conclusions. First, while there was no core ST/CS "canon," certain terms appeared frequently across the reviewed texts. Second, even as these ideas are gaining traction in academic and practitioner communities, most are concentrated in a few journals. Finally, articles on ST/CS remain largely theoretical illustrating the need for further study and practical application. Given the challenge posed by the next phase of development, gaining a better understanding of ST/CS ideas and their use may lead to improvements in the implementation and practice of the Sustainable Development Goals. Key messages Systems thinking and complexity science, theories that acknowledge the dynamic, connected, and context-dependent nature of health, are highly relevant to the post-millennium development goal era yet lack consensus on their use in relation to health Although heterogeneous, terms, and concepts like emergence, dynamic/dynamical Systems, nonlinear(ity), and interdependent/interconnected as well as methods like systems dynamic modelling and agent-based modelling that comprise systems thinking and complexity science in the health literature are shared across an increasing number of publications within medical/healthcare disciplines Planners, practitioners, and theorists that can better understand these key systems thinking and complexity science concepts will be better equipped to tackle the challenges of the upcoming development goals. © 2018 John Wiley & Sons, Ltd.

Roads to Health in Developing Countries: Understanding the Intersection of Culture and Healing.

PubMed

Ibeneme, S; Eni, G; Ezuma, A; Fortwengel, G

2017-01-01

The most important attribute to which all human beings aspire is good health because it enables us to undertake different forms of activities of daily living. The emergence of scientific knowledge in Western societies has enabled scientists to explore and define several parameters of health by drawing boundaries around factors that are known to influence the attainment of good health. For example, the World Health Organization defined health by taking physical and psychological factors into consideration. Their definition of health also included a caveat that says, "not merely the absence of sickness." This definition has guided scientists and health care providers in the Western world in the development of health care programs in non-Western societies. However, ethnomedical beliefs about the cause(s) of illness have given rise to alternative theories of health, sickness, and treatment approaches in the developing world. Thus, there is another side to the story. Much of the population in developing countries lives in rural settings where the knowledge of health, sickness, and care has evolved over centuries of practice and experience. The definition of health in these settings tends to orient toward cultural beliefs, traditional practices, and social relationships. Invariably, whereas biomedicine is the dominant medical system in Western societies, traditional medicine-or ethnomedicine-is often the first port of call for patients in developing countries. The 2 medical systems represent, and are influenced by, the cultural environment in which they exist. On one hand, biomedicine is very effective in the treatment of objective, measurable disease conditions. On the other hand, ethnomedicine is effective in the management of illness conditions or the experience of disease states. Nevertheless, an attempt to supplant 1 system of care with another from a different cultural environment could pose enormous challenges in non-Western societies. In general, we, as human beings, are guided in our health care decisions by past experiences, family and friends, social networks, cultural beliefs, customs, tradition, professional knowledge, and intuition. No medical system has been shown to address all of these elements; hence, the need for collaboration, acceptance, and partnership between all systems of care in cultural communities. In developing countries, the roads to health are incomplete without an examination of the intersection of culture and healing. Perhaps mutual exclusiveness rather inclusiveness of these 2 dominant health systems is the greatest obstacle to health in developing countries.

Developing Crew Health Care and Habitability Systems for the Exploration Vision

NASA Technical Reports Server (NTRS)

Laurini, Kathy; Sawin, Charles F.

2006-01-01

This paper will discuss the specific mission architectures associated with the NASA Exploration Vision and review the challenges and drivers associated with developing crew health care and habitability systems to manage human system risks. Crew health care systems must be provided to manage crew health within acceptable limits, as well as respond to medical contingencies that may occur during exploration missions. Habitability systems must enable crew performance for the tasks necessary to support the missions. During the summer of 2005, NASA defined its exploration architecture including blueprints for missions to the moon and to Mars. These mission architectures require research and technology development to focus on the operational risks associated with each mission, as well as the risks to long term astronaut health. This paper will review the highest priority risks associated with the various missions and discuss NASA s strategies and plans for performing the research and technology development necessary to manage the risks to acceptable levels.

Expecting the unexpected: applying the Develop-Distort Dilemma to maximize positive market impacts in health.

PubMed

Peters, David H; Paina, Ligia; Bennett, Sara

2012-10-01

Although health interventions start with good intentions to develop services for disadvantaged populations, they often distort the health market, making the delivery or financing of services difficult once the intervention is over: a condition called the 'Develop-Distort Dilemma' (DDD). In this paper, we describe how to examine whether a proposed intervention may develop or distort the health market. Our goal is to produce a tool that facilitates meaningful and systematic dialogue for practitioners and researchers to ensure that well-intentioned health interventions lead to productive health systems while reducing the undesirable distortions of such efforts. We apply the DDD tool to plan for development rather than distortions in health markets, using intervention research being conducted under the Future Health Systems consortium in Bangladesh, China and Uganda. Through a review of research proposals and interviews with principal investigators, we use the DDD tool to systematically understand how a project fits within the broader health market system, and to identify gaps in planning for sustainability. We found that while current stakeholders and funding sources for activities were easily identified, future ones were not. The implication is that the projects could raise community expectations that future services will be available and paid for, despite this actually being uncertain. Each project addressed the 'rules' of the health market system differently. The China research assesses changes in the formal financing rules, whereas Bangladesh and Uganda's projects involve influencing community level providers, where informal rules are more important. In each case, we recognize the importance of building trust between providers, communities and government officials. Each project could both develop and distort local health markets. Anyone intervening in the health market must recognize the main market perturbations, whether positive or negative, and manage them so as to maximize the benefits to the health system and population health.

How AIDS funding strengthens health systems: progress in pharmaceutical management.

PubMed

Embrey, Martha; Hoos, David; Quick, Jonathan

2009-11-01

In recent years, new global initiatives responding to the AIDS crisis have dramatically affected-and often significantly improved-how developing countries procure, distribute, and manage pharmaceuticals. A number of developments related to treatment scale-up, initially focused on AIDS-related products, have created frameworks for widening access to medicines for other diseases that disproportionally impact countries with limited resources and for strengthening health systems overall. Examples of such systems strengthening have come in the areas of drug development and pricing; policy and regulation; pharmaceutical procurement, distribution, and use; and management systems, such as for health information and human resources. For example, a hospital in South Africa developed new tools to decentralize provision of antiretroviral therapy to local clinics-bringing treatment closer to patients and shifting responsibility from scarce pharmacists to lower level pharmacy staff. Successful, the system was expanded to patients with other chronic conditions, such as mental illness. Progress toward universal access to HIV prevention, treatment, care, and support will continue the push to strengthen pharmaceutical sectors that serve not only HIV-related needs but all health needs; health experts can likely take these achievements further to maximize their expansion into the wider health system.

Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study.

PubMed

Muinga, Naomi; Magare, Steve; Monda, Jonathan; Kamau, Onesmus; Houston, Stuart; Fraser, Hamish; Powell, John; English, Mike; Paton, Chris

2018-04-18

The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa. ©Naomi Muinga, Steve Magare, Jonathan Monda, Onesmus Kamau, Stuart Houston, Hamish Fraser, John Powell, Mike English, Chris Paton. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 18.04.2018.

Development of a health care systems curriculum.

PubMed

Pruitt, Zachary; Mhaskar, Rahul; Kane, Bryan G; Barraco, Robert D; DeWaay, Deborah J; Rosenau, Alex M; Bresnan, Kristin A; Greenberg, Marna Rayl

2017-01-01

There is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution. This case study describes the application of a problem-based learning approach to system-based practice medical education. A series of behavioral statements, called entrustable professional activities, was created to assess student health system competence. Student evaluation of course curriculum design, delivery, and assessment was provided through web-based surveys. To meet competency standards for system-based practice, a health systems curriculum was developed and delivered across 4 years of medical school training. Each of the health system lectures and problem-based learning activities are described herein. The majority of first and second year medical students stated they gained working knowledge of health systems by engaging in these sessions. The majority of the 2016 graduating students (88.24%) felt that the course content, overall, prepared them for their career. A health systems curriculum in undergraduate medical education using a problem-based learning approach is feasible. The majority of students learning health systems curriculum through this format reported being prepared to improve individual patient care and optimize the health system's value (better care and health for lower cost).

System Justification, Mental Health, and Behavior Among Disadvantaged Mothers and Their Children

PubMed Central

Godfrey, Erin B.

2014-01-01

Integrating social psychological research with work in child development, this study explored relationships between system justification (Jost & Banaji, 1994), maternal mental health and child externalizing behavior among low-income immigrants and racial/ethnic minorities. Dominican, Mexican and African-American families (N = 239) were assessed when children were 14-, 24- and 36-months old. SEM was used to explore longitudinal relationships between maternal system justification and mental health and associations with child behavior. Earlier mental health was negatively related to later system justification and system justification was negatively related to children’s externalizing behavior. Implications for system justification theory, child development and immigration are discussed. PMID:25035527

Fix These First: How the World's Leading Companies Point the Way Toward High Reliability in the Military Health System.

PubMed

Beauvais, Brad; Richter, Jason; Brezinski, Paul

The 2014 Military Health System Review calls for healthcare system leaders to implement effective strategies used by other high-performing organizations. The authors state, " the [military health system] MHS can create an optimal healthcare environment that focuses on continuous quality improvement where every patient receives safe, high-quality care at all times" (Military Health System, 2014, p. 1). Although aspirational, the document does not specify how a highly reliable health system is developed or what systemic factors are necessary to sustain highly reliable performance. Our work seeks to address this gap and provide guidance to MHS leaders regarding how high-performing organizations develop exceptional levels of performance.The authors' expectation is that military medicine will draw on these lessons to enhance leadership, develop exceptional organizational cultures, onboard and engage employees, build customer loyalty, and improve quality of care. Leaders from other segments of the healthcare field likely will find this study valuable given the size of the military healthcare system (9.6 million beneficiaries), the United States' steady progression toward population-based health, and the increasing need for highly reliable systems and performance.

Development of a flood-induced health risk prediction model for Africa

NASA Astrophysics Data System (ADS)

Lee, D.; Block, P. J.

2017-12-01

Globally, many floods occur in developing or tropical regions where the impact on public health is substantial, including death and injury, drinking water, endemic disease, and so on. Although these flood impacts on public health have been investigated, integrated management of floods and flood-induced health risks is technically and institutionally limited. Specifically, while the use of climatic and hydrologic forecasts for disaster management has been highlighted, analogous predictions for forecasting the magnitude and impact of health risks are lacking, as is the infrastructure for health early warning systems, particularly in developing countries. In this study, we develop flood-induced health risk prediction model for African regions using season-ahead flood predictions with climate drivers and a variety of physical and socio-economic information, such as local hazard, exposure, resilience, and health vulnerability indicators. Skillful prediction of flood and flood-induced health risks can contribute to practical pre- and post-disaster responses in both local- and global-scales, and may eventually be integrated into multi-hazard early warning systems for informed advanced planning and management. This is especially attractive for areas with limited observations and/or little capacity to develop flood-induced health risk warning systems.

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.

Meeting the Challenges of Exploration Systems: Health Management Technologies for Aerospace Systems With Emphasis on Propulsion

NASA Technical Reports Server (NTRS)

Melcher, Kevin J.; Sowers, T. Shane; Maul, William A.

2005-01-01

The constraints of future Exploration Missions will require unique Integrated System Health Management (ISHM) capabilities throughout the mission. An ambitious launch schedule, human-rating requirements, long quiescent periods, limited human access for repair or replacement, and long communication delays all require an ISHM system that can span distinct yet interdependent vehicle subsystems, anticipate failure states, provide autonomous remediation, and support the Exploration Mission from beginning to end. NASA Glenn Research Center has developed and applied health management system technologies to aerospace propulsion systems for almost two decades. Lessons learned from past activities help define the approach to proper ISHM development: sensor selection- identifies sensor sets required for accurate health assessment; data qualification and validation-ensures the integrity of measurement data from sensor to data system; fault detection and isolation-uses measurements in a component/subsystem context to detect faults and identify their point of origin; information fusion and diagnostic decision criteria-aligns data from similar and disparate sources in time and use that data to perform higher-level system diagnosis; and verification and validation-uses data, real or simulated, to provide variable exposure to the diagnostic system for faults that may only manifest themselves in actual implementation, as well as faults that are detectable via hardware testing. This presentation describes a framework for developing health management systems and highlights the health management research activities performed by the Controls and Dynamics Branch at the NASA Glenn Research Center. It illustrates how those activities contribute to the development of solutions for Integrated System Health Management.

Developed-developing country partnerships: benefits to developed countries?

PubMed

Syed, Shamsuzzoha B; Dadwal, Viva; Rutter, Paul; Storr, Julie; Hightower, Joyce D; Gooden, Rachel; Carlet, Jean; Bagheri Nejad, Sepideh; Kelley, Edward T; Donaldson, Liam; Pittet, Didier

2012-06-18

Developing countries can generate effective solutions for today's global health challenges. This paper reviews relevant literature to construct the case for international cooperation, and in particular, developed-developing country partnerships. Standard database and web-based searches were conducted for publications in English between 1990 and 2010. Studies containing full or partial data relating to international cooperation between developed and developing countries were retained for further analysis. Of 227 articles retained through initial screening, 65 were included in the final analysis. The results were two-fold: some articles pointed to intangible benefits accrued by developed country partners, but the majority of information pointed to developing country innovations that can potentially inform health systems in developed countries. This information spanned all six WHO health system components. Ten key health areas where developed countries have the most to learn from the developing world were identified and include, rural health service delivery; skills substitution; decentralisation of management; creative problem-solving; education in communicable disease control; innovation in mobile phone use; low technology simulation training; local product manufacture; health financing; and social entrepreneurship. While there are no guarantees that innovations from developing country experiences can effectively transfer to developed countries, combined developed-developing country learning processes can potentially generate effective solutions for global health systems. However, the global pool of knowledge in this area is virgin and further work needs to be undertaken to advance understanding of health innovation diffusion. Even more urgently, a standardized method for reporting partnership benefits is needed--this is perhaps the single most immediate need in planning for, and realizing, the full potential of international cooperation between developed and developing countries.

The State Public Health Laboratory System.

PubMed

Inhorn, Stanley L; Astles, J Rex; Gradus, Stephen; Malmberg, Veronica; Snippes, Paula M; Wilcke, Burton W; White, Vanessa A

2010-01-01

This article describes the development since 2000 of the State Public Health Laboratory System in the United States. These state systems collectively are related to several other recent public health laboratory (PHL) initiatives. The first is the Core Functions and Capabilities of State Public Health Laboratories, a white paper that defined the basic responsibilities of the state PHL. Another is the Centers for Disease Control and Prevention National Laboratory System (NLS) initiative, the goal of which is to promote public-private collaboration to assure quality laboratory services and public health surveillance. To enhance the realization of the NLS, the Association of Public Health Laboratories (APHL) launched in 2004 a State Public Health Laboratory System Improvement Program. In the same year, APHL developed a Comprehensive Laboratory Services Survey, a tool to measure improvement through the decade to assure that essential PHL services are provided.

Strengthening health systems by health sector reforms.

PubMed

Senkubuge, Flavia; Modisenyane, Moeketsi; Bishaw, Tewabech

2014-01-01

The rising burden of disease and weak health systems are being compounded by the persistent economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health systems, including dealing with social, environmental, and economic determinants through multisectoral responses. A review and analysis of data on strengthening health sector reform and health systems was conducted. Attention was paid to the goal of health and interactions between health sector reforms and the functions of health systems. Further, we explored how these interactions contribute toward delivery of health services, equity, financial protection, and improved health. Health sector reforms cannot be developed from a single global or regional policy formula. Any reform will depend on the country's history, values and culture, and the population's expectations. Some of the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a comprehensive policy package for health sector reforms; improving alignment of planning and coordination; use of reliable data; engaging 'street level' policy implementers; strengthening governance and leadership; and allowing a holistic and developmental approach to reforms. The process of reform needs a fundamental rather than merely an incremental and evolutionary change. Without radical structural and systemic changes, existing governance structures and management systems will continue to fail to address the existing health problems.

A layman's guide to the U.S. health care system

PubMed Central

De Lew, Nancy; Greenberg, George; Kinchen, Kraig

1992-01-01

This article provides an overview of the U.S. health care system and recent proposals for health system reform. Prepared for a 15-nation comparative study for the Organization for Economic Cooperation and Development (OECD), the article summarizes descriptive data on the financing, utilization, access, and supply of U.S. health services; analyzes health system cost growth and trends; reviews health reforms adopted in the 1980s; and discusses proposals in the current health system reform debate. PMID:10124436

Challenges and opportunities for effective adoption of HRH information systems in developing countries: national rollout of HRHIS and TIIS in Tanzania.

PubMed

Ishijima, Hisahiro; Mapunda, Martin; Mndeme, Mathew; Sukums, Felix; Mlay, Violeth Solomon

2015-06-16

The establishment of a functional information system for human resource for health (HRH) was one of the major challenges for the Tanzanian health sector. In 2008, the Ministry of Health and Social Welfare developed the HRH Strategic Plan, in which establishment of computerized information systems were one of the strategic objectives. In response to this objective, the Ministry developed two information systems, namely the Human Resource for Health Information System (HRHIS) and the Training Institution Information System (TIIS), to capture information from both the public and private sectors. The national rollout of HRHIS and TIIS was carried out in four phases during a 6 year period between 2009 and 2014. Together with other activities, the rollout process included conducting system operation training and data utilization training for evidence-based planning, development and management of HRH and social welfare workers and health training institutions. HRHIS was rolled out in all 25 regions of the Tanzanian mainland, including 171 districts, and TIIS was rolled out in all 154 health training institutions and universities. Information is captured from both the private and public health sectors with high-data coverage. The authors identified several key factors for the achievements such as using local experts for developing the systems, involvement of system users, positive attitudes among users, focusing on routine work of the system users and provision of operations and data utilization trainings. However, several challenges were also identified such as getting a consensus on sustainable HR information systems among stakeholders, difficulty in obtaining baseline HRH information, inadequate computer skills and unsatisfactory infrastructure for information and communication technology. We learned that detailed situation analysis and understanding of the reality on the ground helped to reduce the "design-reality gap" and contributed to establishing user-friendly systems and to improve sustainability of the systems. This paper illustrates the successful development and national rollout of two information systems for HRH in Tanzania. The approaches used and activities conducted here and lessons learned could be useful for countries which are planning to establish HR information systems.

Health research systems: promoting health equity or economic competitiveness?

PubMed Central

Loff, Bebe

2012-01-01

Abstract International collaborative health research is justifiably expected to help reduce global health inequities. Investment in health policy and systems research in developing countries is essential to this process but, currently, funding for international research is mainly channelled towards the development of new medical interventions. This imbalance is largely due to research legislation and policies used in high-income countries. These policies have increasingly led these countries to invest in health research aimed at boosting national economic competitiveness rather than reducing health inequities. In the United States of America and the United Kingdom of Great Britain and Northern Ireland, the regulation of research has encouraged a model that: leads to products that can be commercialized; targets health needs that can be met by profitable, high-technology products; has the licensing of new products as its endpoint; and does not entail significant research capacity strengthening in other countries. Accordingly, investment in international research is directed towards pharmaceutical trials and product development public–private partnerships for neglected diseases. This diverts funding away from research that is needed to implement existing interventions and to strengthen health systems, i.e. health policy and systems research. Governments must restructure their research laws and policies to increase this essential research in developing countries. PMID:22271965

Building health research systems: WHO is generating global perspectives, and who's celebrating national successes?

PubMed

Hanney, Stephen R; González-Block, Miguel A

2016-12-28

In 2016, England's National Institute for Health Research (NIHR) celebrated its tenth anniversary as an innovative national health research system with a focus on meeting patients' needs. This provides a good opportunity to reflect on how the creation of the NIHR has greatly enhanced important work, started in 1991, to develop a health research system in England that is embedded in the National Health Service.In 2004, WHO identified a range of functions that a national health research system should undertake to improve the health of populations. Health Research Policy and Systems (HRPS) has taken particular interest in the pioneering developments in the English health research system, where the comprehensive approach has covered most, if not all, of the functions identified by WHO. Furthermore, several significant recent developments in thinking about health research are relevant for the NIHR and have informed accounts of its achievements. These include recognition of the need to combat waste in health research, which had been identified as a global problem in successive papers in the Lancet, and an increasing emphasis on demonstrating impact. Here, pioneering evaluation of United Kingdom research, conducted through the impact case studies of the Research Excellence Framework, is particularly important. Analyses informed by these and other approaches identified many aspects of NIHR's progress in combating waste, building and sustaining research capacity, creating centres of research excellence linked to leading healthcare institutions, developing research networks, involving patients and others in identifying research needs, and producing and adopting research findings that are improving health outcomes.The NIHR's overall success, and an analysis of the remaining problems, might have lessons for other systems, notwithstanding important advances in many countries, as described in papers in HRPS and elsewhere. WHO's recently established Global Observatory for Health Research and Development provides an opportunity to promote some of these lessons. To inform its work, the Observatory is sponsoring a thematic series of papers in HRPS focusing on health research issues such as funding flows, priority setting, capacity building, utilisation and equity. While important papers on these have been published, this series is still open to new submissions.

International obligations through collective rights: Moving from foreign health assistance to global health governance.

PubMed

Meier, Benjamin Mason; Fox, Ashley M

2010-06-15

This article analyzes the growing chasm between international power and state responsibility in health rights, proposing an international legal framework for collective rights - rights that can reform international institutions and empower developing states to realize the determinants of health structured by global forces. With longstanding recognition that many developing state governments cannot realize the health of their peoples without international cooperation, scholars have increasingly sought to codify international obligations under the purview of an evolving human right to health, applying this rights-based approach as a foundational framework for reducing global health inequalities through foreign assistance. Yet the inherent limitations of the individual human rights framework stymie the right to health in impacting the global institutions that are most crucial for realizing underlying determinants of health through the strengthening of primary health care systems. Whereas the right to health has been advanced as an individual right to be realized by a state duty-bearer, the authors find that this limited, atomized right has proven insufficient to create accountability for international obligations in global health policy, enabling the deterioration of primary health care systems that lack the ability to address an expanding set of public health claims. For rights scholars to advance disease protection and health promotion through national primary health care systems - creating the international legal obligations necessary to spur development supportive of the public's health - the authors conclude that scholars must look beyond the individual right to health to create collective international legal obligations commensurate with a public health-centered approach to primary health care. Through the development and implementation of these collective health rights, states can address interconnected determinants of health within and across countries, obligating the international community to scale-up primary health care systems in the developing world and thereby reduce public health inequities through global health governance.

Health policy and systems research: towards a better understanding and review of ethical issues.

PubMed

Luyckx, Valerie Ann; Biller-Andorno, Nikola; Saxena, Abha; Tran, Nhan T

2017-01-01

Given the focus on health systems in the post-millennium development goal era and moving towards the sustainable development goals, there is a compelling need for a common framework for health policy and systems research ethics to guide researchers and facilitate review by research ethics committees. A consultation of global health policy and systems research and ethics experts was convened to identify ethical considerations relevant to health policy and systems research based on existing knowledge and to identify knowledge gaps through a scoping review and further expert deliberation. Health policy and systems research is highly complex and, in the absence of guidance documents, there is significant variability in ethics review. Although fundamental ethical principles pertain to both traditional clinical research and health policy and systems research, the application of these principles requires a comprehensive understanding of the nature of health policy and systems research with its distinct challenges. Such awareness must be raised among researchers and research ethics committees. Current research ethics committees lack familiarity with health policy and systems research and because health policy and systems research is conducted in real-world contexts, committees often have difficulties in determining whether a project is indeed research and/or requires ethical review. Given the strong current focus on health policy and systems research to rapidly improve health and health systems functioning globally, greater engagement and dialogue around the ethical concerns is required to optimise research review and research conduct in this rapidly evolving field.

Health policy and systems research: towards a better understanding and review of ethical issues

PubMed Central

Biller-Andorno, Nikola; Saxena, Abha; Tran, Nhan T

2017-01-01

Given the focus on health systems in the post-millennium development goal era and moving towards the sustainable development goals, there is a compelling need for a common framework for health policy and systems research ethics to guide researchers and facilitate review by research ethics committees. A consultation of global health policy and systems research and ethics experts was convened to identify ethical considerations relevant to health policy and systems research based on existing knowledge and to identify knowledge gaps through a scoping review and further expert deliberation. Health policy and systems research is highly complex and, in the absence of guidance documents, there is significant variability in ethics review. Although fundamental ethical principles pertain to both traditional clinical research and health policy and systems research, the application of these principles requires a comprehensive understanding of the nature of health policy and systems research with its distinct challenges. Such awareness must be raised among researchers and research ethics committees. Current research ethics committees lack familiarity with health policy and systems research and because health policy and systems research is conducted in real-world contexts, committees often have difficulties in determining whether a project is indeed research and/or requires ethical review. Given the strong current focus on health policy and systems research to rapidly improve health and health systems functioning globally, greater engagement and dialogue around the ethical concerns is required to optimise research review and research conduct in this rapidly evolving field. PMID:29225934

Optimal Sensor Selection for Health Monitoring Systems

NASA Technical Reports Server (NTRS)

Santi, L. Michael; Sowers, T. Shane; Aguilar, Robert B.

2005-01-01

Sensor data are the basis for performance and health assessment of most complex systems. Careful selection and implementation of sensors is critical to enable high fidelity system health assessment. A model-based procedure that systematically selects an optimal sensor suite for overall health assessment of a designated host system is described. This procedure, termed the Systematic Sensor Selection Strategy (S4), was developed at NASA John H. Glenn Research Center in order to enhance design phase planning and preparations for in-space propulsion health management systems (HMS). Information and capabilities required to utilize the S4 approach in support of design phase development of robust health diagnostics are outlined. A merit metric that quantifies diagnostic performance and overall risk reduction potential of individual sensor suites is introduced. The conceptual foundation for this merit metric is presented and the algorithmic organization of the S4 optimization process is described. Representative results from S4 analyses of a boost stage rocket engine previously under development as part of NASA's Next Generation Launch Technology (NGLT) program are presented.

Community health nursing vision for 2020: shaping the future.

PubMed

Schofield, Ruth; Ganann, Rebecca; Brooks, Sandy; McGugan, Jennifer; Dalla Bona, Kim; Betker, Claire; Dilworth, Katie; Parton, Laurie; Reid-Haughian, Cheryl; Slepkov, Marlene; Watson, Cori

2011-12-01

As health care is shifting from hospital to community, community health nurses (CHNs) are directly affected. This descriptive qualitative study sought to understand priority issues currently facing CHNs, explore development of a national vision for community health nursing, and develop recommendations to shape the future of the profession moving toward the year 2020. Focus groups and key informant interviews were conducted across Canada. Five key themes were identified: community health nursing in crisis now, a flawed health care system, responding to the public, vision for the future, and CHNs as solution makers. Key recommendations include developing a common definition and vision of community health nursing, collaborating on an aggressive plan to shift to a primary health care system, developing a comprehensive social marketing strategy, refocusing basic baccalaureate education, enhancing the capacity of community health researchers and knowledge in community health nursing, and establishing a community health nursing center of excellence.

The Role of the U.S. Army in Health System Reconstruction and Development During Counterinsurgency

DTIC Science & Technology

2012-06-08

freedom. — Amartya Sen Development as Freedom Military medical personnel involved in health system reconstruction and development in Iraq and...Afghanistan. New York: W.W. Norton and Company, 2009. Sen , Amartya . Development as Freedom. New York: Anchor Books, 2000. Special Inspector General for

Use of Electronic Technologies to Promote Community and Personal Health for Individuals Unconnected to Health Care Systems

PubMed Central

Crilly, John F.; Volpe, Fred

2011-01-01

Ensuring health care services for populations outside the mainstream health care system is challenging for all providers. But developing the health care infrastructure to better serve such unconnected individuals is critical to their health care status, to third-party payers, to overall cost savings in public health, and to reducing health disparities. Our increasingly sophisticated electronic technologies offer promising ways to more effectively engage this difficult to reach group and increase its access to health care resources. This process requires developing not only newer technologies but also collaboration between community leaders and health care providers to bring unconnected individuals into formal health care systems. We present three strategies to reach vulnerable groups, outline benefits and challenges, and provide examples of successful programs. PMID:21566023

Assessing health information technology in a national health care system--an example from Taiwan.

PubMed

Chi, Chunhuei; Lee, Jwo-Leun; Schoon, Rebecca

2012-01-01

The purpose of this article is to investigate one core research question: How can health information technology (HIT) be assessed in a national health care system context? We examine this question by taking a systematic approach within a national care system, in which the purpose of HIT is to contribute to a common national health care system's goal. to promote population health in an efficient way. Based on this approach we first develop a framework and our criteria of assessment, and then using Taiwan as a case study, demonstrate how one can apply this framework to assess a national system's HIT. The five criteria we developed are how well does the HIT (1) provide accessible and accurate public health and health care information to the population; (2) collect and provide population health and health care data for government and researchers to analyze population health and processes and outcomes of health care services, (3) provide accessible and timely information that helps to improve provision of cost-effective health care at an institutional level and promotes system-wide efficiency; (4) minimize transaction and administrative costs of the health care system; and (5) establish channels for population participation in governance while also protecting individual privacy. The results indicate that Taiwan has high levels of achievement in two criteria while falling short in the other three. Major lessons we learned from this study are that HIT exists to serve a health care system, and the national health care system context dictates how one assesses its HIT. There is a large body of literature published on the implementation of HIT and its impact on the quality and cost of health care delivery. The vast majority of the literature, however, is focused on a micro institutional level such as a hospital or a bit higher up, on an HMO or health insurance firm. Few have gone further to evaluate the implementation of HIT and its impact on a national health care system. The lack of such research motivated this study. The major contributions of this study are (i) to develop a framework that follows systems thinking principles and (ii) propose a process through which a nation can identify its objectives for HIT and systematically assess its national HIT system. Using Taiwan's national health care system as a case study, this paper demonstrated how it can be done.

Development of a wearable wireless body area network for health monitoring of the elderly and disabled

NASA Astrophysics Data System (ADS)

Rushambwa, Munyaradzi C.; Gezimati, Mavis; Jeeva, J. B.

2017-11-01

Novel advancements in systems miniaturization, electronics in health care and communication technologies are enabling the integration of both patients and doctors involvement in health care system. A Wearable Wireless Body Area Network (WWBAN) provides continuous, unobtrusive ambulatory, ubiquitous health monitoring, and provide real time patient’s status to the physician without any constraint on their normal daily life activities. In this project we developed a wearable wireless body area network system that continuously monitor the health of the elderly and the disabled and provide them with independent, safe and secure living. The WWBAN system monitors the following parameters; blood oxygen saturation using a pulse oximeter sensor (SpO2), heart rate (HR) pulse sensor, Temperature, hydration, glucose level and fall detection. When the wearable system is put on, the sensor values are processed and analysed. If any of the monitored parameter values falls below or exceeds the normal range, there is trigger of remote alert by which an SMS is send to a doctor or physician via GSM module and network. The developed system offers flexibility and mobility to the user; it is a real time system and has significance in revolutionizing health care system by enabling non-invasive, inexpensive, continuous health monitoring.

The modern mental health system in Nepal: organizational persistence in the absence of legitimating myths.

PubMed

Tausig, M; Subedi, S

1997-08-01

This paper advances an organizational explanation for the slow pace of modernization of mental health care systems in developing societies. In complement to cultural and political economic explanations of this condition, we suggest that the value of establishing modern systems in developing societies lies in the legitimation such structures provide for indigenous modernizing efforts vis-a-vis both indigenous and external audiences. The system need not meet actual levels of service demand. Its importance is in its symbolic value as an indicator of modernity. The result is a system in "permanent failure". Implications for institutional theory and the growth of modern mental health systems in developing societies are discussed.

Europeanisation of health systems: a qualitative study of domestic actors in a small state.

PubMed

Azzopardi-Muscat, Natasha; Sorensen, Kristine; Aluttis, Christoph; Pace, Roderick; Brand, Helmut

2016-04-14

Health systems are not considered to be significantly influenced by European Union (EU) policies given the subsidiarity principle. Yet, recent developments including the patients' rights and cross-border directive (2011/24 EU), as well as measures taken following the financial crisis, appear to be increasing the EU's influence on health systems. The aim of this study is to explore how health system Europeanisation is perceived by domestic stakeholders within a small state. A qualitative study was conducted in the Maltese health system using 33 semi-structured interviews. Inductive analysis was carried out with codes and themes being generated from the data. EU membership brought significant public health reforms, transformation in the regulation of medicines and development of specialised training for doctors. Health services financing and delivery were primarily unaffected. Stakeholders positively perceived improvements to the policy-making process, networking opportunities and capacity building as important benefits. However, the administrative burden and the EU's tendency to adopt a 'one size fits all' approach posed considerable challenges. The lack of power and visibility for health policy at the EU level is a major disappointment. A strong desire exists for the EU to exercise a more effective role in ensuring access to affordable medicines and preventing non-communicable diseases. However, the EU's interference with core health system values is strongly resisted. Overall domestic stakeholders have a positive outlook regarding their health system Europeanisation experience. Whilst welcoming further policy developments at the EU level, they believe that improved consideration must be given to the specificities of small health systems.

Health Systems Innovation at Academic Health Centers: Leading in a New Era of Health Care Delivery.

PubMed

Ellner, Andrew L; Stout, Somava; Sullivan, Erin E; Griffiths, Elizabeth P; Mountjoy, Ashlin; Phillips, Russell S

2015-07-01

Challenged by demands to reduce costs and improve service delivery, the U.S. health care system requires transformational change. Health systems innovation is defined broadly as novel ideas, products, services, and processes-including new ways to promote healthy behaviors and better integrate health services with public health and other social services-which achieve better health outcomes and/or patient experience at equal or lower cost. Academic health centers (AHCs) have an opportunity to focus their considerable influence and expertise on health systems innovation to create new approaches to service delivery and to nurture leaders of transformation. AHCs have traditionally used their promotions criteria to signal their values; creating a health systems innovator promotion track could be a critical step towards creating opportunities for innovators in academic medicine. In this Perspective, the authors review publicly available promotions materials at top-ranked medical schools and find that while criteria for advancement increasingly recognize systems innovation, there is a lack of specificity on metrics beyond the traditional yardstick of peer-reviewed publications. In addition to new promotions pathways and alternative evidence for the impact of scholarship, other approaches to fostering health systems innovation at AHCs include more robust funding for career development in health systems innovation, new curricula to enable trainees to develop skills in health systems innovation, and new ways for innovators to disseminate their work. AHCs that foster health systems innovation could meet a critical need to contribute both to the sustainability of our health care system and to AHCs' continued leadership role within it.

Thinking shift on health systems: from blueprint health programmes towards resilience of health systems Comment on "Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries".

PubMed

Blanchet, Karl

2015-03-03

International health is still highly dominated by equilibrium approaches. The emergence of systems thinking in international health provides a great avenue to develop innovative health interventions adapted to changing contexts. The public health community, nevertheless, has the responsibility to translate concepts related to systems thinking and complexity into concrete research methods and interventions. One possibility is to consider the properties of systems such as resilience and adaptability as entry points to better understand how health systems react to shocks. © 2015 by Kerman University of Medical Sciences.

Developing family practice to respond to global health challenges: The Besrour Papers: a series on the state of family medicine in the world.

PubMed

Arya, Neil; Dahlman, Bruce; Gibson, Christine; Ponka, David; Haq, Cynthia; Rouleau, Katherine; Hansel, Stephanie

2017-08-01

To assess family medicine's role in developing strong, coordinated, community-based, integrated health care systems in low-resource settings globally. A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with selected international colleagues with expertise in international family medicine practice, health systems and capacity building, and teaching to map family medicine globally and give a bird's eye view of family medicine internationally. Following a background literature review, the authors collectively reflected on their substantial international experience to attempt to describe best practices for various contexts. With the failure of vertical, disease-oriented models to provide sustained improvements in health outcomes, the need to develop integrated primary care involving the most appropriate health professionals for differing contexts is becoming apparent worldwide. Health system planning is required to develop policies on health professional training to achieve this. Advocating and offering appropriate incentives for, and coordination of, local opportunities within the health system also becomes paramount. The adaptability and generalist nature of family medicine allows it to respond to the unique needs of a given population. Family physicians with adequate financial and physical resources can function most effectively as members of interdisciplinary teams, thus providing valuable, comprehensive health services in any area of the world. Copyright© the College of Family Physicians of Canada.

Levels of health development: a new tool for comparative research and policy formulation.

PubMed

Hunter, S S

1990-01-01

Levels of health development are formed by mathematically clustering countries using six health status indicators: crude birth, crude death, infant mortality and child death rates, and male and female life expectancy. Stratifying two international samples of 128 and 163 countries into levels of health development--groups with similar health status profiles--improves the results of regression analyses used to identify economic, political, social, educational, health and other health determinants. For this reason, health development levels are a systematic framework for delineation of health determinants. Earlier large scale statistical studies have been limited in their success in part because they did not partition their data sets prior to analysis, or used inappropriate criteria that blurred rather than heightened developmental differences in underlying social systems. These developmental differences regulate the way in which health status inputs are converted into health status outputs, defining the relative importance of health determinants at various developmental levels. At lowest health development levels (countries with poorer health status), the under-development of economic, health and educational infrastructures creates a vacuum which allows international intervention (aid, investment, export/import activities) to play a dominant role in health status determination. At middle health development levels, health and educational infrastructures are better developed, but still secondary in importance as health status determinants to basic economic infrastructure. Demographic problems are particularly apparent at these levels. At higher health development levels, education, women's status, and political structure are especially important health status determinants. This research has facilitated the identification of health status determinants for use in health policy analysis. Recommendations for future research include use of findings in health policymaking by individual countries and by comparative researchers, and development of appropriate health systems models for each level of health development.

Sustainable Health Development Goals (SHDG): breaking down the walls

PubMed Central

Oleribe, Obinna Ositadimma; Crossey, Mary Margaret Elizabeth; Taylor-Robinson, Simon David

2015-01-01

The world's governments failed to achieve the Health for All 2000 goals from the Alma Ata Declaration of 1978. Although a lot of milestones have been covered since 2000, the world's governing authorities are unlikely to achieve the current Millennium Development Goals (MDGs) which expire by the end of this year. The inability to achieve these goals may be linked to the multiplicity of health-related directives and fragmentation of health systems in many countries. However, with the proposed 17 sustainability development goals, health has only one universal aim: to ensure healthy lives and promote wellbeing for all at all ages. Accomplishing this will require a focus on health systems (system-thinking), commonization of services and full integration of services with total dismantling of vertical programs across the world. PMID:26966502

Sustainable Health Development Goals (SHDG): breaking down the walls.

PubMed

Oleribe, Obinna Ositadimma; Crossey, Mary Margaret Elizabeth; Taylor-Robinson, Simon David

2015-01-01

The world's governments failed to achieve the Health for All 2000 goals from the Alma Ata Declaration of 1978. Although a lot of milestones have been covered since 2000, the world's governing authorities are unlikely to achieve the current Millennium Development Goals (MDGs) which expire by the end of this year. The inability to achieve these goals may be linked to the multiplicity of health-related directives and fragmentation of health systems in many countries. However, with the proposed 17 sustainability development goals, health has only one universal aim: to ensure healthy lives and promote wellbeing for all at all ages. Accomplishing this will require a focus on health systems (system-thinking), commonization of services and full integration of services with total dismantling of vertical programs across the world.

A web-based information system for a regional public mental healthcare service network in Brazil.

PubMed

Yoshiura, Vinicius Tohoru; de Azevedo-Marques, João Mazzoncini; Rzewuska, Magdalena; Vinci, André Luiz Teixeira; Sasso, Ariane Morassi; Miyoshi, Newton Shydeo Brandão; Furegato, Antonia Regina Ferreira; Rijo, Rui Pedro Charters Lopes; Del-Ben, Cristina Marta; Alves, Domingos

2017-01-01

Regional networking between services that provide mental health care in Brazil's decentralized public health system is challenging, partly due to the simultaneous existence of services managed by municipal and state authorities and a lack of efficient and transparent mechanisms for continuous and updated communication between them. Since 2011, the Ribeirao Preto Medical School and the XIII Regional Health Department of the Sao Paulo state, Brazil, have been developing and implementing a web-based information system to facilitate an integrated care throughout a public regional mental health care network. After a profound on-site analysis, the structure of the network was identified and a web-based information system for psychiatric admissions and discharges was developed and implemented using a socio-technical approach. An information technology team liaised with mental health professionals, health-service managers, municipal and state health secretariats and judicial authorities. Primary care, specialized community services, general emergency and psychiatric wards services, that comprise the regional mental healthcare network, were identified and the system flow was delineated. The web-based system overcame the fragmentation of the healthcare system and addressed service specific needs, enabling: detailed patient information sharing; active coordination of the processes of psychiatric admissions and discharges; real-time monitoring; the patients' status reports; the evaluation of the performance of each service and the whole network. During a 2-year period of operation, it registered 137 services, 480 health care professionals and 4271 patients, with a mean number of 2835 accesses per month. To date the system is successfully operating and further expanding. We have successfully developed and implemented an acceptable, useful and transparent web-based information system for a regional mental healthcare service network in a medium-income country with a decentralized public health system. Systematic collaboration between an information technology team and a wide range of stakeholders is essential for the system development and implementation.

Developing and implementing mental health policy in Zanzibar, a low income country off the coast of East Africa

PubMed Central

2011-01-01

Background The Zanzibar Ministry of Health and Social Welfare, concerned about mental health in the country, requested technical assistance from WHO in 1997. Aims This article describes the facilitation over many years by a WHO Collaborating Centre, of sustainable mental health developments in Zanzibar, one of the poorest countries in the world, using systematic approaches to policy design and implementation. Methods Based on intensive prior situation appraisal and consultation, a multi-faceted set of interventions combining situation appraisal to inform planning; sustained policy dialogue at Union and state levels; development of policy and legislation, development of strategic action plans, establishment of intersectoral national mental health implementation committee, establishment of national mental health coordination system, integration of mental health into primary care, strengthening of primary-secondary care liaison, rationalisation and strengthening of secondary care system, ensuring adequate supply of medicines, use of good practice guidelines and health information systems, development of services for people with intellectual disability, establishment of formal mechanism for close liaison between the mental health services and other governmental, non-governmental and traditional sectors, mental health promotion, suicide prevention, and research and development. Results The policy and legislation introduced in 1999 have resulted in enhanced mental health activities over the ensuing decade, within a setting of extreme low resource. However, advances ebb and flow and continued efforts are required to maintain progress and continue mental health developments. Lessons learnt have informed the development of mental health policies in neighbouring countries. Conclusions A multi-faceted and comprehensive programme can be effective in achieving considerable strengthening of mental health programmes and services even in extremely low resource settings, but requires sustained input and advocacy if gains are to be maintained and enhanced. PMID:21320308

System-level planning, coordination, and communication: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

PubMed

Dichter, Jeffrey R; Kanter, Robert K; Dries, David; Luyckx, Valerie; Lim, Matthew L; Wilgis, John; Anderson, Michael R; Sarani, Babak; Hupert, Nathaniel; Mutter, Ryan; Devereaux, Asha V; Christian, Michael D; Kissoon, Niranjan

2014-10-01

System-level planning involves uniting hospitals and health systems, local/regional government agencies, emergency medical services, and other health-care entities involved in coordinating and enabling care in a major disaster. We reviewed the literature and sought expert opinions concerning system-level planning and engagement for mass critical care due to disasters or pandemics and offer suggestions for system-planning, coordination, communication, and response. The suggestions in this chapter are important for all of those involved in a pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. The American College of Chest Physicians (CHEST) consensus statement development process was followed in developing suggestions. Task Force members met in person to develop nine key questions believed to be most relevant for system-planning, coordination, and communication. A systematic literature review was then performed for relevant articles and documents, reports, and other publications reported since 1993. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Suggestions were developed and grouped according to the following thematic elements: (1) national government support of health-care coalitions/regional health authorities (HC/RHAs), (2) teamwork within HC/RHAs, (3) system-level communication, (4) system-level surge capacity and capability, (5) pediatric patients and special populations, (6) HC/RHAs and networks, (7) models of advanced regional care systems, and (8) the use of simulation for preparedness and planning. System-level planning is essential to provide care for large numbers of critically ill patients because of disaster or pandemic. It also entails a departure from the routine, independent system and involves all levels from health-care institutions to regional health authorities. National government support is critical, as are robust communication systems and advanced planning supported by realistic exercises.

System-Level Planning, Coordination, and Communication

PubMed Central

Kanter, Robert K.; Dries, David; Luyckx, Valerie; Lim, Matthew L.; Wilgis, John; Anderson, Michael R.; Sarani, Babak; Hupert, Nathaniel; Mutter, Ryan; Devereaux, Asha V.; Christian, Michael D.; Kissoon, Niranjan; Christian, Michael D.; Devereaux, Asha V.; Dichter, Jeffrey R.; Kissoon, Niranjan; Rubinson, Lewis; Amundson, Dennis; Anderson, Michael R.; Balk, Robert; Barfield, Wanda D.; Bartz, Martha; Benditt, Josh; Beninati, William; Berkowitz, Kenneth A.; Daugherty Biddison, Lee; Braner, Dana; Branson, Richard D; Burkle, Frederick M.; Cairns, Bruce A.; Carr, Brendan G.; Courtney, Brooke; DeDecker, Lisa D.; De Jong, Marla J.; Dominguez-Cherit, Guillermo; Dries, David; Einav, Sharon; Erstad, Brian L.; Etienne, Mill; Fagbuyi, Daniel B.; Fang, Ray; Feldman, Henry; Garzon, Hernando; Geiling, James; Gomersall, Charles D.; Grissom, Colin K.; Hanfling, Dan; Hick, John L.; Hodge, James G.; Hupert, Nathaniel; Ingbar, David; Kanter, Robert K.; King, Mary A.; Kuhnley, Robert N.; Lawler, James; Leung, Sharon; Levy, Deborah A.; Lim, Matthew L.; Livinski, Alicia; Luyckx, Valerie; Marcozzi, David; Medina, Justine; Miramontes, David A.; Mutter, Ryan; Niven, Alexander S.; Penn, Matthew S.; Pepe, Paul E.; Powell, Tia; Prezant, David; Reed, Mary Jane; Rich, Preston; Rodriquez, Dario; Roxland, Beth E.; Sarani, Babak; Shah, Umair A.; Skippen, Peter; Sprung, Charles L.; Subbarao, Italo; Talmor, Daniel; Toner, Eric S.; Tosh, Pritish K.; Upperman, Jeffrey S.; Uyeki, Timothy M.; Weireter, Leonard J.; West, T. Eoin; Wilgis, John; Ornelas, Joe; McBride, Deborah; Reid, David; Baez, Amado; Baldisseri, Marie; Blumenstock, James S.; Cooper, Art; Ellender, Tim; Helminiak, Clare; Jimenez, Edgar; Krug, Steve; Lamana, Joe; Masur, Henry; Mathivha, L. Rudo; Osterholm, Michael T.; Reynolds, H. Neal; Sandrock, Christian; Sprecher, Armand; Tillyard, Andrew; White, Douglas; Wise, Robert; Yeskey, Kevin

2014-01-01

BACKGROUND: System-level planning involves uniting hospitals and health systems, local/regional government agencies, emergency medical services, and other health-care entities involved in coordinating and enabling care in a major disaster. We reviewed the literature and sought expert opinions concerning system-level planning and engagement for mass critical care due to disasters or pandemics and offer suggestions for system-planning, coordination, communication, and response. The suggestions in this chapter are important for all of those involved in a pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS: The American College of Chest Physicians (CHEST) consensus statement development process was followed in developing suggestions. Task Force members met in person to develop nine key questions believed to be most relevant for system-planning, coordination, and communication. A systematic literature review was then performed for relevant articles and documents, reports, and other publications reported since 1993. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. RESULTS: Suggestions were developed and grouped according to the following thematic elements: (1) national government support of health-care coalitions/regional health authorities (HC/RHAs), (2) teamwork within HC/RHAs, (3) system-level communication, (4) system-level surge capacity and capability, (5) pediatric patients and special populations, (6) HC/RHAs and networks, (7) models of advanced regional care systems, and (8) the use of simulation for preparedness and planning. CONCLUSIONS: System-level planning is essential to provide care for large numbers of critically ill patients because of disaster or pandemic. It also entails a departure from the routine, independent system and involves all levels from health-care institutions to regional health authorities. National government support is critical, as are robust communication systems and advanced planning supported by realistic exercises. PMID:25144713

A web application to support telemedicine services in Brazil.

PubMed

Barbosa, Ana Karina P; de A Novaes, Magdala; de Vasconcelos, Alexandre M L

2003-01-01

This paper describes a system that has been developed to support Telemedicine activities in Brazil, a country that has serious problems in the delivery of health services. The system is a part of the broader Tele-health Project that has been developed to make health services more accessible to the low-income population in the northeast region. The HealthNet system is based upon a pilot area that uses fetal and pediatric cardiology. This article describes both the system's conceptual model, including the tele-diagnosis and second medical opinion services, as well as its architecture and development stages. The system model describes both collaborating tools used asynchronously, such as discussion forums, and synchronous tools, such as videoconference services. Web and free-of-charge tools are utilized for implementation, such as Java and MySQL database. Furthermore, an interface with Electronic Patient Record (EPR) systems using Extended Markup Language (XML) technology is also proposed. Finally, considerations concerning the development and implementation process are presented.

Health information and communication system for emergency management in a developing country, Iran.

PubMed

Seyedin, Seyed Hesam; Jamali, Hamid R

2011-08-01

Disasters are fortunately rare occurrences. However, accurate and timely information and communication are vital to adequately prepare individual health organizations for such events. The current article investigates the health related communication and information systems for emergency management in Iran. A mixed qualitative and quantitative methodology was used in this study. A sample of 230 health service managers was surveyed using a questionnaire and 65 semi-structured interviews were also conducted with public health and therapeutic affairs managers who were responsible for emergency management. A range of problems were identified including fragmentation of information, lack of local databases, lack of clear information strategy and lack of a formal system for logging disaster related information at regional or local level. Recommendations were made for improving the national emergency management information and communication system. The findings have implications for health organizations in developing and developed countries especially in the Middle East. Creating disaster related information databases, creating protocols and standards, setting an information strategy, training staff and hosting a center for information system in the Ministry of Health to centrally manage and share the data could improve the current information system.

Implementing an overdose education and naloxone distribution program in a health system.

PubMed

Devries, Jennifer; Rafie, Sally; Polston, Gregory

To design and implement a health system-wide program increasing provision of take-home naloxone in patients at risk for opioid overdose, with the downstream aim of reducing fatalities. The program includes health care professional education and guidelines, development, and dissemination of patient education materials, electronic health record changes to promote naloxone prescriptions, and availability of naloxone in pharmacies. Academic health system, San Diego, California. University of California, San Diego Health (UCSDH), offers both inpatient and outpatient primary care and specialty services with 563 beds spanning 2 hospitals and 6 pharmacies. UCSDH is part of the University of California health system, and it serves as the county's safety net hospital. In January 2016, a multisite academic health system initiated a system-wide overdose education and naloxone distribution program to prevent opioid overdose and opioid overdose-related deaths. An interdisciplinary, interdepartmental team came together to develop and implement the program. To strengthen institutional support, naloxone prescribing guidelines were developed and approved for the health system. Education on naloxone for physicians, pharmacists, and nurses was provided through departmental trainings, bulletins, and e-mail notifications. Alerts in the electronic health record and preset naloxone orders facilitated co-prescribing of naloxone with opioid prescriptions. Electronic health record reports captured naloxone prescriptions ordered. Summary reports on the electronic health record measured naloxone reminder alerts and response rates. Since the start of the program, the health system has trained 252 physicians, pharmacists, and nurses in overdose education and take-home naloxone. There has been an increase in the number of prescriptions for naloxone from a baseline of 4.5 per month to an average of 46 per month during the 3 months following full implementation of the program including implementation of electronic health record alerts. Initiating and implementing an overdose education and naloxone distribution program is feasible in an academic health system. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Working towards a national health information system in Australia.

PubMed

Bomba, B; Cooper, J; Miller, M

1995-01-01

One of the major administrative dilemmas facing the Australian national health care system is the need to reform practices associated with massive data-information overload. The current system is burdened with paper-based administrative forms, patient record files, referral notes and other manual methods of data organisation. An integrated computer-based information system may be perceived as an attractive solution to such burdens. However, computerisation must not be seen as a panacea with the possibility of exacerbating information overload and accentuating privacy concerns. Recent surveys in Australia [1] and the US [2] indicate a perceived causal link between computers and privacy invasion. Any moves toward a national health information system must counter this perception through macro-level education schemes of affected parties and micro-level mechanisms such as the establishment of hospital privacy officers. Such concerns may be viewed as a subset of the wider privacy debate, and information policy development should address such considerations to develop policies to prevent unauthorized access to personal information and to avoid the extraction and sale of sensitive health data. Conservative in nature and slow to change the health care sector may be forced to adopt more efficient work practices through the increasing proliferation of information technology (IT) in health care delivery and an escalating emphasis upon accountability and efficiency of the public health care dollar. The economic rationalist stance taken by governments in Australia and other nations generally will also force health care workers to adopt and develop more efficient information management practices, health indicators and best practice care methods than presently employed by this sector The benefits of a national health information system are far reaching, particularly in developing a more effective health care system through better identifying and understanding community health care trends and in applying IT to the efficient collection of data for the development of more appropriate performance measures and statistical indicators. A coherent and integrated approach is called for in the design of a national health information system which incorporates the necessary and requisite security features to meet privacy concerns. Protecting information privacy poses complex political, economic, technological, legal and social problems for systems developers and health care providers alike [2]. According to Brannigan [3] there are three components involved in the formulation and implementation of privacy: public policy (What level of privacy does society want?); legal structure (Does the law adequately provide for society's privacy requirements?); and technical (how much privacy can technical tools provide, at what cost, and with what effects on the system?). Examining technical tools alone, it is apparent that the necessary technologies are available in Australia to provide the security of medical records required by public policy. Such tools may include encryption, user and data authentication methods, authorisation schemes and mechanisms for the prevention of data inference. While none of these available measures are infallible, it is suitable for most applications where the encryption mechanism can provide protection for a given length of time. Australia needs to develop a coherent national health information infrastructure policy to ultimately avoid fragmented, duplicated and incompatible systems that rely on different standards and protocols. Such a policy will only work by addressing the key issue of patient privacy within a technological framework. The application of IT to health care systems is a sensitive social experiment affecting many professions including general practitioners, medical administrators, politicians, lawyers, computer specialists, privacy advocates and patients whose records will ultimately reside in the system. (abstract trun

Developing a new syndromic surveillance system for the London 2012 Olympic and Paralympic Games.

PubMed

Harcourt, S E; Fletcher, J; Loveridge, P; Bains, A; Morbey, R; Yeates, A; McCloskey, B; Smyth, B; Ibbotson, S; Smith, G E; Elliot, A J

2012-12-01

Syndromic surveillance is vital for monitoring public health during mass gatherings. The London 2012 Olympic and Paralympic Games represents a major challenge to health protection services and community surveillance. In response to this challenge the Health Protection Agency has developed a new syndromic surveillance system that monitors daily general practitioner out-of-hours and unscheduled care attendances. This new national system will fill a gap identified in the existing general practice-based syndromic surveillance systems by providing surveillance capability of general practice activity during evenings/nights, over weekends and public holidays. The system will complement and supplement the existing tele-health phone line, general practitioner and emergency department syndromic surveillance systems. This new national system will contribute to improving public health reassurance, especially to meet the challenges of the London 2012 Olympic and Paralympic Games.

Theory of constraints for publicly funded health systems.

PubMed

Sadat, Somayeh; Carter, Michael W; Golden, Brian

2013-03-01

Originally developed in the context of publicly traded for-profit companies, theory of constraints (TOC) improves system performance through leveraging the constraint(s). While the theory seems to be a natural fit for resource-constrained publicly funded health systems, there is a lack of literature addressing the modifications required to adopt TOC and define the goal and performance measures. This paper develops a system dynamics representation of the classical TOC's system-wide goal and performance measures for publicly traded for-profit companies, which forms the basis for developing a similar model for publicly funded health systems. The model is then expanded to include some of the factors that affect system performance, providing a framework to apply TOC's process of ongoing improvement in publicly funded health systems. Future research is required to more accurately define the factors affecting system performance and populate the model with evidence-based estimates for various parameters in order to use the model to guide TOC's process of ongoing improvement.

Carbon pollution increases health inequities: lessons in resilience from the most vulnerable.

PubMed

Ebi, Kristie L; Fawcett, Stephen B; Spiegel, Jerry; Tovalin, Horacio

2016-09-01

Climate change is a social justice as well as an environmental issue. The magnitude and pattern of changes in weather and climate variables are creating differential exposures, vulnerabilities, and health risks that increase stress on health systems while exacerbating existing and creating new health inequities. Examples from national and local health adaptation projects highlight that developing partnerships across sectors and levels are critical for building climate-resilient health systems and communities. Strengthening current and implementing new health interventions, such as using environmental information to develop early warning systems, can be effective in protecting the most vulnerable. However, not all projected risks of climate change can be avoided by climate policies and programs, so health system strengthening is also critical. Applying a health inequity lens can reduce current vulnerabilities while building resilience to longer-term climate change. Taking inequities into account is critical if societies are to effectively prepare for and manage the challenges ahead.

Mental health system development in Asia: Does Australia have a role?

PubMed

Arandjelovic, Katarina; Eyre, Harris A; Forbes, Malcolm P; Bauer, Renee; Aggarwal, Shilpa; Singh, Ajeet B; Baune, Bernhard T; Everall, Ian; Berk, Michael; Ng, Chee

2016-09-01

Socioeconomic trends herald what many describe as the Asian Century, whereby Asian economic, political and cultural influence is in global ascendency. Broadening relevant ties between Australia and Asia is evident and logical and may include strengthening alliances in mental health systems. We argue the importance of strengthening Asian mental health systems and some of the roles Australian mental health workers could have in promoting strengthening the Asian mental health system. This paper is a narrative review which sources data from reputable search databases. A well-articulated Australian strategy to support strengthening the mental health system in Asia is lacking. While there are active initiatives operating in this space, these remain fragmented and underdeveloped. Coordinated, collaborative and culturally respectful efforts to enhance health education, research, policy, leadership and development assistance are key opportunities. Psychiatrists and other mental health professionals have a unique opportunity to contribute to improved mental health outcomes in Asia. © The Royal Australian and New Zealand College of Psychiatrists 2016.

The development and assessment of Web-based health information for a corporate Intranet--a pilot study.

PubMed

Matarrese, P; Helwig, A

2000-01-01

Consumers readily use the Internet for medical information, advice and support. Studies of general clinic populations show that moderated internet patient education systems can improve patient satisfaction and affect self help behaviors. Many Americans have Internet access through their employers and large corporations have often developed Intranets for employee information. There is little study of health information available online to employees through company Intranets. This study relates the development of an employer sponsored online health education system, the effects of this system on employee satisfaction with their health care, and the potential effects on worker productivity.

Developing and refining the methods for a 'one-stop shop' for research evidence about health systems.

PubMed

Lavis, John N; Wilson, Michael G; Moat, Kaelan A; Hammill, Amanda C; Boyko, Jennifer A; Grimshaw, Jeremy M; Flottorp, Signe

2015-02-25

Policymakers, stakeholders and researchers have not been able to find research evidence about health systems using an easily understood taxonomy of topics, know when they have conducted a comprehensive search of the many types of research evidence relevant to them, or rapidly identify decision-relevant information in their search results. To address these gaps, we developed an approach to building a 'one-stop shop' for research evidence about health systems. We developed a taxonomy of health system topics and iteratively refined it by drawing on existing categorization schemes and by using it to categorize progressively larger bundles of research evidence. We identified systematic reviews, systematic review protocols, and review-derived products through searches of Medline, hand searches of several databases indexing systematic reviews, hand searches of journals, and continuous scanning of listservs and websites. We developed an approach to providing 'added value' to existing content (e.g., coding systematic reviews according to the countries in which included studies were conducted) and to expanding the types of evidence eligible for inclusion (e.g., economic evaluations and health system descriptions). Lastly, we developed an approach to continuously updating the online one-stop shop in seven supported languages. The taxonomy is organized by governance, financial, and delivery arrangements and by implementation strategies. The 'one-stop shop', called Health Systems Evidence, contains a comprehensive inventory of evidence briefs, overviews of systematic reviews, systematic reviews, systematic review protocols, registered systematic review titles, economic evaluations and costing studies, health reform descriptions and health system descriptions, and many types of added-value coding. It is continuously updated and new content is regularly translated into Arabic, Chinese, English, French, Portuguese, Russian, and Spanish. Policymakers and stakeholders can now easily access and use a wide variety of types of research evidence about health systems to inform decision-making and advocacy. Researchers and research funding agencies can use Health Systems Evidence to identify gaps in the current stock of research evidence and domains that could benefit from primary research, systematic reviews, and review overviews.

Trust information-based privacy architecture for ubiquitous health.

PubMed

Ruotsalainen, Pekka Sakari; Blobel, Bernd; Seppälä, Antto; Nykänen, Pirkko

2013-10-08

Ubiquitous health is defined as a dynamic network of interconnected systems that offers health services independent of time and location to a data subject (DS). The network takes place in open and unsecure information space. It is created and managed by the DS who sets rules that regulate the way personal health information is collected and used. Compared to health care, it is impossible in ubiquitous health to assume the existence of a priori trust between the DS and service providers and to produce privacy using static security services. In ubiquitous health features, business goals and regulations systems followed often remain unknown. Furthermore, health care-specific regulations do not rule the ways health data is processed and shared. To be successful, ubiquitous health requires novel privacy architecture. The goal of this study was to develop a privacy management architecture that helps the DS to create and dynamically manage the network and to maintain information privacy. The architecture should enable the DS to dynamically define service and system-specific rules that regulate the way subject data is processed. The architecture should provide to the DS reliable trust information about systems and assist in the formulation of privacy policies. Furthermore, the architecture should give feedback upon how systems follow the policies of DS and offer protection against privacy and trust threats existing in ubiquitous environments. A sequential method that combines methodologies used in system theory, systems engineering, requirement analysis, and system design was used in the study. In the first phase, principles, trust and privacy models, and viewpoints were selected. Thereafter, functional requirements and services were developed on the basis of a careful analysis of existing research published in journals and conference proceedings. Based on principles, models, and requirements, architectural components and their interconnections were developed using system analysis. The architecture mimics the way humans use trust information in decision making, and enables the DS to design system-specific privacy policies using computational trust information that is based on systems' measured features. The trust attributes that were developed describe the level systems for support awareness and transparency, and how they follow general and domain-specific regulations and laws. The monitoring component of the architecture offers dynamic feedback concerning how the system enforces the polices of DS. The privacy management architecture developed in this study enables the DS to dynamically manage information privacy in ubiquitous health and to define individual policies for all systems considering their trust value and corresponding attributes. The DS can also set policies for secondary use and reuse of health information. The architecture offers protection against privacy threats existing in ubiquitous environments. Although the architecture is targeted to ubiquitous health, it can easily be modified to other ubiquitous applications.

Development of a health care systems curriculum

PubMed Central

Pruitt, Zachary; Mhaskar, Rahul; Kane, Bryan G; Barraco, Robert D; DeWaay, Deborah J; Rosenau, Alex M; Bresnan, Kristin A; Greenberg, Marna Rayl

2017-01-01

Background There is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution. Methods This case study describes the application of a problem-based learning approach to system-based practice medical education. A series of behavioral statements, called entrustable professional activities, was created to assess student health system competence. Student evaluation of course curriculum design, delivery, and assessment was provided through web-based surveys. Results To meet competency standards for system-based practice, a health systems curriculum was developed and delivered across 4 years of medical school training. Each of the health system lectures and problem-based learning activities are described herein. The majority of first and second year medical students stated they gained working knowledge of health systems by engaging in these sessions. The majority of the 2016 graduating students (88.24%) felt that the course content, overall, prepared them for their career. Conclusion A health systems curriculum in undergraduate medical education using a problem-based learning approach is feasible. The majority of students learning health systems curriculum through this format reported being prepared to improve individual patient care and optimize the health system’s value (better care and health for lower cost). PMID:29138614

Developed-developing country partnerships: Benefits to developed countries?

PubMed Central

2012-01-01

Developing countries can generate effective solutions for today’s global health challenges. This paper reviews relevant literature to construct the case for international cooperation, and in particular, developed-developing country partnerships. Standard database and web-based searches were conducted for publications in English between 1990 and 2010. Studies containing full or partial data relating to international cooperation between developed and developing countries were retained for further analysis. Of 227 articles retained through initial screening, 65 were included in the final analysis. The results were two-fold: some articles pointed to intangible benefits accrued by developed country partners, but the majority of information pointed to developing country innovations that can potentially inform health systems in developed countries. This information spanned all six WHO health system components. Ten key health areas where developed countries have the most to learn from the developing world were identified and include, rural health service delivery; skills substitution; decentralisation of management; creative problem-solving; education in communicable disease control; innovation in mobile phone use; low technology simulation training; local product manufacture; health financing; and social entrepreneurship. While there are no guarantees that innovations from developing country experiences can effectively transfer to developed countries, combined developed-developing country learning processes can potentially generate effective solutions for global health systems. However, the global pool of knowledge in this area is virgin and further work needs to be undertaken to advance understanding of health innovation diffusion. Even more urgently, a standardized method for reporting partnership benefits is needed—this is perhaps the single most immediate need in planning for, and realizing, the full potential of international cooperation between developed and developing countries. PMID:22709651

Electronic health systems: challenges faced by hospital-based providers.

PubMed

Agno, Christina Farala; Guo, Kristina L

2013-01-01

The purpose of this article is to discuss specific challenges faced by hospitals adopting the use of electronic medical records and implementing electronic health record (EHR) systems. Challenges include user and information technology support; ease of technical use and software interface capabilities; compliance; and financial, legal, workforce training, and development issues. Electronic health records are essential to preventing medical errors, increasing consumer trust and use of the health system, and improving quality and overall efficiency. Government efforts are focused on ways to accelerate the adoption and use of EHRs as a means of facilitating data sharing, protecting health information privacy and security, quickly identifying emerging public health threats, and reducing medical errors and health care costs and increasing quality of care. This article will discuss physician and nonphysician staff training before, during, and after implementation; the effective use of EHR systems' technical features; the selection of a capable and secure EHR system; and the development of collaborative system implementation. Strategies that are necessary to help health care providers achieve successful implementation of EHR systems will be addressed.

Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study.

PubMed

Upadhaya, Nawaraj; Jordans, Mark J D; Pokhrel, Ruja; Gurung, Dristy; Adhikari, Ramesh P; Petersen, Inge; Komproe, Ivan H

2017-01-01

Assessing and understanding health systems governance is crucial to ensure accountability and transparency, and to improve the performance of mental health systems. There is a lack of systematic procedures to assess governance in mental health systems at a country level. The aim of this study was to appraise mental health systems governance in Nepal, with the view to making recommendations for improvements. In-depth individual interviews were conducted with national-level policymakers (n = 17) and district-level planners (n = 11). The interview checklist was developed using an existing health systems governance framework developed by Siddiqi and colleagues as a guide. Data analysis was done with NVivo 10, using the procedure of framework analysis. The mental health systems governance assessment reveals a few enabling factors and many barriers. Factors enabling good governance include availability of mental health policy, inclusion of mental health in other general health policies and plans, increasing presence of Non-Governmental Organizations (NGOs) and service user organizations in policy forums, and implementation of a few mental health projects through government-NGO collaborations. Legal and policy barriers include the failure to officially revise or fully implement the mental health policy of 1996, the existence of legislation and several laws that have discriminatory provisions for people with mental illness, and lack of a mental health act and associated regulations to protect against this. Other barriers include lack of a mental health unit within the Ministry of Health, absence of district-level mental health planning, inadequate mental health record-keeping systems, inequitable allocation of funding for mental health, very few health workers trained in mental health, and the lack of availability of psychotropic drugs at the primary health care level. In the last few years, some positive developments have emerged in terms of policy recognition for mental health, as well as the increased presence of NGOs, increased presence of service users or caregivers in mental health governance, albeit restricted to only some of its domains. However, the improvements at the policy level have not been translated into implementation due to lack of strong leadership and governance mechanisms.

Intermountain Health Care, Inc.: Standard Costing System Methodology and Implementation

PubMed Central

Rosqvist, W.V.

1984-01-01

Intermountain Health Care, Inc. (IHC) a notfor-profit hospital chain with 22 hospitals in the intermountain area and corporate offices located in Salt Lake City, Utah, has developed a Standard Costing System to provide hospital management with a tool for confronting increased cost pressures in the health care environment. This document serves as a description of methodology used in developing the standard costing system and outlines the implementation process.

Real-Time Rocket/Vehicle System Integrated Health Management Laboratory For Development and Testing of Health Monitoring/Management Systems

NASA Technical Reports Server (NTRS)

Aguilar, R.

2006-01-01

Pratt & Whitney Rocketdyne has developed a real-time engine/vehicle system integrated health management laboratory, or testbed, for developing and testing health management system concepts. This laboratory simulates components of an integrated system such as the rocket engine, rocket engine controller, vehicle or test controller, as well as a health management computer on separate general purpose computers. These general purpose computers can be replaced with more realistic components such as actual electronic controllers and valve actuators for hardware-in-the-loop simulation. Various engine configurations and propellant combinations are available. Fault or failure insertion capability on-the-fly using direct memory insertion from a user console is used to test system detection and response. The laboratory is currently capable of simulating the flow-path of a single rocket engine but work is underway to include structural and multiengine simulation capability as well as a dedicated data acquisition system. The ultimate goal is to simulate as accurately and realistically as possible the environment in which the health management system will operate including noise, dynamic response of the engine/engine controller, sensor time delays, and asynchronous operation of the various components. The rationale for the laboratory is also discussed including limited alternatives for demonstrating the effectiveness and safety of a flight system.

A European late starter: lessons from the history of reform in Irish health care.

PubMed

Wren, Maev-Ann; Connolly, Sheelah

2017-12-26

The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care. The majority of the population pays out-of-pocket fees to access primary health care. Due to long waits for public hospital care, many purchase private health insurance, which facilitates faster access to public and private hospital services. The system has been the subject of much criticism and repeated reform attempts. Proposals in 2011 to develop a universal health care system, funded by Universal Health Insurance, were abandoned in 2015 largely due to cost concerns. Despite this experience, there remains strong political support for developing a universal health care system. By applying an historical institutionalist approach, the paper develops an understanding of why Ireland has been a European outlier. The aim of the paper is to identify and discuss issues that may arise in introducing a universal healthcare system to Ireland informed by an understanding of previous unsuccessful reform proposals. Challenges in system design faced by a late-starter country like Ireland, including overcoming stakeholder resistance, achieving clarity in the definition of universality and avoiding barriers to access, may be shared by countries whose universal systems have been compromised in the period of austerity.

Development and Usefulness of a District Health Systems Tool for Performance Improvement in Essential Public Health Functions in Botswana and Mozambique.

PubMed

Bishai, David; Sherry, Melissa; Pereira, Claudia C; Chicumbe, Sergio; Mbofana, Francisco; Boore, Amy; Smith, Monica; Nhambi, Leonel; Borse, Nagesh N

2016-01-01

This study describes the development of a self-audit tool for public health and the associated methodology for implementing a district health system self-audit tool that can provide quantitative data on how district governments perceive their performance of the essential public health functions. Development began with a consensus-building process to engage Ministry of Health and provincial health officers in Mozambique and Botswana. We then worked with lists of relevant public health functions as determined by these stakeholders to adapt a self-audit tool describing essential public health functions to each country's health system. We then piloted the tool across districts in both countries and conducted interviews with district health personnel to determine health workers' perception of the usefulness of the approach. Country stakeholders were able to develop consensus around 11 essential public health functions that were relevant in each country. Pilots of the self-audit tool enabled the tool to be effectively shortened. Pilots also disclosed a tendency to upcode during self-audits that was checked by group deliberation. Convening sessions at the district enabled better attendance and representative deliberation. Instant feedback from the audit was a feature that 100% of pilot respondents found most useful. The development of metrics that provide feedback on public health performance can be used as an aid in the self-assessment of health system performance at the district level. Measurements of practice can open the door to future applications for practice improvement and research into the determinants and consequences of better public health practice. The current tool can be assessed for its usefulness to district health managers in improving their public health practice. The tool can also be used by the Ministry of Health or external donors in the African region for monitoring the district-level performance of the essential public health functions.

Development and Usefulness of a District Health Systems Tool for Performance Improvement in Essential Public Health Functions in Botswana and Mozambique

PubMed Central

Bishai, David; Sherry, Melissa; Pereira, Claudia C.; Chicumbe, Sergio; Mbofana, Francisco; Boore, Amy; Smith, Monica; Nhambi, Leonel; Borse, Nagesh N.

2018-01-01

Introduction This study describes the development of a self-audit tool for public health and the associated methodology for implementing a district health system self-audit tool that can provide quantitative data on how district governments perceive their own performance of the essential public health functions. Methods Development began with a consensus building process to engage Ministry of Health and provincial health officers in Mozambique and Botswana. We then worked with lists of relevant public health functions as determined by these stakeholders to adapt a self-audit tool describing essential public health functions to each country’s health system. We then piloted the tool across districts in both countries and conducted interviews with district health personnel to determine health workers’ perception of the usefulness of the approach. Results Country stakeholders were able to develop consensus around eleven essential public health functions that were relevant in each country. Pilots of the self-audit tool enabled the tool to be effectively shortened. Pilots also disclosed a tendency to up code during self-audits that was checked by group deliberation. Convening sessions at the district enabled better attendance and representative deliberation. Instant feedback from the audit was a feature that 100% of pilot respondents found most useful. Conclusions The development of metrics that provide feedback on public health performance can be used as an aid in the self-assessment of health system performance at the district level. Measurements of practice can open the door to future applications for practice improvement and research into the determinants and consequences of better public health practice. The current tool can be assessed for its usefulness to district health managers in improving their public health practice. The tool can also be used by ministry of health or external donors in the African region for monitoring the district level performance of the essential public health functions. PMID:27682727

Strengthening health systems by health sector reforms

PubMed Central

Senkubuge, Flavia; Modisenyane, Moeketsi; Bishaw, Tewabech

2014-01-01

Background The rising burden of disease and weak health systems are being compounded by the persistent economic downturn, re-emerging diseases, and violent conflicts. There is a growing recognition that the global health agenda needs to shift from an emphasis on disease-specific approaches to strengthening of health systems, including dealing with social, environmental, and economic determinants through multisectoral responses. Methods A review and analysis of data on strengthening health sector reform and health systems was conducted. Attention was paid to the goal of health and interactions between health sector reforms and the functions of health systems. Further, we explored how these interactions contribute toward delivery of health services, equity, financial protection, and improved health. Findings Health sector reforms cannot be developed from a single global or regional policy formula. Any reform will depend on the country's history, values and culture, and the population's expectations. Some of the emerging ingredients that need to be explored are infusion of a health systems agenda; development of a comprehensive policy package for health sector reforms; improving alignment of planning and coordination; use of reliable data; engaging ‘street level’ policy implementers; strengthening governance and leadership; and allowing a holistic and developmental approach to reforms. Conclusions The process of reform needs a fundamental rather than merely an incremental and evolutionary change. Without radical structural and systemic changes, existing governance structures and management systems will continue to fail to address the existing health problems. PMID:24560261

Automated information systems provide health information management support to veterans' healthcare.

PubMed

Lloyd, S S

1992-06-01

The Veterans Health Administration has implemented a comprehsnsive DHCP which supports the VA healthcare system at both local and national levels. Numerous clinical and management modules have been developed; an overview was given of selected applications impacting health information managers. Continuing development includes an automated clinical record and expanded electronic data exchange.

Medical Education Capacity-Building Partnerships for Health Care Systems Development.

PubMed

Rabin, Tracy L; Mayanja-Kizza, Harriet; Rastegar, Asghar

2016-07-01

Health care workforce development is a key pillar of global health systems strengthening that requires investment in health care worker training institutions. This can be achieved by developing partnerships between training institutions in resource-limited and resource-rich areas and leveraging the unique expertise and opportunities both have to offer. To realize their full potential, however, these relationships must be equitable. In this article, we use a previously described global health ethics framework and our ten-year experience with the Makerere University-Yale University (MUYU) Collaboration to provide an example of an equity-focused global health education partnership. © 2016 American Medical Association. All Rights Reserved. ISSN 2376-6980.

SAMS--a systems architecture for developing intelligent health information systems.

PubMed

Yılmaz, Özgün; Erdur, Rıza Cenk; Türksever, Mustafa

2013-12-01

In this paper, SAMS, a novel health information system architecture for developing intelligent health information systems is proposed and also some strategies for developing such systems are discussed. The systems fulfilling this architecture will be able to store electronic health records of the patients using OWL ontologies, share patient records among different hospitals and provide physicians expertise to assist them in making decisions. The system is intelligent because it is rule-based, makes use of rule-based reasoning and has the ability to learn and evolve itself. The learning capability is provided by extracting rules from previously given decisions by the physicians and then adding the extracted rules to the system. The proposed system is novel and original in all of these aspects. As a case study, a system is implemented conforming to SAMS architecture for use by dentists in the dental domain. The use of the developed system is described with a scenario. For evaluation, the developed dental information system will be used and tried by a group of dentists. The development of this system proves the applicability of SAMS architecture. By getting decision support from a system derived from this architecture, the cognitive gap between experienced and inexperienced physicians can be compensated. Thus, patient satisfaction can be achieved, inexperienced physicians are supported in decision making and the personnel can improve their knowledge. A physician can diagnose a case, which he/she has never diagnosed before, using this system. With the help of this system, it will be possible to store general domain knowledge in this system and the personnel's need to medical guideline documents will be reduced.

Health Care System Reforms in Developing Countries

PubMed Central

Han, Wei

2012-01-01

This article proposes a critical but non-systematic review of recent health care system reforms in developing countries. The literature reports mixed results as to whether reforms improve the financial protection of the poor or not. We discuss the reasons for these differences by comparing three representative countries: Mexico, Vietnam, and China. First, the design of the health care system reform, as well as the summary of its evaluation, is briefly described for each country. Then, the discussion is developed along two lines: policy design and evaluation methodology. The review suggests that i) background differences, such as social development, poverty level, and population health should be considered when taking other countries as a model; ii) although demand-side reforms can be improved, more attention should be paid to supply-side reforms; and iii) the findings of empirical evaluation might be biased due to the evaluation design, the choice of outcome, data quality, and evaluation methodology, which should be borne in mind when designing health care system reforms. PMID:25170464

A systems engineering perspective on the human-centered design of health information systems.

PubMed

Samaras, George M; Horst, Richard L

2005-02-01

The discipline of systems engineering, over the past five decades, has used a structured systematic approach to managing the "cradle to grave" development of products and processes. While elements of this approach are typically used to guide the development of information systems that instantiate a significant user interface, it appears to be rare for the entire process to be implemented. In fact, a number of authors have put forth development lifecycle models that are subsets of the classical systems engineering method, but fail to include steps such as incremental hazard analysis and post-deployment corrective and preventative actions. In that most health information systems have safety implications, we argue that the design and development of such systems would benefit by implementing this systems engineering approach in full. Particularly with regard to bringing a human-centered perspective to the formulation of system requirements and the configuration of effective user interfaces, this classical systems engineering method provides an excellent framework for incorporating human factors (ergonomics) knowledge and integrating ergonomists in the interdisciplinary development of health information systems.

Processes, contexts, and rationale for disinvestment: a protocol for a critical interpretive synthesis.

PubMed

Wilson, Michael G; Ellen, Moriah E; Lavis, John N; Grimshaw, Jeremy M; Moat, Kaelan A; Shemer, Joshua; Sullivan, Terry; Garner, Sarah; Goeree, Ron; Grilli, Roberto; Peffer, Justin; Samra, Kevin

2014-12-11

Practical solutions are needed to support the appropriate use of available health system resources as countries are continually pressured to 'do more with less' in health care. Increasingly, health systems and organizations are exploring the reassessment of possibly obsolete, inefficient, or ineffective health system resources and potentially redirecting funds to those that are more effective and efficient. Such processes are often referred to as 'disinvestment'. Our objective is to gain further understanding about: 1) whether how and under what conditions health systems decide to pursue disinvestment; 2) how health systems have chosen to undertake disinvestment; and 3) how health systems have implemented their disinvestment approach. We will use a critical interpretive synthesis (CIS) approach, to develop a theoretical framework based on insights drawn from a range of relevant sources. We will conduct systematic searches of databases as well as purposive searches to identify literature to fill conceptual gaps that may emerge during our inductive process of synthesis and analysis. Two independent reviewers will assess search results for relevance and conceptually map included references. We will include all empirical and non-empirical articles that focus on disinvestment at a system level. We will then extract key findings from a purposive sample of articles using frameworks related to government agendas, policy development and implementation, and health system contextual factors and then synthesize and integrate the findings to develop a framework about our core areas of interest. Lastly, we will convene a stakeholder dialogue with Canadian and international policymakers and other stakeholders to solicit targeted feedback about the framework (e.g., by identifying any gaps in the literature that we may want to revisit before finalizing it) and deliberating about barriers for developing and implementing approaches to disinvestment, strategies to address these barriers and about next steps that could be taken by different constituencies. Disinvestment is an emerging field and there is a need for evidence to inform the prioritization, development, and implementation of strategies in different contexts. Our CIS and the framework developed through it will support the actions of those involved in the prioritization, development, and implementation of disinvestment initiatives. PROSPERO CRD42014013204.

Health care systems in Sweden and China: Legal and formal organisational aspects

PubMed Central

2010-01-01

Background Sharing knowledge and experience internationally can provide valuable information, and comparative research can make an important contribution to knowledge about health care and cost-effective use of resources. Descriptions of the organisation of health care in different countries can be found, but no studies have specifically compared the legal and formal organisational systems in Sweden and China. Aim To describe and compare health care in Sweden and China with regard to legislation, organisation, and finance. Methods Literature reviews were carried out in Sweden and China to identify literature published from 1985 to 2008 using the same keywords. References in recent studies were scrutinized, national legislation and regulations and government reports were searched, and textbooks were searched manually. Results The health care systems in Sweden and China show dissimilarities in legislation, organisation, and finance. In Sweden there is one national law concerning health care while in China the law includes the "Hygienic Common Law" and the "Fundamental Health Law" which is under development. There is a tendency towards market-orientated solutions in both countries. Sweden has a well-developed primary health care system while the primary health care system in China is still under development and relies predominantly on hospital-based care concentrated in cities. Conclusion Despite dissimilarities in health care systems, Sweden and China have similar basic assumptions, i.e. to combine managerial-organisational efficiency with the humanitarian-egalitarian goals of health care, and both strive to provide better care for all. PMID:20569468

The role of international NGOs in health systems strengthening: the case of Timor-Leste.

PubMed

Mercer, Mary Anne; Thompson, Susan M; de Araujo, Rui Maria

2014-01-01

Achieving the United Nations Millennium Development Goals for health will require that programs supporting health in developing countries focus on strengthening national health care systems. However, the dominant neoliberal model of development mandates reduced public spending on health and other social services, often resulting in increased funding for nongovernmental organizations (NGOs) at the expense of support for government systems. East Timor, later Timor-Leste, is an example of a post-crisis country where international NGO efforts were initially critical to providing relief efforts to a traumatized population. Those groups were not prepared to help develop and support a standardized Timorese national health plan, however, and the cost of their support was unsustainable in the long term. In response, local authorities designed and implemented a post-crisis NGO phase-over plan that addressed risks to service disruption and monitored the process. Since then, some NGOs have worked collaboratively with the Ministry of Health to support specific efforts and initiatives under a framework provided by the ministry. Timor-Leste has shown that ministries of health can facilitate an effective transition of NGO support from crisis to development if they are allowed to plan and manage the process.

European Union health policy and its implications for national convergence.

PubMed

Cucic, S

2000-06-01

This paper explores the relevance for health care of European Union (EU) legislation, regulation and policies. Reports, communications and other materials of the European Commission and other relevant European bodies are screened for their implications for health care, primarily on the national health system level. The paper provides a brief overview of EU history and its main institutions, followed by an analysis of health (care)-related provisions in the EU's main legal documents--its treaties. The impact of the EU actions on health protection is considered with regard to both actions in the field of public health and health protection requirements in its policies. In the public health area, information systems that are now being developed are discussed, followed by an outline of health protection requirements in EU policies that can have an impact on health systems. These policies are then analysed using the political factions model. Finally an attempt is made to predict future developments, stressing the need for a far-reaching synchronization of national systems.

Health Systems Sustainability and Rare Diseases.

PubMed

Ferrelli, Rita Maria; De Santis, Marta; Egle Gentile, Amalia; Taruscio, Domenica

2017-01-01

The paper is addressing aspects of health system sustainability for rare diseases in relation to the current economic crisis and equity concerns. It takes into account the results of the narrative review carried out in the framework of the Joint Action for Rare Diseases (Joint RD-Action) "Promoting Implementation of Recommendations on Policy, Information and Data for Rare Diseases", that identified networks as key factors for health systems sustainability for rare diseases. The legal framework of European Reference Networks and their added value is also presented. Networks play a relevant role for health systems sustainability, since they are based upon, pay special attention to and can intervene on health systems knowledge development, partnership, organizational structure, resources, leadership and governance. Moreover, sustainability of health systems can not be separated from the analysis of the context and the action on it, including fiscal equity. As a result of the financial crisis of 2008, cuts of public health-care budgets jeopardized health equity, since the least wealthy suffered from the greatest health effects. Moreover, austerity policies affected economic growth much more adversely than previously believed. Therefore, reducing public health expenditure not only is going to jeopardise citizens' health, but also to hamper fair and sustainable development.

An approach to addressing governance from a health system framework perspective

PubMed Central

2011-01-01

As countries strive to strengthen their health systems in resource constrained contexts, policy makers need to know how best to improve the performance of their health systems. To aid these decisions, health system stewards should have a good understanding of how health systems operate in order to govern them appropriately. While a number of frameworks for assessing governance in the health sector have been proposed, their application is often hindered by unrealistic indicators or they are overly complex resulting in limited empirical work on governance in health systems. This paper reviews contemporary health sector frameworks which have focused on defining and developing indicators to assess governance in the health sector. Based on these, we propose a simplified approach to look at governance within a common health system framework which encourages stewards to take a systematic perspective when assessing governance. Although systems thinking is not unique to health, examples of its application within health systems has been limited. We also provide an example of how this approach could be applied to illuminate areas of governance weaknesses which are potentially addressable by targeted interventions and policies. This approach is built largely on prior literature, but is original in that it is problem-driven and promotes an outward application taking into consideration the major health system building blocks at various levels in order to ensure a more complete assessment of a governance issue rather than a simple input-output approach. Based on an assessment of contemporary literature we propose a practical approach which we believe will facilitate a more comprehensive assessment of governance in health systems leading to the development of governance interventions to strengthen system performance and improve health as a basic human right. PMID:22136318

Distributed systems status and control

NASA Technical Reports Server (NTRS)

Kreidler, David; Vickers, David

1990-01-01

Concepts are investigated for an automated status and control system for a distributed processing environment. System characteristics, data requirements for health assessment, data acquisition methods, system diagnosis methods and control methods were investigated in an attempt to determine the high-level requirements for a system which can be used to assess the health of a distributed processing system and implement control procedures to maintain an accepted level of health for the system. A potential concept for automated status and control includes the use of expert system techniques to assess the health of the system, detect and diagnose faults, and initiate or recommend actions to correct the faults. Therefore, this research included the investigation of methods by which expert systems were developed for real-time environments and distributed systems. The focus is on the features required by real-time expert systems and the tools available to develop real-time expert systems.

The scope of cell phones in diabetes management in developing country health care settings.

PubMed

Ajay, Vamadevan S; Prabhakaran, Dorairaj

2011-05-01

Diabetes has emerged as a major public health concern in developing nations. Health systems in most developing countries are yet to integrate effective prevention and control programs for diabetes into routine health care services. Given the inadequate human resources and underfunctioning health systems, we need novel and innovative approaches to combat diabetes in developing-country settings. In this regard, the tremendous advances in telecommunication technology, particularly cell phones, can be harnessed to improve diabetes care. Cell phones could serve as a tool for collecting information on surveillance, service delivery, evidence-based care, management, and supply systems pertaining to diabetes from primary care settings in addition to providing health messages as part of diabetes education. As a screening/diagnostic tool for diabetes, cell phones can aid the health workers in undertaking screening and diagnostic and follow-up care for diabetes in the community. Cell phones are also capable of acting as a vehicle for continuing medical education; a decision support system for evidence-based management; and a tool for patient education, self-management, and compliance. However, for widespread use, we need robust evaluations of cell phone applications in existing practices and appropriate interventions in diabetes. © 2011 Diabetes Technology Society.

The Scope of Cell Phones in Diabetes Management in Developing Country Health Care Settings

PubMed Central

Ajay, Vamadevan S; Prabhakaran, Dorairaj

2011-01-01

Diabetes has emerged as a major public health concern in developing nations. Health systems in most developing countries are yet to integrate effective prevention and control programs for diabetes into routine health care services. Given the inadequate human resources and underfunctioning health systems, we need novel and innovative approaches to combat diabetes in developing-country settings. In this regard, the tremendous advances in telecommunication technology, particularly cell phones, can be harnessed to improve diabetes care. Cell phones could serve as a tool for collecting information on surveillance, service delivery, evidence-based care, management, and supply systems pertaining to diabetes from primary care settings in addition to providing health messages as part of diabetes education. As a screening/diagnostic tool for diabetes, cell phones can aid the health workers in undertaking screening and diagnostic and follow-up care for diabetes in the community. Cell phones are also capable of acting as a vehicle for continuing medical education; a decision support system for evidence-based management; and a tool for patient education, self-management, and compliance. However, for widespread use, we need robust evaluations of cell phone applications in existing practices and appropriate interventions in diabetes. PMID:21722593

Climate Change and Health under the Shared Socioeconomic Pathway Framework

PubMed Central

Ebi, Kristie L.

2017-01-01

A growing body of literature addresses how climate change is likely to have substantial and generally adverse effects on population health and health systems around the world. These effects are likely to vary within and between countries and, importantly, will vary depending on different socioeconomic development patterns. Transitioning to a more resilient and sustainable world to prepare for and manage the effects of climate change is likely to result in better health outcomes. Sustained fossil fuel development will likely result in continued high burdens of preventable conditions, such as undernutrition, malaria, and diarrheal diseases. Using a new set of socioeconomic development trajectories, the Shared Socioeconomic Pathways (SSPs), along with the World Health Organization’s Operational Framework for Building Climate Resilient Health Systems, we extend existing storylines to illustrate how various aspects of health systems are likely to be affected under each SSP. We also discuss the implications of our findings on how the burden of mortality and the achievement of health-related Sustainable Development Goal targets are likely to vary under different SSPs. PMID:29267204

Trust Information-Based Privacy Architecture for Ubiquitous Health

PubMed Central

2013-01-01

Background Ubiquitous health is defined as a dynamic network of interconnected systems that offers health services independent of time and location to a data subject (DS). The network takes place in open and unsecure information space. It is created and managed by the DS who sets rules that regulate the way personal health information is collected and used. Compared to health care, it is impossible in ubiquitous health to assume the existence of a priori trust between the DS and service providers and to produce privacy using static security services. In ubiquitous health features, business goals and regulations systems followed often remain unknown. Furthermore, health care-specific regulations do not rule the ways health data is processed and shared. To be successful, ubiquitous health requires novel privacy architecture. Objective The goal of this study was to develop a privacy management architecture that helps the DS to create and dynamically manage the network and to maintain information privacy. The architecture should enable the DS to dynamically define service and system-specific rules that regulate the way subject data is processed. The architecture should provide to the DS reliable trust information about systems and assist in the formulation of privacy policies. Furthermore, the architecture should give feedback upon how systems follow the policies of DS and offer protection against privacy and trust threats existing in ubiquitous environments. Methods A sequential method that combines methodologies used in system theory, systems engineering, requirement analysis, and system design was used in the study. In the first phase, principles, trust and privacy models, and viewpoints were selected. Thereafter, functional requirements and services were developed on the basis of a careful analysis of existing research published in journals and conference proceedings. Based on principles, models, and requirements, architectural components and their interconnections were developed using system analysis. Results The architecture mimics the way humans use trust information in decision making, and enables the DS to design system-specific privacy policies using computational trust information that is based on systems’ measured features. The trust attributes that were developed describe the level systems for support awareness and transparency, and how they follow general and domain-specific regulations and laws. The monitoring component of the architecture offers dynamic feedback concerning how the system enforces the polices of DS. Conclusions The privacy management architecture developed in this study enables the DS to dynamically manage information privacy in ubiquitous health and to define individual policies for all systems considering their trust value and corresponding attributes. The DS can also set policies for secondary use and reuse of health information. The architecture offers protection against privacy threats existing in ubiquitous environments. Although the architecture is targeted to ubiquitous health, it can easily be modified to other ubiquitous applications. PMID:25099213

Designing a model for trauma system management using public health approach: the case of Iran.

PubMed

Tarighi, Payam; Tabibi, Seyed Jamaledin; Motevalian, Seyed Abbas; Tofighi, Shahram; Maleki, Mohammad Reza; Delgoshaei, Bahram; Panahi, Farzad; Masoomi, Gholam Reza

2012-01-01

Trauma is a leading cause of death and disability around the world. Injuries are responsible for about six million deaths annually, of which ninety percent occur in developing countries. In Iran, injuries are the most common cause of death among age groups below fifty. Trauma system development is a systematic and comprehensive approach to injury prevention and treatment whose effectiveness has been proved. The present study aims at designing a trauma system management model as the first step toward trauma system establishment in Iran. In this qualitative research, a conceptual framework was developed based on the public health approach and three well-known trauma system models. We used Benchmarks, Indicators and Scoring (BIS) to analyze the current situation of Iran trauma care system. Then the trauma system management was designed using the policy development phase of public health approach The trauma system management model, validated by a panel of experts, describes lead agency, trauma system plan, policy-making councils, and data-based control according to the four main functions of management: leading, planning, organizing and controlling. This model may be implemented in two phases: the exclusive phase, focusing on resource integration and the inclusive phase, which concentrates on system development. The model could facilitate the development of trauma system in Iran through pilot studies as the assurance phase of public health approach. Furthermore, the model can provide a practical framework for trauma system management at the international level.

Building a Workforce for Future Health Systems: Reflections from Health Policy and Systems Research.

PubMed

Javadi, Dena; Tran, Nhan; Ghaffar, Abdul

2018-05-24

The era of the Sustainable Development Goals calls for multidisciplinary research and intersectoral approaches to addressing health challenges. This presents a unique opportunity for multidisciplinary fields concerned with complex systems. Those working in system-oriented fields such as health policy and systems research (HPSR) and health services research must be forward-thinking in optimizing their collective ability to address these global challenges. The objective of this commentary was to share reflections on challenges and strategies in managing the HPSR workforce in order to stimulate dialogue and cross-learning across similar fields. The following strategies are discussed here: definitional clarity of expected competencies and coordination across HPS researchers, national investment in HPSR, institutional capacity for coproduction of knowledge across different types of actors, and participatory leadership. Creative approaches in training, financing, developing, and leading the diverse workforce required to strengthen health systems can pave the way for its full-time and part-time members to work together. © Health Research and Educational Trust.

Organization of ambulatory care provision: a critical determinant of health system performance in developing countries.

PubMed Central

Berman, P.

2000-01-01

Success in the provision of ambulatory personal health services, i.e. providing individuals with treatment for acute illness and preventive health care on an ambulatory basis, is the most significant contributor to the health care system's performance in most developing countries. Ambulatory personal health care has the potential to contribute the largest immediate gains in health status in populations, especially for the poor. At present, such health care accounts for the largest share of the total health expenditure in most lower income countries. It frequently comprises the largest share of the financial burden on households associated with health care consumption, which is typically regressively distributed. The "organization" of ambulatory personal health services is a critical determinant of the health system's performance which, at present, is poorly understood and insufficiently considered in policies and programmes for reforming health care systems. This article begins with a brief analysis of the importance of ambulatory care in the overall health system performance and this is followed by a summary of the inadequate global data on ambulatory care organization. It then defines the concept of "macro organization of health care" at a system level. Outlined also is a framework for analysing the organization of health care services and the major pathways through which the organization of ambulatory personal health care services can affect system performance. Examples of recent policy interventions to influence primary care organization--both government and nongovernmental providers and market structure--are reviewed. It is argued that the characteristics of health care markets in developing countries and of most primary care goods result in relatively diverse and competitive environments for ambulatory care services, compared with other types of health care. Therefore, governments will be required to use a variety of approaches beyond direct public provision of services to improve performance. To do this wisely, much better information on ambulatory care organization is needed, as well as more experience with diverse approaches to improve performance. PMID:10916916

Necessity and feasibility of improving mental health services in China: A systematic qualitative review.

PubMed

Zhao, Xudong; Liu, Liang; Hu, Chengping; Chen, Fazhan; Sun, Xirong

2017-07-01

It has been nearly 40 years since the reform and opening up of Mainland China. The mental health services system has developed rapidly as a part of the profound socioeconomic changes that ensued. However, its development has not been as substantial as other areas of medical care. For the current qualitative systematic review, we searched databases, including China Biology Medicine disc, Weipu, China National Knowledge Infrastructure, Wanfang digital periodical full text data, China's important newspaper full text database, China Statistical Yearbook database, etc. The content of primary research, literature, and policy papers about the evolution and development of Chinese mental health services was systemically reviewed and analysed by using thematic analysis. Two main themes relative to the necessity and feasibility of reforming the current mental health services system emerged. We discuss 5 corresponding subthemes under the umbrella of the necessity of improving the current treatment, rehabilitation, prevention, and service systems and 7 requirements for the feasibility of reforming the current system. We conclude that as the development of the Chinese economy and the spirit of humanistic care continue, the improvement and reformation of the mental health services system are both necessary and feasible. Copyright © 2017 John Wiley & Sons, Ltd.

Explaining equity gains in child survival in Bangladesh: scale, speed, and selectivity in health and development.

PubMed

Adams, Alayne M; Rabbani, Atonu; Ahmed, Shamim; Mahmood, Shehrin Shaila; Al-Sabir, Ahmed; Rashid, Sabina F; Evans, Timothy G

2013-12-14

By disaggregating gains in child health in Bangladesh over the past several decades, significant improvements in gender and socioeconomic inequities have been revealed. With the use of a social determinants of health approach, key features of the country's development experience can be identified that help explain its unexpected health trajectory. The systematic equity orientation of health and socioeconomic development in Bangladesh, and the implementation attributes of scale, speed, and selectivity, have been important drivers of health improvement. Despite this impressive pro-equity trajectory, there remain significant residual inequities in survival of girls and lower wealth quintiles as well as a host of new health and development challenges such as urbanisation, chronic disease, and climate change. Further progress in sustaining and enhancing equity-oriented achievements in health hinges on stronger governance and longer-term systems thinking regarding how to effectively promote inclusive and equitable development within and beyond the health system. Copyright © 2013 Elsevier Ltd. All rights reserved.

A conceptual framework and principles for trusted pervasive health.

PubMed

Ruotsalainen, Pekka Sakari; Blobel, Bernd Gerhard; Seppälä, Antto Veikko; Sorvari, Hannu Olavi; Nykänen, Pirkko Anneli

2012-04-06

Ubiquitous computing technology, sensor networks, wireless communication and the latest developments of the Internet have enabled the rise of a new concept-pervasive health-which takes place in an open, unsecure, and highly dynamic environment (ie, in the information space). To be successful, pervasive health requires implementable principles for privacy and trustworthiness. This research has two interconnected objectives. The first is to define pervasive health as a system and to understand its trust and privacy challenges. The second goal is to build a conceptual model for pervasive health and use it to develop principles and policies which can make pervasive health trustworthy. In this study, a five-step system analysis method is used. Pervasive health is defined using a metaphor of digital bubbles. A conceptual framework model focused on trustworthiness and privacy is then developed for pervasive health. On that model, principles and rules for trusted information management in pervasive health are defined. In the first phase of this study, a new definition of pervasive health was created. Using this model, differences between pervasive health and health care are stated. Reviewed publications demonstrate that the widely used principles of predefined and static trust cannot guarantee trustworthiness and privacy in pervasive health. Instead, such an environment requires personal dynamic and context-aware policies, awareness, and transparency. A conceptual framework model focused on information processing in pervasive health is developed. Using features of pervasive health and relations from the framework model, new principles for trusted pervasive health have been developed. The principles propose that personal health data should be under control of the data subject. The person shall have the right to verify the level of trust of any system which collects or processes his or her health information. Principles require that any stakeholder or system collecting or processing health data must support transparency and shall publish its trust and privacy attributes and even its domain specific policies. The developed principles enable trustworthiness and guarantee privacy in pervasive health. The implementation of principles requires new infrastructural services such as trust verification and policy conflict resolution. After implementation, the accuracy and usability of principles should be analyzed.

A Review of Literature to Understand the Complexity of Equity, Ethics and Management for Achieving Public Health Goals in India

PubMed Central

Garg, Pankaj; Nagpal, Jitender

2014-01-01

In the context of inadequate public spending on health care in India (0.9% of the GDP); government liberalized its policies in the form of subsidized lands and tax incentives, resulting in the mushrooming of private hospitals and clinics in India. Paradoxically, a robust framework was not developed for the regulation of these health care providers, resulting in disorganized health sector, inadequate financing models, and lack of prioritization of services, as well as a sub-optimal achievement of the Millennium Development Goals (MDG). We systematically reviewed the evidence base regarding regulation of private hospitals, applicability of private-public mix, state of health insurance and effective policy development for India, while seeking lessons on regulation of private health systems, from South African (a developing country) and Australian (a developed country) health care systems. PMID:24701465

Developing Health Education Programs in Rural Areas.

ERIC Educational Resources Information Center

Colle, Royal D.

If primary medical care is to be provided to remote rural populations in developing countries, alternative and innovative delivery systems emphasizing community participation, use of paraprofessionals, and health education programs must be considered. A recent American Public Health Association study of 180 health projects in developing countries…

The role and uptake of private health insurance in different health care systems: are there lessons for developing countries?

PubMed

Odeyemi, Isaac Ao; Nixon, John

2013-01-01

Social and national health insurance schemes are being introduced in many developing countries in moving towards universal health care. However, gaps in coverage are common and can only be met by out-of-pocket payments, general taxation, or private health insurance (PHI). This study provides an overview of PHI in different health care systems and discusses factors that affect its uptake and equity. A representative sample of countries was identified (United States, United Kingdom, The Netherlands, France, Australia, and Latvia) that illustrates the principal forms and roles of PHI. Literature describing each country's health care system was used to summarize how PHI is utilized and the factors that affect its uptake and equity. In the United States, PHI is a primary source of funding in conjunction with tax-based programs to support vulnerable groups; in the UK and Latvia, PHI is used in a supplementary role to universal tax-based systems; in France and Latvia, complementary PHI is utilized to cover gaps in public funding; in The Netherlands, PHI is supplementary to statutory private and social health insurance; in Australia, the government incentivizes the uptake of complementary PHI through tax rebates and penalties. The uptake of PHI is influenced by age, income, education, health care system typology, and the incentives or disincentives applied by governments. The effect on equity can either be positive or negative depending on the type of PHI adopted and its role within the wider health care system. PHI has many manifestations depending on the type of health care system used and its role within that system. This study has illustrated its common applications and the factors that affect its uptake and equity in different health care systems. The results are anticipated to be helpful in informing how developing countries may utilize PHI to meet the aim of achieving universal health care.

Developing a dashboard to help measure and achieve the triple aim: a population-based cohort study.

PubMed

Seow, Hsien-Yeang; Sibley, Lyn M

2014-08-30

Health system planners aim to pursue the three goals of Triple Aim: 1) reduce health care costs; 2) improve population health; and 3) improve the care experience. Moreover, they also need measures that can reliably predict future health care needs in order to manage effectively the health system performance. Yet few measures exist to assess Triple Aim and predict future needs at a health system level. The purpose of this study is to explore the novel application of a case-mix adjustment method in order to measure and help improve the Triple Aim of health system performance. We applied a case-mix adjustment method to a population-based analysis to assess its usefulness as a measure of health system performance and Triple Aim. The study design was a retrospective, cohort study of adults from Ontario, Canada using administrative databases: individuals were assigned a predicted illness burden score using a case-mix adjustment system from diagnoses and health utilization data in 2008, and then followed forward to assess the actual health care utilization and costs in the following year (2009). We applied the Johns Hopkins Adjusted Clinical Group (ACG) Case-Mix System to categorize individuals into 60 levels of healthcare need, called ACGs. The outcomes were: 1) Number of individuals per ACG; 2) Total system costs per ACG; and 3) Mean cost per person per ACG, which together formed a health system "dashboard". We identified 11.4 million adults. 16.1% were aged 65 or older, 3.2 million (28%) did not use health care services that year, and 45,000 (0.4%) were in the highest acuity ACG category using 12 times more than an average adult. The sickest 1%, 5% and 15% of the population use about 10%, 30% and 50% of total health system costs respectively. The dashboard measures 2 dimensions of Triple Aim: 1) reduced costs: when total system costs per ACG or when average costs per person is reduced; and 2) improved population health: when more people move into healthier rather than sicker ACGs. It can help to achieve the third aim, improved care experience, when ACG utilization predictions are reported to providers to proactively develop care plans. The dashboard, developed via case-mix methods, measures 2 of the Triple Aim goals and can help health system planners better manage their health delivery systems.

Study of Global Health Strategy Based on International Trends: -Promoting Universal Health Coverage Globally and Ensuring the Sustainability of Japan's Universal Coverage of Health Insurance System: Problems and Proposals.

PubMed

Hatanaka, Takashi; Eguchi, Narumi; Deguchi, Mayumi; Yazawa, Manami; Ishii, Masami

2015-09-01

The Japanese government at present is implementing international health and medical growth strategies mainly from the viewpoint of business. However, the United Nations is set to resolve the Post-2015 Development Agenda in the fall of 2015; the agenda will likely include the achievement of universal health coverage (UHC) as a specific development goal. Japan's healthcare system, the foundation of which is its public, nationwide universal health insurance program, has been evaluated highly by the Lancet. The World Bank also praised it as a global model. This paper presents suggestions and problems for Japan regarding global health strategies, including in regard to several prerequisite domestic preparations that must be made. They are summarized as follows. (1) The UHC development should be promoted in coordination with the United Nations, World Bank, and Asian Development Bank. (2) The universal health insurance system of Japan can be a global model for UHC and ensuring its sustainability should be considered a national policy. (3) Trade agreements such as the Trans-Pacific Partnership (TPP) should not disrupt or interfere with UHC, the form of which is unique to each nation, including Japan. (4) Japan should disseminate information overseas, including to national governments, people, and physicians, regarding the course of events that led to the establishment of the Japan's universal health insurance system and should make efforts to develop international human resources to participate in UHC policymaking. (5) The development of separate healthcare programs and UHC preparation should be promoted by streamlining and centralizing maternity care, school health, infectious disease management such as for tuberculosis, and emergency medicine such as for traffic accidents. (6) Japan should disseminate information overseas about its primary care physicians (kakaritsuke physicians) and develop international human resources. (7) Global health should be developed in integration with global environment problem management. (8) Support systems, such as for managing large-scale disasters of international scale or preventing the spread of infectious diseases, should be developed and maintained. (9) International healthcare policy, which the Japanese government is trying to promote in accordance with international trends, and international development of Japanese healthcare industry should be reconsidered.

[The health system of El Salvador].

PubMed

Acosta, Mónica; Sáenz, María del Rocío; Gutiérrez, Blanca; Bermúdez, Juan Luis

2011-01-01

This paper describes the health conditions in El Salvador and the main característics of the Salvadoran health system, including its structure and coverage, its financial sources, the physical, material and human resources available, the stewardship functions developed by the Ministry of Public Health, and the participation of health care users in the evaluation of the system. It also discusses the most recent policy innovations including the approval of the Law for the Creation of the National Health System, which intends to expand coverage, reduce health inequalities and improve the coordination of public health institutions.

Use of the self-organising map network (SOMNet) as a decision support system for regional mental health planning.

PubMed

Chung, Younjin; Salvador-Carulla, Luis; Salinas-Pérez, José A; Uriarte-Uriarte, Jose J; Iruin-Sanz, Alvaro; García-Alonso, Carlos R

2018-04-25

Decision-making in mental health systems should be supported by the evidence-informed knowledge transfer of data. Since mental health systems are inherently complex, involving interactions between its structures, processes and outcomes, decision support systems (DSS) need to be developed using advanced computational methods and visual tools to allow full system analysis, whilst incorporating domain experts in the analysis process. In this study, we use a DSS model developed for interactive data mining and domain expert collaboration in the analysis of complex mental health systems to improve system knowledge and evidence-informed policy planning. We combine an interactive visual data mining approach, the self-organising map network (SOMNet), with an operational expert knowledge approach, expert-based collaborative analysis (EbCA), to develop a DSS model. The SOMNet was applied to the analysis of healthcare patterns and indicators of three different regional mental health systems in Spain, comprising 106 small catchment areas and providing healthcare for over 9 million inhabitants. Based on the EbCA, the domain experts in the development team guided and evaluated the analytical processes and results. Another group of 13 domain experts in mental health systems planning and research evaluated the model based on the analytical information of the SOMNet approach for processing information and discovering knowledge in a real-world context. Through the evaluation, the domain experts assessed the feasibility and technology readiness level (TRL) of the DSS model. The SOMNet, combined with the EbCA, effectively processed evidence-based information when analysing system outliers, explaining global and local patterns, and refining key performance indicators with their analytical interpretations. The evaluation results showed that the DSS model was feasible by the domain experts and reached level 7 of the TRL (system prototype demonstration in operational environment). This study supports the benefits of combining health systems engineering (SOMNet) and expert knowledge (EbCA) to analyse the complexity of health systems research. The use of the SOMNet approach contributes to the demonstration of DSS for mental health planning in practice.

Health in the service of state-building in fragile and conflict affected contexts: an additional challenge in the medical-humanitarian environment.

PubMed

Philips, Mit; Derderian, Katharine

2015-01-01

Global health policy and development aid trends also affect humanitarian health work. Reconstruction, rehabilitation and development initiatives start increasingly earlier after crisis, unleashing tensions between development and humanitarian paradigms. Recently, development aid shows specific interest in contexts affected by conflict and fragility, with increasing expectations for health interventions to demonstrate transformative potential, including towards more resilient health systems as a contribution to state-building agendas. Current drives towards state-building opportunities in health interventions is mainly based on political aspirations, with little conclusive evidence on linking state-building efforts to conflict prevention, neither on transformative effects of health systems support. Moreover, negative consequences are possible in such volatile environments. We explore how to anticipate, discuss and monitor potential negative effects of current state-building approaches on health interventions, including on humanitarian aid. Overriding health systems approaches might increase tension in fragile and conflict affected contexts, because at odds with goals typically associated with immediate emergency response to populations' needs. Especially in protracted crisis, quality and timeliness of humanitarian response can be compromised, with strain on impartiality, targeting the most vulnerable, prioritising direct health benefits and most effective strategies. State-building focus could shift health aid priorities away from sick people and disease. Precedence of state institutions support over immediate, effective health service delivery can reduce population level results. As consequence people might question health workers' intention to privilege health above political, ethnic or other alliances, altering health and humanitarian workers' perception. Particularly in conflict, neither health system nor state are impartial bystanders. In spite of scarce evidence on benefits of health systems support for state-building, current dominant line of thought among donors might influence aid strategies and modalities in settings of crisis, conflict and longer-term health system fragility. Negative consequences may arise from dominance of political agendas over health needs, with risk for effectiveness, nature and perception of health interventions. Potential effects in at least three key health areas merit critical review: quality of humanitarian health interventions, tangible contributions to population level health benefits, perception of health and humanitarian workers. To keep health needs as yardstick to determine effective health and humanitarian priority investments, is challenging.

Development and usability testing of FOCUS: a smartphone system for self-management of schizophrenia.

PubMed

Ben-Zeev, Dror; Kaiser, Susan M; Brenner, Christopher J; Begale, Mark; Duffecy, Jennifer; Mohr, David C

2013-12-01

Mobile Health (mHealth) approaches can support the rehabilitation of individuals with psychiatric conditions. In the current article, we describe the development of a smartphone illness self-management system for people with schizophrenia. The research was conducted with consumers and practitioners at a community-based rehabilitation agency. Stage 1: 904 individuals with schizophrenia or schizoaffective disorder completed a survey reporting on their current use of mobile devices and interest in mHealth services. Eight practitioners completed a survey examining their attitudes and expectations from an mHealth intervention, and identified needs and potential obstacles. Stage 2: A multidisciplinary team incorporated consumer and practitioner input and employed design principles for the development of e-resources for people with schizophrenia to produce an mHealth intervention. Stage 3: 12 consumers participated in laboratory usability sessions. They performed tasks involved in operating the new system, and provided "think aloud" commentary and post-session usability ratings. 570 (63%) of survey respondents reported owning a mobile device and many expressed interest in receiving mHealth services. Most practitioners believed that consumers could learn to use and would benefit from an mHealth intervention. In response, we developed a smartphone system that targets medication adherence, mood regulation, sleep, social functioning, and coping with symptoms. Usability testing revealed several design vulnerabilities, and the system was adapted to address consumer needs and preferences accordingly. Through a comprehensive development process, we produced an mHealth illness self-management intervention that is likely to be used successfully, and is ready for deployment and systemic evaluation in real-world conditions. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Autonomous Operations System: Development and Application

NASA Technical Reports Server (NTRS)

Toro Medina, Jaime A.; Wilkins, Kim N.; Walker, Mark; Stahl, Gerald M.

2016-01-01

Autonomous control systems provides the ability of self-governance beyond the conventional control system. As the complexity of mechanical and electrical systems increases, there develops a natural drive for developing robust control systems to manage complicated operations. By closing the bridge between conventional automated systems to knowledge based self-awareness systems, nominal control of operations can evolve into relying on safe critical mitigation processes to support any off-nominal behavior. Current research and development efforts lead by the Autonomous Propellant Loading (APL) group at NASA Kennedy Space Center aims to improve cryogenic propellant transfer operations by developing an automated control and health monitoring system. As an integrated systems, the center aims to produce an Autonomous Operations System (AOS) capable of integrating health management operations with automated control to produce a fully autonomous system.

Health systems engineering fellowship: curriculum and program development.

PubMed

Watts, Bradley V; Shiner, Brian; Cully, Jeffrey A; Gilman, Stuart C; Benneyan, James C; Eisenhauer, William

2015-01-01

Industrial engineering and related disciplines have been used widely in improvement efforts in many industries. These approaches have been less commonly attempted in health care. One factor limiting application is the limited workforce resulting from a lack of specific education and professional development in health systems engineering (HSE). The authors describe the development of an HSE fellowship within the United States Department of Veterans Affairs, Veterans Health Administration (VA). This fellowship includes a novel curriculum based on specifically established competencies for HSE. A 1-year HSE curriculum was developed and delivered to fellows at several VA engineering resource centers over several years. On graduation, a majority of the fellows accepted positions in the health care field. Challenges faced in developing the fellowship are discussed. Advanced educational opportunities in applied HSE have the potential to develop the workforce capacity needed to improve the quality of health care. © 2014 by the American College of Medical Quality.

Leveraging finances for public health system improvement: results from the Turning Point initiative.

PubMed

Bekemeier, Betty; Riley, Catharine M; Berkowitz, Bobbie

2007-01-01

Reforming the public health infrastructure requires substantial system changes at the state level; state health agencies, however, often lack the resources and support for strategic planning and systemwide improvement. The Turning Point Initiative provided support for states to focus on large-scale system changes that resulted in increased funding for public health capacity and infrastructure development. Turning Point provides a test case for obtaining financial and institutional resources focused on systems change and infrastructure development-areas for which it has been historically difficult to obtain long-term support. The purpose of this exploratory, descriptive survey research was to enumerate the actual resources leveraged toward public health system improvement through the partnerships, planning, and implementation activities funded by the Robert Wood Johnson Foundation as a part of the Turning Point Initiative.

Development of a master health facility list in Nigeria.

PubMed

Makinde, Olusesan Ayodeji; Azeez, Aderemi; Bamidele, Samson; Oyemakinde, Akin; Oyediran, Kolawole Azeez; Adebayo, Wura; Fapohunda, Bolaji; Abioye, Abimbola; Mullen, Stephanie

2014-01-01

Abstract. Routine Health Information Systems (RHIS) are increasingly transitioning to electronic platforms in several developing countries. Establishment of a Master Facility List (MFL) to standardize the allocation of unique identifiers for health facilities can overcome identification issues and support health facility management. The Nigerian Federal Ministry of Health (FMOH) recently developed a MFL, and we present the process and outcome. The MFL was developed from the ground up, and includes a state code, a local government area (LGA) code, health facility ownership (public or private), the level of care, and an exclusive LGA level health facility serial number, as part of the unique identifier system in Nigeria. To develop the MFL, the LGAs sent the list of all health facilities in their jurisdiction to the state, which in turn collated for all LGAs under them before sending to the FMOH. At the FMOH, a group of RHIS experts verified the list and identifiers for each state. The national MFL consists of 34,423 health facilities uniquely identified. The list has been published and is available for worldwide access; it is currently used for planning and management of health services in Nigeria. Unique identifiers are a basic component of any information system. However, poor planning and execution of implementing this key standard can diminish the success of the RHIS. Development and adherence to standards is the hallmark for a national health information infrastructure. Explicit processes and multi-level stakeholder engagement is necessary to ensuring the success of the effort.

Integrated Electronic Health Record Database Management System: A Proposal.

PubMed

Schiza, Eirini C; Panos, George; David, Christiana; Petkov, Nicolai; Schizas, Christos N

2015-01-01

eHealth has attained significant importance as a new mechanism for health management and medical practice. However, the technological growth of eHealth is still limited by technical expertise needed to develop appropriate products. Researchers are constantly in a process of developing and testing new software for building and handling Clinical Medical Records, being renamed to Electronic Health Record (EHR) systems; EHRs take full advantage of the technological developments and at the same time provide increased diagnostic and treatment capabilities to doctors. A step to be considered for facilitating this aim is to involve more actively the doctor in building the fundamental steps for creating the EHR system and database. A global clinical patient record database management system can be electronically created by simulating real life medical practice health record taking and utilizing, analyzing the recorded parameters. This proposed approach demonstrates the effective implementation of a universal classic medical record in electronic form, a procedure by which, clinicians are led to utilize algorithms and intelligent systems for their differential diagnosis, final diagnosis and treatment strategies.

Developing nursing capacity for health systems and services research in Cuba, 2008-2011.

PubMed

Martínez, Nelcy

2012-07-01

Health systems and services research by nursing personnel could inform decision-making and nursing care, providing evidence concerning quality of and patient satisfaction. Such studies are rather uncommon in Cuban research institutes, where clinical research predominates. Assess the results of a strategy implemented between 2008 and 2011 to develop nursing capacity for health systems and services research in 14 national research institutes based in Havana. The study comprised four stages: description of approaches to health systems and services research by nurses worldwide and in Cuba; analysis of current capacities for such research in Cuba; intervention design and implementation; and evaluation. Various techniques were used including: literature review, bibliometric analysis, questionnaire survey, consultation with experts, focus groups, and workshops for participant orientation and design and followup of research projects. Qualitative information reduction and quantitative information summary methods were used. Initially, 32 nursing managers participated; a further 105 nurses from the institutes were involved in research teams formed during intervention implementation. Of all published nursing research articles retrieved, 8.9% (185 of 2081) concerned health systems and services research, of which 26.5% (49 of 185) dealt with quality assessment. At baseline, 75% of Cuban nurses surveyed had poor knowledge of health systems and services research. Orientation, design and followup workshops for all institute teams developed individual and institutional capacity for health systems and services research. Post-intervention, 84.7% (27) of nurses reached good knowledge and 14.3% (5) fair; institutional research teams were formed and maintained in 9 institutes, and 13 projects designed and implemented (11 institutional, 2 addressing ministerial-level priorities) to research nursing issues at selected centers. A systematic strategy to build nursing capacity for health systems and services research can be effective in involving nurses in such research and in developing institutional support for it, fostering compliance with Cuban and international professional development priorities for nursing, as well as contributing to quality of patient services.

[Smart card systems in health care (protection, key-functions, divided data bases, applications)].

PubMed

Simon, P

1999-04-25

Barely more than 15 years have passed since electronic memory cards appeared, their popularity has grown rapidly (first of all as a cash-saving device and later for other purposes, as well). This is due also to the growing interest towards development of the intelligence of information systems for the follow-up of patients' health condition and medical care in countries with a highly developed health and insurance system (need for the creation of data bases divided for individuals) and also to their commitment towards a better control of the quality and costs of health care. We can come to the conclusion that the aim of research, development and the creation of systems in health informatics is to prevent illness and to give a direct informatic support to medical and nursing activity carried out in the patients' interests. The smart card and the surrounding application systems are certainly the appropriate means for the achievement of these aims.

A Conceptual Framework and Principles for Trusted Pervasive Health

PubMed Central

Blobel, Bernd Gerhard; Seppälä, Antto Veikko; Sorvari, Hannu Olavi; Nykänen, Pirkko Anneli

2012-01-01

Background Ubiquitous computing technology, sensor networks, wireless communication and the latest developments of the Internet have enabled the rise of a new concept—pervasive health—which takes place in an open, unsecure, and highly dynamic environment (ie, in the information space). To be successful, pervasive health requires implementable principles for privacy and trustworthiness. Objective This research has two interconnected objectives. The first is to define pervasive health as a system and to understand its trust and privacy challenges. The second goal is to build a conceptual model for pervasive health and use it to develop principles and polices which can make pervasive health trustworthy. Methods In this study, a five-step system analysis method is used. Pervasive health is defined using a metaphor of digital bubbles. A conceptual framework model focused on trustworthiness and privacy is then developed for pervasive health. On that model, principles and rules for trusted information management in pervasive health are defined. Results In the first phase of this study, a new definition of pervasive health was created. Using this model, differences between pervasive health and health care are stated. Reviewed publications demonstrate that the widely used principles of predefined and static trust cannot guarantee trustworthiness and privacy in pervasive health. Instead, such an environment requires personal dynamic and context-aware policies, awareness, and transparency. A conceptual framework model focused on information processing in pervasive health is developed. Using features of pervasive health and relations from the framework model, new principles for trusted pervasive health have been developed. The principles propose that personal health data should be under control of the data subject. The person shall have the right to verify the level of trust of any system which collects or processes his or her health information. Principles require that any stakeholder or system collecting or processing health data must support transparency and shall publish its trust and privacy attributes and even its domain specific policies. Conclusions The developed principles enable trustworthiness and guarantee privacy in pervasive health. The implementation of principles requires new infrastructural services such as trust verification and policy conflict resolution. After implementation, the accuracy and usability of principles should be analyzed. PMID:22481297

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies

PubMed Central

Marais, Debbie; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Chisholm, Dan; Egbe, Catherine; Gureje, Oye; Hanlon, Charlotte; Lund, Crick; Shidhaye, Rahul; Jordans, Mark; Kigozi, Fred; Mugisha, James; Upadhaya, Nawaraj; Thornicroft, Graham

2017-01-01

Abstract Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries. PMID:28369396

Examining construct and predictive validity of the Health-IT Usability Evaluation Scale: confirmatory factor analysis and structural equation modeling results

PubMed Central

Yen, Po-Yin; Sousa, Karen H; Bakken, Suzanne

2014-01-01

Background In a previous study, we developed the Health Information Technology Usability Evaluation Scale (Health-ITUES), which is designed to support customization at the item level. Such customization matches the specific tasks/expectations of a health IT system while retaining comparability at the construct level, and provides evidence of its factorial validity and internal consistency reliability through exploratory factor analysis. Objective In this study, we advanced the development of Health-ITUES to examine its construct validity and predictive validity. Methods The health IT system studied was a web-based communication system that supported nurse staffing and scheduling. Using Health-ITUES, we conducted a cross-sectional study to evaluate users’ perception toward the web-based communication system after system implementation. We examined Health-ITUES's construct validity through first and second order confirmatory factor analysis (CFA), and its predictive validity via structural equation modeling (SEM). Results The sample comprised 541 staff nurses in two healthcare organizations. The CFA (n=165) showed that a general usability factor accounted for 78.1%, 93.4%, 51.0%, and 39.9% of the explained variance in ‘Quality of Work Life’, ‘Perceived Usefulness’, ‘Perceived Ease of Use’, and ‘User Control’, respectively. The SEM (n=541) supported the predictive validity of Health-ITUES, explaining 64% of the variance in intention for system use. Conclusions The results of CFA and SEM provide additional evidence for the construct and predictive validity of Health-ITUES. The customizability of Health-ITUES has the potential to support comparisons at the construct level, while allowing variation at the item level. We also illustrate application of Health-ITUES across stages of system development. PMID:24567081

Oral health information systems--towards measuring progress in oral health promotion and disease prevention.

PubMed Central

Petersen, Poul Erik; Bourgeois, Denis; Bratthall, Douglas; Ogawa, Hiroshi

2005-01-01

This article describes the essential components of oral health information systems for the analysis of trends in oral disease and the evaluation of oral health programmes at the country, regional and global levels. Standard methodology for the collection of epidemiological data on oral health has been designed by WHO and used by countries worldwide for the surveillance of oral disease and health. Global, regional and national oral health databanks have highlighted the changing patterns of oral disease which primarily reflect changing risk profiles and the implementation of oral health programmes oriented towards disease prevention and health promotion. The WHO Oral Health Country/Area Profile Programme (CAPP) provides data on oral health from countries, as well as programme experiences and ideas targeted to oral health professionals, policy-makers, health planners, researchers and the general public. WHO has developed global and regional oral health databanks for surveillance, and international projects have designed oral health indicators for use in oral health information systems for assessing the quality of oral health care and surveillance systems. Modern oral health information systems are being developed within the framework of the WHO STEPwise approach to surveillance of noncommunicable, chronic disease, and data stored in the WHO Global InfoBase may allow advanced health systems research. Sound knowledge about progress made in prevention of oral and chronic disease and in health promotion may assist countries to implement effective public health programmes to the benefit of the poor and disadvantaged population groups worldwide. PMID:16211160

Understanding the organization of public health delivery systems: an empirical typology.

PubMed

Mays, Glen P; Scutchfield, F Douglas; Bhandari, Michelyn W; Smith, Sharla A

2010-03-01

Policy discussions about improving the U.S. health care system increasingly recognize the need to strengthen its capacities for delivering public health services. A better understanding of how public health delivery systems are organized across the United States is critical to improvement. To facilitate the development of such evidence, this article presents an empirical method of classifying and comparing public health delivery systems based on key elements of their organizational structure. This analysis uses data collected through a national longitudinal survey of local public health agencies serving communities with at least 100,000 residents. The survey measured the availability of twenty core public health activities in local communities and the types of organizations contributing to each activity. Cluster analysis differentiated local delivery systems based on the scope of activities delivered, the range of organizations contributing, and the distribution of effort within the system. Public health delivery systems varied widely in organizational structure, but the observed patterns of variation suggested that systems adhere to one of seven distinct configurations. Systems frequently migrated from one configuration to another over time, with an overall trend toward offering a broader scope of services and engaging a wider range of organizations. Public health delivery systems exhibit important structural differences that may influence their operations and outcomes. The typology developed through this analysis can facilitate comparative studies to identify which delivery system configurations perform best in which contexts.

Implementing what works: a case study of integrated primary health care revitalisation in Timor-Leste

PubMed Central

2014-01-01

Background Revitalising primary health care (PHC) and the need to reach MDG targets requires developing countries to adapt current evidence about effective health systems to their local context. Timor-Leste in one of the world’s newest developing nations, with high maternal and child mortality rates, malaria, TB and malnutrition. Mountainous terrain and lack of transport pose serious challenges for accessing health services and implementing preventive health strategies. Methods We conducted a non-systematic review of the literature and identified six components of an effective PHC system. These were mapped onto three countries’ PHC systems and present a case study from Timor-Leste’s Servisu Integrado du Saude Comunidade (SISCa) focussing on MDGs. Some of the challenges of implementing these into practice are shown through locally collected health system data. Results An effective PHC system comprises 1) Strong leadership and government in human rights for health; 2) Prioritisation of cost-effective interventions; 3) Establishing an interactive and integrated culture of community engagement; 4) Providing an integrated continuum of care at the community level; 5) Supporting skilled and equipped health workers at all levels of the health system; 6) Creating a systems cycle of feedback using data to inform health care. The implementation case study from Timor-Leste (population 1 million) shows that in its third year, limited country-wide data had been collected and the SISCa program provided over half a million health interactions at the village level. However, only half of SISCa clinics were functional across the country. Attendances included not only pregnant women and children, but also adults and older community members. Development partners have played a key role in supporting this implementation process. Conclusion The SISCa program is a PHC model implementing current best practice to reach remote communities in a new developing country. Despite limited resources, village level healthcare and engagement can be achieved but takes a long-term commitment and partnership. PMID:24559229

Data for development in health: a case study and monitoring framework from Kazakhstan

PubMed Central

Obermann, Konrad; Chanturidze, Tata; Richardson, Erica; Tanirbergenov, Serik; Shoranov, Marat; Nurgozhaev, Ali

2016-01-01

Healthcare reforms are often not coupled with a relevant and appropriate monitoring framework, leaving policymakers and the public without evidence about the implications of such reforms. Kazakhstan has embarked on a large-scale reform of its healthcare system in order to achieve Universal Health Coverage. The health-related 2020 Strategic Development Goals reflect this political ambition. In a case-study approach and on the basis of published and unpublished evidence as well as personal involvement and experience (A) the indicators in the 2020 Strategic Development Goals were assessed and (B) a ‘data-mapping’ exercise was conducted, where the WHO health system framework was used to describe the data available at present in Kazakhstan and comment on the different indicators regarding their usefulness for monitoring the current health-related 2020 Strategic Development Goals in Kazakhstan. It was concluded that the country’s current monitoring framework needs further development to track the progress and outcomes of policy implementation. The application of a modified WHO/World Bank/Global Fund health system monitoring framework was suggested to examine the implications of recent health sector reforms. Lessons drawn from the Kazakhstan experience on tailoring the suggested framework, collecting the data, and using the generated intelligence in policy development and decision-making can serve as a useful example for other middle-income countries, potentially enabling them to fast-track developments in the health sector. PMID:28588905

Belarus: health system review.

PubMed

Richardson, Erica; Malakhova, Irina; Novik, Irina; Famenka, Andrei

2013-01-01

This analysis of the Belarusian health system reviews the developments in organization and governance, health financing, healthcare provision, health reforms and health system performance since 2008. Despite considerable change since independence, Belarus retains a commitment to the principle of universal access to health care, provided free at the point of use through predominantly state-owned facilities, organized hierarchically on a territorial basis. Incremental change, rather than radical reform, has also been the hallmark of health-care policy, although capitation funding has been introduced in some areas and there have been consistent efforts to strengthen the role of primary care. Issues of high costs in the hospital sector and of weaknesses in public health demonstrate the necessity of moving forward with the reform programme. The focus for future reform is on strengthening preventive services and improving the quality and efficiency of specialist services. The key challenges in achieving this involve reducing excess hospital capacity, strengthening health-care management, use of evidence-based treatment and diagnostic procedures, and the development of more efficient financing mechanisms. Involving all stakeholders in the development of further reform planning and achieving consensus among them will be key to its success. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

Coordinating Systems of Care Using Health Information Technology: Development of the ADHD Care Assistant

ERIC Educational Resources Information Center

Power, Thomas J.; Michel, Jeremy; Mayne, Stephanie; Miller, Jeffrey; Blum, Nathan J.; Grundmeier, Robert W.; Guevara, James P.; Fiks, Alexander G.

2016-01-01

Perhaps the two principal venues for the delivery of mental health services are schools and primary care practices. Unfortunately, these systems of care are poorly connected, which may result in care that is fragmented and suboptimal. This article describes the development and implementation of an electronic health record portal, known as the ADHD…

The State of Open Source Electronic Health Record Projects: A Software Anthropology Study

PubMed Central

2017-01-01

Background Electronic health records (EHR) are a key tool in managing and storing patients’ information. Currently, there are over 50 open source EHR systems available. Functionality and usability are important factors for determining the success of any system. These factors are often a direct reflection of the domain knowledge and developers’ motivations. However, few published studies have focused on the characteristics of free and open source software (F/OSS) EHR systems and none to date have discussed the motivation, knowledge background, and demographic characteristics of the developers involved in open source EHR projects. Objective This study analyzed the characteristics of prevailing F/OSS EHR systems and aimed to provide an understanding of the motivation, knowledge background, and characteristics of the developers. Methods This study identified F/OSS EHR projects on SourceForge and other websites from May to July 2014. Projects were classified and characterized by license type, downloads, programming languages, spoken languages, project age, development status, supporting materials, top downloads by country, and whether they were “certified” EHRs. Health care F/OSS developers were also surveyed using an online survey. Results At the time of the assessment, we uncovered 54 open source EHR projects, but only four of them had been successfully certified under the Office of the National Coordinator for Health Information Technology (ONC Health IT) Certification Program. In the majority of cases, the open source EHR software was downloaded by users in the United States (64.07%, 148,666/232,034), underscoring that there is a significant interest in EHR open source applications in the United States. A survey of EHR open source developers was conducted and a total of 103 developers responded to the online questionnaire. The majority of EHR F/OSS developers (65.3%, 66/101) are participating in F/OSS projects as part of a paid activity and only 25.7% (26/101) of EHR F/OSS developers are, or have been, health care providers in their careers. In addition, 45% (45/99) of developers do not work in the health care field. Conclusion The research presented in this study highlights some challenges that may be hindering the future of health care F/OSS. A minority of developers have been health care professionals, and only 55% (54/99) work in the health care field. This undoubtedly limits the ability of functional design of F/OSS EHR systems from being a competitive advantage over prevailing commercial EHR systems. Open source software seems to be a significant interest to many; however, given that only four F/OSS EHR systems are ONC-certified, this interest is unlikely to yield significant adoption of these systems in the United States. Although the Health Information Technology for Economic and Clinical Health (HITECH) act was responsible for a substantial infusion of capital into the EHR marketplace, the lack of a corporate entity in most F/OSS EHR projects translates to a marginal capacity to market the respective F/OSS system and to navigate certification. This likely has further disadvantaged F/OSS EHR adoption in the United States. PMID:28235750

Reflexive aerostructures: increased vehicle survivability

NASA Astrophysics Data System (ADS)

Margraf, Thomas W.; Hemmelgarn, Christopher D.; Barnell, Thomas J.; Franklin, Mark A.

2007-04-01

Aerospace systems stand to benefit significantly from the advancement of reflexive aerostructure technologies for increased vehicle survivability. Cornerstone Research Group Inc. (CRG) is developing lightweight, healable composite systems for use as primary load-bearing aircraft components. The reflexive system is comprised of piezoelectric structural health monitoring systems, localized thermal activation systems, and lightweight, healable composite structures. The reflexive system is designed to mimic the involuntary human response to damage. Upon impact, the structural health monitoring system will identify the location and magnitude of the damage, sending a signal to a discrete thermal activation control system to resistively heat the shape memory polymer (SMP) matrix composite above activation temperature, resulting in localized shape recovery and healing of the damaged areas. CRG has demonstrated SMP composites that can recover 90 percent of flexural yield stress and modulus after postfailure healing. During the development, CRG has overcome issues of discrete activation, structural health monitoring integration, and healable resin systems. This paper will address the challenges associated with development of a reflexive aerostructure, including integration of structural health monitoring, discrete healing, and healable shape memory resin systems.

Restructuring Graduate Medical Education to Meet the Health Care Needs of Emirati Citizens

PubMed Central

Abdel-Razig, Sawsan; Alameri, Hatem

2013-01-01

Many nations are struggling with the design, implementation, and ongoing improvement of health care systems to meet the needs of their citizens. In the United Arab Emirates, a small nation with vast wealth, the lives of average citizens have evolved from a harsh, nomadic existence to enjoyment of the comforts of modern life. Substantial progress has been made in the provision of education, housing, health, employment, and other forms of social advancement. Having covered these basic needs, the government of Abu Dhabi, United Arab Emirates, is responding to the challenge of developing a comprehensive health system to serve the needs of its citizens, including restructuring the nation's graduate medical education (GME) system. We describe how Abu Dhabi is establishing GME policies and infrastructure to develop and support a comprehensive health care system, while also being responsive to population health needs. We review recent progress in developing a systematic approach for developing GME infrastructure in this small emirate, and discuss how the process of designing a GME system to meet the needs of Emirati citizens has benefited from the experience of “Western” nations. We also examine the challenges we encountered in this process and the solutions adopted, adapted, or specifically developed to meet local needs. We conclude by highlighting how our experience “at the GME drawing board” reflects the challenges encountered by scholars, administrators, and policymakers in nations around the world as they seek to coordinate health care and GME resources to ensure care for populations. PMID:24404259

Applying User Input to the Design and Testing of an Electronic Behavioral Health Information System for Wraparound Care Coordination

PubMed Central

Bruns, Eric J.; Hyde, Kelly L.; Sather, April; Hook, Alyssa; Lyon, Aaron R.

2015-01-01

Health information technology (HIT) and care coordination for individuals with complex needs are high priorities for quality improvement in health care. However, there is little empirical guidance about how best to design electronic health record systems and related technologies to facilitate implementation of care coordination models in behavioral health, or how best to apply user input to the design and testing process. In this paper, we describe an iterative development process that incorporated user/stakeholder perspectives at multiple points and resulted in an electronic behavioral health information system (EBHIS) specific to the wraparound care coordination model for youth with serious emotional and behavioral disorders. First, we review foundational HIT research on how EBHIS can enhance efficiency and outcomes of wraparound that was used to inform development. After describing the rationale for and functions of a prototype EBHIS for wraparound, we describe methods and results for a series of six small studies that informed system development across four phases of effort – predevelopment, development, initial user testing, and commercialization – and discuss how these results informed system design and refinement. Finally, we present next steps, challenges to dissemination, and guidance for others aiming to develop specialized behavioral health HIT. The research team's experiences reinforce the opportunity presented by EBHIS to improve care coordination for populations with complex needs, while also pointing to a litany of barriers and challenges to be overcome to implement such technologies. PMID:26060099

Restructuring graduate medical education to meet the health care needs of emirati citizens.

PubMed

Abdel-Razig, Sawsan; Alameri, Hatem

2013-06-01

Many nations are struggling with the design, implementation, and ongoing improvement of health care systems to meet the needs of their citizens. In the United Arab Emirates, a small nation with vast wealth, the lives of average citizens have evolved from a harsh, nomadic existence to enjoyment of the comforts of modern life. Substantial progress has been made in the provision of education, housing, health, employment, and other forms of social advancement. Having covered these basic needs, the government of Abu Dhabi, United Arab Emirates, is responding to the challenge of developing a comprehensive health system to serve the needs of its citizens, including restructuring the nation's graduate medical education (GME) system. We describe how Abu Dhabi is establishing GME policies and infrastructure to develop and support a comprehensive health care system, while also being responsive to population health needs. We review recent progress in developing a systematic approach for developing GME infrastructure in this small emirate, and discuss how the process of designing a GME system to meet the needs of Emirati citizens has benefited from the experience of "Western" nations. We also examine the challenges we encountered in this process and the solutions adopted, adapted, or specifically developed to meet local needs. We conclude by highlighting how our experience "at the GME drawing board" reflects the challenges encountered by scholars, administrators, and policymakers in nations around the world as they seek to coordinate health care and GME resources to ensure care for populations.

A Dynamic Human Health Risk Assessment System

PubMed Central

Prasad, Umesh; Singh, Gurmit; Pant, A. B.

2012-01-01

An online human health risk assessment system (OHHRAS) has been designed and developed in the form of a prototype database-driven system and made available for the population of India through a website – www.healthriskindia.in. OHHRAS provide the three utilities, that is, health survey, health status, and bio-calculators. The first utility health survey is functional on the basis of database being developed dynamically and gives the desired output to the user on the basis of input criteria entered into the system; the second utility health status is providing the output on the basis of dynamic questionnaire and ticked (selected) answers and generates the health status reports based on multiple matches set as per advise of medical experts and the third utility bio-calculators are very useful for the scientists/researchers as online statistical analysis tool that gives more accuracy and save the time of user. The whole system and database-driven website has been designed and developed by using the software (mainly are PHP, My-SQL, Deamweaver, C++ etc.) and made available publically through a database-driven website (www.healthriskindia.in), which are very useful for researchers, academia, students, and general masses of all sectors. PMID:22778520

Understanding the information needs of public health practitioners: a literature review to inform design of an interactive digital knowledge management system.

PubMed

Revere, Debra; Turner, Anne M; Madhavan, Ann; Rambo, Neil; Bugni, Paul F; Kimball, AnnMarie; Fuller, Sherrilynne S

2007-08-01

The need for rapid access to information to support critical decisions in public health cannot be disputed; however, development of such systems requires an understanding of the actual information needs of public health professionals. This paper reports the results of a literature review focused on the information needs of public health professionals. The authors reviewed the public health literature to answer the following questions: (1) What are the information needs of public health professionals? (2) In what ways are those needs being met? (3) What are the barriers to meeting those needs? (4) What is the role of the Internet in meeting information needs? The review was undertaken in order to develop system requirements to inform the design and development of an interactive digital knowledge management system. The goal of the system is to support the collection, management, and retrieval of public health documents, data, learning objects, and tools. The search method extended beyond traditional information resources, such as bibliographic databases, tables of contents (TOC), and bibliographies, to include information resources public health practitioners routinely use or have need to use--for example, grey literature, government reports, Internet-based publications, and meeting abstracts. Although few formal studies of information needs and information-seeking behaviors of public health professionals have been reported, the literature consistently indicated a critical need for comprehensive, coordinated, and accessible information to meet the needs of the public health workforce. Major barriers to information access include time, resource reliability, trustworthiness/credibility of information, and "information overload". Utilizing a novel search method that included the diversity of information resources public health practitioners use, has produced a richer and more useful picture of the information needs of the public health workforce than other literature reviews. There is a critical need for public health digital knowledge management systems designed to reflect the diversity of public health activities, to enable human communications, and to provide multiple access points to critical information resources. Public health librarians and other information specialists can serve a significant role in helping public health professionals meet their information needs through the development of evidence-based decision support systems, human-mediated expert searching and training in the use information retrieval systems.

Health care for some: a Nigerian study of who gets what, where and why?

PubMed

Stock, R

1985-01-01

The persistent underdevelopment of health in the Third World belies the optimism of the "Health care for all by the year 2000" campaign. In order to understand the underdevelopment of health, it is essential to examine the historical evolution of specific health systems. These ideas are developed in a case study of health care in Kano State, Nigeria. The nature and contemporary development of the health care system, which includes state voluntary agency and private sector outlets for Western scientific medicine and a large and varied traditional medicine sector, are examined. Although the deepening health care crisis may potentially spur a reconsideration of priorities and strategies, past experience suggests that a stubborn retention of a pared-down and increasingly unjust version of the present system is more likely.

A Network Based Theory of Health Systems and Cycles of Well-being

PubMed Central

Rhodes, Michael Grant

2013-01-01

There are two dominant approaches to describe and understand the anatomy of complete health and well-being systems internationally. Yet, neither approach has been able to either predict or explain occasional but dramatic crises in health and well-being systems around the world and in developed emerging market or developing country contexts. As the impacts of such events can be measured not simply in terms of their social and economic consequences but also public health crises, there is a clear need to look for and formulate an alternative approach. This paper examines multi-disciplinary theoretical evidence to suggest that health systems exhibit natural and observable systemic and long cycle characteristics that can be modelled. A health and well-being system model of two slowly evolving anthropological network sub-systems is defined. The first network sub-system consists of organised professional networks of exclusive suppliers of health and well-being services. The second network sub-system consists of communities organising themselves to resource those exclusive services. Together these two network sub-systems interact to form the specific (sovereign) health and well-being systems we know today. But the core of a truly ‘complex adaptive system’ can also be identified and a simplified two sub-system model of recurring Lotka-Volterra predator-prey cycles is specified. The implications of such an adaptive and evolving model of system anatomy for effective public health, social security insurance and well-being systems governance could be considerable. PMID:24596831

Leadership for child health in the developing countries of the Western Pacific

PubMed Central

Subhi, Rami; Duke, Trevor

2011-01-01

The content and landscape of global child health is increasingly complex. There is strong evidence for the effectiveness of local, national and institutional leadership in reducing child mortality, but this has not been a focus of global health initiatives. Interventions to strengthen health systems should include support for local leadership: building-up institutions of training, empowering national paediatric professional associations, creating opportunities for contribution and leadership at national, provincial and local level, and networks of support for staff working in child health in remote areas. In the poorer high mortality burden countries of the Pacific, to meet the clinical and public health gaps, there is a need for increases in the education of child health nurse practitioners, and development of systems of continuing professional development for paediatric doctors and nurses. Involvement in local research, especially that which contributes directly to critical issues in child health policy or strengthening national data systems builds capacity for leadership. PMID:23198107

Telemedicine: lessons remain unheeded.

PubMed Central

McLaren, P.; Ball, C. J.

1995-01-01

Telemedicine, the delivery of health care with the patient and health professional at different locations, has been around for over 30 years. Its driving force has been developments in communications technology, and as new communications systems are developed health applications are proposed such as supporting the delivery of primary health care to geographically remote areas or regions underserved through the maldistribution of professional expertise. Despite rapid technological advances, evaluations of such systems have been largely superficial, and more thorough evaluations have failed to show significant advantages for more advanced and expensive technology over older technology such as the telephone. Methods for evaluating the impact of particular technologies on the health care system need to be developed and clearer benefits shown in terms of improved standards of care. Images p1391-a PMID:7787547

Future of health care delivery in iran, opportunities and threats.

PubMed

Rajabi, F; Esmailzadeh, H; Rostamigooran, N; Majdzadeh, R; Doshmangir, L

2013-01-01

The aim of this study was to determine the impact of important social and technological trends on health care delivery, in the context of developing "Iran's Health System Reform Plan by 2025". A detailed review of the national and international literature was done to identify the main trends affecting health system. To collect the experts' opinions about important trends and their impact on health care delivery, Focus Group Discussions (FGDs) and semi-structured in-depth interviews techniques were used. The study was based on the STEEP model. Final results were approved in an expert's panel session. The important social and technological trends, affecting health system in Iran in the next 15 years are demographic transition, epidemiologic transition, increasing bio-environmental pollution, increasing slums, increasing private sector partnership in health care delivery, moving toward knowledge-based society, development of information and communication technology, increasing use of high technologies in health system, and development of traditional and alternative medicine. The opportunities and threats resulting from the above mentioned trends were also assessed in this study. Increasing healthcare cost due to some trends like demographic and epidemiologic transition and uncontrolled increase in using new technologies in health care is one of the most important threats that the health system will be facing. The opportunities that advancement in technology and moving toward knowledge-based society create are important and should not be ignored.

Indoor Air Nuclear, Biological, and Chemical Health Modeling and Assessment System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stenner, Robert D.; Hadley, Donald L.; Armstrong, Peter R.

2001-03-01

Indoor air quality effects on human health are of increasing concern to public health agencies and building owners. The prevention and treatment of 'sick building' syndrome and the spread of air-borne diseases in hospitals, for example, are well known priorities. However, increasing attention is being directed to the vulnerability of our public buildings/places, public security and national defense facilities to terrorist attack or the accidental release of air-borne biological pathogens, harmful chemicals, or radioactive contaminants. The Indoor Air Nuclear, Biological, and Chemical Health Modeling and Assessment System (IA-NBC-HMAS) was developed to serve as a health impact analysis tool for usemore » in addressing these concerns. The overall goal was to develop a user-friendly fully functional prototype Health Modeling and Assessment system, which will operate under the PNNL FRAMES system for ease of use and to maximize its integration with other modeling and assessment capabilities accessible within the FRAMES system (e.g., ambient air fate and transport models, water borne fate and transport models, Physiologically Based Pharmacokinetic models, etc.). The prototype IA-NBC-HMAS is designed to serve as a functional Health Modeling and Assessment system that can be easily tailored to meet specific building analysis needs of a customer. The prototype system was developed and tested using an actual building (i.e., the Churchville Building located at the Aberdeen Proving Ground) and release scenario (i.e., the release and measurement of tracer materials within the building) to ensure realism and practicality in the design and development of the prototype system. A user-friendly "demo" accompanies this report to allow the reader the opportunity for a "hands on" review of the prototype system's capability.« less

Supporting Active Patient and Health Care Collaboration: A Prototype for Future Health Care Information Systems.

PubMed

Åhlfeldt, Rose-Mharie; Persson, Anne; Rexhepi, Hanife; Wåhlander, Kalle

2016-12-01

This article presents and illustrates the main features of a proposed process-oriented approach for patient information distribution in future health care information systems, by using a prototype of a process support system. The development of the prototype was based on the Visuera method, which includes five defined steps. The results indicate that a visualized prototype is a suitable tool for illustrating both the opportunities and constraints of future ideas and solutions in e-Health. The main challenges for developing and implementing a fully functional process support system concern both technical and organizational/management aspects. © The Author(s) 2015.

The prospects for national health insurance reform.

PubMed

Belcher, J R; Palley, H A

1991-01-01

This article explores the unequal access to health care in the context of efforts by the American Medical Association (AMA) and its allies to maintain a market-maximizing health care system. The coalition between the AMA and its traditional allies is breaking down, in part, because of converging developments creating an atmosphere which may be more conducive to national health care reform and the development of a reformed health care delivery system that will be accessible, adequate, and equitable in meeting the health care and related social service needs of the American people.

Chile: perspectives in school health.

PubMed

Langdon, M C; Gazmuri, C; Venegas, L

1990-09-01

The leading health problems of children and adolescents in Chile is reviewed. The Chilean educational system and how the system addresses its principal health problems are described. A school health program is described as well as other educational programs designed and developed by nongovernmental institutions which have a smaller coverage. Current research studies regarding growth and development, child morbidity, nutritional level, and mental health studies are reviewed. In addition, principal challenges that include developing more efficient ways of referring children, enriching the curriculum and teacher training, assigning school hours for health teachers, and enlarging coverage of the health care evaluation programs are outlined. Of special importance is developing prevention programs for parents and children using school and community leaders to prevent health problems in areas such as human sexuality education, decision-making, social abilities, and alcohol and drug abuse. Main efforts should be directed toward low-income families and children to improve life conditions.

Global HIV/AIDS funding and health systems: Searching for the win-win.

PubMed

Levine, Ruth; Oomman, Nandini

2009-11-01

Donors, developing country governments, and NGOs are searching for ways to use funding for HIV/AIDS programs that strengthen the functioning of weak health systems. This is motivated both by the realization that a large share of donor funding for global health is and will continue to be dedicated to HIV/AIDS, and that the aims of more and better treatment, prevention, and care can be achieved only with attention to systemic capacities. For AIDS resources to strengthen health systems, decision makers should: (a) mitigate the risks that AIDS spending may weaken the ability of health systems to respond to other health problems; (b) find ways for procurement, supply chain, management information, and other systems that are created to support AIDS treatment to be broadened to serve other types of services; and (c) build upon the ways in which AIDS programs have overcome some demand-side barriers to use of services. In pursuing this agenda, donors should recognize that health system development is a function of the national and local political economy and place respect for national sovereignty as a central tenet of their policies and practices.

China-Africa Health Development Initiatives: Benefits and Implications for Shaping Innovative and Evidence-informed National Health Policies and Programs in Sub-saharan African Countries.

PubMed

Tambo, Ernest; Ugwu, Chidiebere E; Guan, Yayi; Wei, Ding; Xiao-Ning; Xiao-Nong, Zhou

2016-01-01

This review paper examines the growing implications of China's engagement in shaping innovative national initiatives against infectious diseases and poverty control and elimination in African countries. It seeks to understand the factors and enhancers that can promote mutual and innovative health development initiatives, and those that are necessary in generating reliable and quality data for evidence-based contextual policy, priorities and programs. We examined the China-Africa health cooperation in supporting global health agenda on infectious diseases such as malaria, schistosomiasis, Ebola, TB, HIV/AIDS, neglected tropical diseases (NTDs) prevention, control and elimination spanning a period of 10 years. We reviewed referenced publications, global support data, and extensive sources related to and other emerging epidemics and infectious diseases of poverty, programs and interventions, health systems development issues, challenges, opportunities and investments. Published literature in PubMed, Scopus, Google Scholar, Books and web-based peer-reviewed journal articles, government annual reports were assessed from the first Forum on China-Africa Cooperation (FOCAC) in November 2006 to December 2015 Third Ministerial conferences. Our findings highlight current shared public health challenges and emphasize the need to nurture, develop and establish effective, functional and sustainable health systems capacity to detect and respond to all public health threats and epidemic burdens, evidence-based programs and quality care outcomes. China's significant health diplomacy emphasizes the importance of health financing in establishing health development commitment and investment in improving the gains and opportunities, importantly efficiency and value health priorities and planning. Strengthening China-Africa health development agenda towards collective commitment and investment in quality care delivery, effective programs coverage and efficiency, preparedness and emergency response is needed in transforming African health information systems, and local health governance structures and management in emerging epidemics. Furthermore, innovative evidence of operational joint solutions and strategies are critical in advancing healthcare delivery, and further enhancing Universal Health Care, and Sustainable Development Goals to attain global health improvements and economic prosperity.

Demographic and health surveillance of mobile pastoralists in Chad: integration of biometric fingerprint identification into a geographical information system.

PubMed

Weibel, Daniel; Schelling, Esther; Bonfoh, Bassirou; Utzinger, Jürg; Hattendorf, Jan; Abdoulaye, Mahamat; Madjiade, Toguina; Zinsstag, Jakob

2008-11-01

There is a pressing need for baseline demographic and health-related data to plan, implement and evaluate health interventions in developing countries, and to monitor progress towards international development goals. However, mobile pastoralists, i.e. people who depend on a livestock production system and follow their herds as they move, remain marginalized from rural development plans and interventions. The fact that mobile people are hard to reach and stay in contact with is a plausible reason why they are underrepresented in national censuses and/or alternative sequential sample survey systems. We present a proof-of-concept of monitoring highly mobile, pastoral people by recording demographic and health-related data from 933 women and 2020 children and establishing a biometric identification system (BIS) based on the registration and identification of digital fingerprints. Although only 22 women, representing 2.4% of the total registered women, were encountered twice in the four survey rounds, the approach implemented is shown to be feasible. The BIS described here is linked to a geographical information system to facilitate the creation of the first health and demographic surveillance system in a mobile, pastoralist setting. Our ultimate goal is to implement and monitor interventions with the "one health" concept, thus integrating and improving human, animal and ecosystem health.

Health system vision of iran in 2025.

PubMed

Rostamigooran, N; Esmailzadeh, H; Rajabi, F; Majdzadeh, R; Larijani, B; Dastgerdi, M Vahid

2013-01-01

Vast changes in disease features and risk factors and influence of demographic, economical, and social trends on health system, makes formulating a long term evolutionary plan, unavoidable. In this regard, to determine health system vision in a long term horizon is a primary stage. After narrative and purposeful review of documentaries, major themes of vision statement were determined and its context was organized in a work group consist of selected managers and experts of health system. Final content of the statement was prepared after several sessions of group discussions and receiving ideas of policy makers and experts of health system. Vision statement in evolutionary plan of health system is considered to be :"a progressive community in the course of human prosperity which has attained to a developed level of health standards in the light of the most efficient and equitable health system in visionary region(1) and with the regarding to health in all policies, accountability and innovation". An explanatory context was compiled either to create a complete image of the vision. Social values and leaders' strategic goals, and also main orientations are generally mentioned in vision statement. In this statement prosperity and justice are considered as major values and ideals in society of Iran; development and excellence in the region as leaders' strategic goals; and also considering efficiency and equality, health in all policies, and accountability and innovation as main orientations of health system.

SSME Advanced Health Management: Project Overview

NASA Technical Reports Server (NTRS)

Plowden, John

2000-01-01

This document is the viewgraphs from a presentation concerning the development of the Health Management system for the Space Shuttle Main Engine (SSME). It reviews the historical background of the SSME Advanced Health Management effort through the present final Health management configuration. The document includes reviews of three subsystems to the Advanced Health Management System: (1) the Real-Time Vibration Monitor System, (2) the Linear Engine Model, and (3) the Optical Plume Anomaly Detection system.

Developing a response to family violence in primary health care: the New Zealand experience.

PubMed

Gear, Claire; Koziol-McLain, Jane; Wilson, Denise; Clark, Faye

2016-08-20

Despite primary health care being recognised as an ideal setting to effectively respond to those experiencing family violence, responses are not widely integrated as part of routine health care. A lack of evidence testing models and approaches for health sector integration, alongside challenges of transferability and sustainability, means the best approach in responding to family violence is still unknown. The Primary Health Care Family Violence Responsiveness Evaluation Tool was developed as a guide to implement a formal systems-led response to family violence within New Zealand primary health care settings. Given the difficulties integrating effective, sustainable responses to family violence, we share the experience of primary health care sites that embarked on developing a response to family violence, presenting the enablers, barriers and resources required to maintain, progress and sustain family violence response development. In this qualitative descriptive study data were collected from two sources. Firstly semi-structured focus group interviews were conducted during 24-month follow-up evaluation visits of primary health care sites to capture the enablers, barriers and resources required to maintain, progress and sustain a response to family violence. Secondly the outcomes of a group activity to identify response development barriers and implementation strategies were recorded during a network meeting of primary health care professionals interested in family violence prevention and intervention; findings were triangulated across the two data sources. Four sites, representing three PHOs and four general practices participated in the focus group interviews; 35 delegates from across New Zealand attended the network meeting representing a wider perspective on family violence response development within primary health care. Enablers and barriers to developing a family violence response were identified across four themes: 'Getting started', 'Building effective relationships', 'Sourcing funding' and 'Shaping a national approach to family violence'. The strong commitment of key people dedicated to addressing family violence is essential for response sustainability and would be strengthened by prioritising family violence response as a national health target with dedicated resourcing. Further analysis of the health care system as a complex adaptive system may provide insight into effective approaches to response development and health system integration.

Development of health policy and systems research in Nigeria: lessons for developing countries' evidence-based health policy making process and practice.

PubMed

Uneke, Chigozie J; Ezeoha, Abel E; Ndukwe, Chinwendu D; Oyibo, Patrick G; Onwe, Friday

2010-08-01

Health policy and systems research (HPSR), which aims to produce reliable and rigorous evidence to inform the many critical decisions that must be made about health systems, is a new concept in Nigeria. In this study, policy makers and other stakeholders in the health sector identified the challenges and the potential intervention strategies to HPSR evidence use in policy making in Nigeria. The major challenges identified included capacity constraints at individual and organizational levels, communication gaps and poor networking between policy makers and researchers, and the non-involvement of healthcare recipients in identifying and planning care delivery needs. The main solutions suggested included promotion of strategies to encourage partnership between researchers and policy makers, improvement of staff incentives and facilities for research activities, improved budgetary provision for research, and sustainable institutional capacity development. These strategies have been shown to improve evidence-based policy making in developed countries and are likely to produce better outcomes in the developing world.

Development of Health Policy and Systems Research in Nigeria: Lessons for Developing Countries' Evidence-Based Health Policy Making Process and Practice

PubMed Central

Uneke, Chigozie J.; Ezeoha, Abel E.; Ndukwe, Chinwendu D.; Oyibo, Patrick G.; Onwe, Friday

2010-01-01

Health policy and systems research (HPSR), which aims to produce reliable and rigorous evidence to inform the many critical decisions that must be made about health systems, is a new concept in Nigeria. In this study, policy makers and other stakeholders in the health sector identified the challenges and the potential intervention strategies to HPSR evidence use in policy making in Nigeria. The major challenges identified included capacity constraints at individual and organizational levels, communication gaps and poor networking between policy makers and researchers, and the non-involvement of healthcare recipients in identifying and planning care delivery needs. The main solutions suggested included promotion of strategies to encourage partnership between researchers and policy makers, improvement of staff incentives and facilities for research activities, improved budgetary provision for research, and sustainable institutional capacity development. These strategies have been shown to improve evidence-based policy making in developed countries and are likely to produce better outcomes in the developing world. PMID:21804832

Design and Development of a Linked Open Data-Based Health Information Representation and Visualization System: Potentials and Preliminary Evaluation

PubMed Central

Kauppinen, Tomi; Keßler, Carsten; Fritz, Fleur

2014-01-01

Background Healthcare organizations around the world are challenged by pressures to reduce cost, improve coordination and outcome, and provide more with less. This requires effective planning and evidence-based practice by generating important information from available data. Thus, flexible and user-friendly ways to represent, query, and visualize health data becomes increasingly important. International organizations such as the World Health Organization (WHO) regularly publish vital data on priority health topics that can be utilized for public health policy and health service development. However, the data in most portals is displayed in either Excel or PDF formats, which makes information discovery and reuse difficult. Linked Open Data (LOD)—a new Semantic Web set of best practice of standards to publish and link heterogeneous data—can be applied to the representation and management of public level health data to alleviate such challenges. However, the technologies behind building LOD systems and their effectiveness for health data are yet to be assessed. Objective The objective of this study is to evaluate whether Linked Data technologies are potential options for health information representation, visualization, and retrieval systems development and to identify the available tools and methodologies to build Linked Data-based health information systems. Methods We used the Resource Description Framework (RDF) for data representation, Fuseki triple store for data storage, and Sgvizler for information visualization. Additionally, we integrated SPARQL query interface for interacting with the data. We primarily use the WHO health observatory dataset to test the system. All the data were represented using RDF and interlinked with other related datasets on the Web of Data using Silk—a link discovery framework for Web of Data. A preliminary usability assessment was conducted following the System Usability Scale (SUS) method. Results We developed an LOD-based health information representation, querying, and visualization system by using Linked Data tools. We imported more than 20,000 HIV-related data elements on mortality, prevalence, incidence, and related variables, which are freely available from the WHO global health observatory database. Additionally, we automatically linked 5312 data elements from DBpedia, Bio2RDF, and LinkedCT using the Silk framework. The system users can retrieve and visualize health information according to their interests. For users who are not familiar with SPARQL queries, we integrated a Linked Data search engine interface to search and browse the data. We used the system to represent and store the data, facilitating flexible queries and different kinds of visualizations. The preliminary user evaluation score by public health data managers and users was 82 on the SUS usability measurement scale. The need to write queries in the interface was the main reported difficulty of LOD-based systems to the end user. Conclusions The system introduced in this article shows that current LOD technologies are a promising alternative to represent heterogeneous health data in a flexible and reusable manner so that they can serve intelligent queries, and ultimately support decision-making. However, the development of advanced text-based search engines is necessary to increase its usability especially for nontechnical users. Further research with large datasets is recommended in the future to unfold the potential of Linked Data and Semantic Web for future health information systems development. PMID:25601195

Design and development of a linked open data-based health information representation and visualization system: potentials and preliminary evaluation.

PubMed

Tilahun, Binyam; Kauppinen, Tomi; Keßler, Carsten; Fritz, Fleur

2014-10-25

Healthcare organizations around the world are challenged by pressures to reduce cost, improve coordination and outcome, and provide more with less. This requires effective planning and evidence-based practice by generating important information from available data. Thus, flexible and user-friendly ways to represent, query, and visualize health data becomes increasingly important. International organizations such as the World Health Organization (WHO) regularly publish vital data on priority health topics that can be utilized for public health policy and health service development. However, the data in most portals is displayed in either Excel or PDF formats, which makes information discovery and reuse difficult. Linked Open Data (LOD)-a new Semantic Web set of best practice of standards to publish and link heterogeneous data-can be applied to the representation and management of public level health data to alleviate such challenges. However, the technologies behind building LOD systems and their effectiveness for health data are yet to be assessed. The objective of this study is to evaluate whether Linked Data technologies are potential options for health information representation, visualization, and retrieval systems development and to identify the available tools and methodologies to build Linked Data-based health information systems. We used the Resource Description Framework (RDF) for data representation, Fuseki triple store for data storage, and Sgvizler for information visualization. Additionally, we integrated SPARQL query interface for interacting with the data. We primarily use the WHO health observatory dataset to test the system. All the data were represented using RDF and interlinked with other related datasets on the Web of Data using Silk-a link discovery framework for Web of Data. A preliminary usability assessment was conducted following the System Usability Scale (SUS) method. We developed an LOD-based health information representation, querying, and visualization system by using Linked Data tools. We imported more than 20,000 HIV-related data elements on mortality, prevalence, incidence, and related variables, which are freely available from the WHO global health observatory database. Additionally, we automatically linked 5312 data elements from DBpedia, Bio2RDF, and LinkedCT using the Silk framework. The system users can retrieve and visualize health information according to their interests. For users who are not familiar with SPARQL queries, we integrated a Linked Data search engine interface to search and browse the data. We used the system to represent and store the data, facilitating flexible queries and different kinds of visualizations. The preliminary user evaluation score by public health data managers and users was 82 on the SUS usability measurement scale. The need to write queries in the interface was the main reported difficulty of LOD-based systems to the end user. The system introduced in this article shows that current LOD technologies are a promising alternative to represent heterogeneous health data in a flexible and reusable manner so that they can serve intelligent queries, and ultimately support decision-making. However, the development of advanced text-based search engines is necessary to increase its usability especially for nontechnical users. Further research with large datasets is recommended in the future to unfold the potential of Linked Data and Semantic Web for future health information systems development.

Measuring the Value of Public Health Systems: The Disconnect Between Health Economists and Public Health Practitioners

PubMed Central

Jacobson, Peter D.; Palmer, Jennifer A.

2008-01-01

We investigated ways of defining and measuring the value of services provided by governmental public health systems. Our data sources included literature syntheses and qualitative interviews of public health professionals. Our examination of the health economic literature revealed growing attempts to measure value of public health services explicitly, but few studies have addressed systems or infrastructure. Interview responses demonstrated no consensus on metrics and no connection to the academic literature. Key challenges for practitioners include developing rigorous, data-driven methods and skilled staff; being politically willing to base allocation decisions on economic evaluation; and developing metrics to capture “intangibles” (e.g., social justice and reassurance value). Academic researchers evaluating the economics of public health investments should increase focus on the working needs of public health professionals. PMID:18923123

Health care reform and changes: the Malaysian experience.

PubMed

Merican, Mohd Ismail; bin Yon, Rohaizat

2002-01-01

Health care reform is an intentional, sustained and systematic process of structural change to one or more health subsystems to improve efficiency, effectiveness, patient choices and equity. Health care all over the world is continuously reforming with time. Health care reform has become an increasingly important agenda for policy change in both developed and developing countries including Malaysia. This paper provides an overview of the Malaysian health care system, its achievements, and issues and challenges leading to ongoing reform towards a more efficient and equitable health care system that possess a better quality of life for the population.

Integrated System Health Management Development Toolkit

NASA Technical Reports Server (NTRS)

Figueroa, Jorge; Smith, Harvey; Morris, Jon

2009-01-01

This software toolkit is designed to model complex systems for the implementation of embedded Integrated System Health Management (ISHM) capability, which focuses on determining the condition (health) of every element in a complex system (detect anomalies, diagnose causes, and predict future anomalies), and to provide data, information, and knowledge (DIaK) to control systems for safe and effective operation.

Network Performance and Coordination in the Health, Education, Telecommunications System. Satellite Technology Demonstration, Technical Report No. 0422.

ERIC Educational Resources Information Center

Braunstein, Jean; Janky, James M.

This paper describes the network coordination for the Health, Education, Telecommunications (HET) system. Specifically, it discusses HET network performance as a function of a specially-developed coordination system which was designed to link terrestrial equipment to satellite operations centers. Because all procedures and equipment developed for…

[Stewardship of public health surveillance in the health system in Colombia: a case study].

PubMed

López, Yolanda Lucía; González, Claudia; Gallego, Berta Natalia; Moreno, Ana Lida

2009-12-01

With the reform of the Colombian health system in 1993, public health surveillance continued to be a governmental responsibility under the stewardship of the Ministry of Social Protection along with state and local health authorities. The effectiveness of the development and organization of state and municipality public health surveillance programs will be studied as they have evolved under the general social security system in Colombia. Qualitative study and case-study method are applied to several institutions as they function in 5 states and 11 counties, ten years after the health system reforms. Public health authorities have reduced resources for providing advice, technical assistance, supervision and control of the process of the public health surveillance. Weaknesses in administrative control are common. Quantity and quality of human resources, as well as, staffing and financial resources are inadequate to meet the responsibilities that have been assigned to each state and county. The public health surveillance has prioritized the notification and registration of cases, and the strength of development of particular areas occasionally has been subject to the particular interests of officials in charge, particularly in the public hospitals. Little commitment or interest is shown by mayors, insurance companies, and institutions providing health services that are supposed to be involved with monitoring. A lack of cross-institutional collaboration is apparent in the development of health services surveillance. The implementation of public health surveillance at state and local levels is weak due to problems with the governmental stewardship. These weaknesses are manifested in the lack of regulation, financing and control of the health system.

The essence of governance in health development.

PubMed

Kirigia, Joses Muthuri; Kirigia, Doris Gatwiri

2011-03-28

Governance and leadership in health development are critically important for the achievement of the health Millennium Development Goals (MDGs) and other national health goals. Those two factors might explain why many countries in Africa are not on track to attain the health MDGs by 2015. This paper debates the meaning of 'governance in health development', reviews briefly existing governance frameworks, proposes a modified framework on health development governance (HDG), and develops a HDG index. We argue that unlike 'leadership in health development', 'governance in health development' is the sole prerogative of the Government through the Ministry of Health, which can choose to delegate (but not abrogate) some of the governance tasks. The general governance domains of the UNDP and the World Bank are very pertinent but not sufficient for assessment of health development governance. The WHO six domains of governance do not include effective external partnerships for health, equity in health development, efficiency in resource allocation and use, ethical practises in health research and service provision, and macroeconomic and political stability. The framework for assessing health systems governance developed by Siddiqi et al also does not include macroeconomic and political stability as a separate principle. The Siddiqi et al framework does not propose a way of scoring the various governance domains to facilitate aggregation, inter-country comparisons and health development governance tracking over time.This paper argues for a broader health development governance framework because other sectors that assure human rights to education, employment, food, housing, political participation, and security combined have greater impact on health development than the health systems. It also suggests some amendments to Siddigi et al's framework to make it more relevant to the broader concept of 'governance in health development' and to the WHO African Region context. A strong case for broader health development governance framework has been made. A health development governance index with 10 functions and 42 sub-functions has been proposed to facilitate inter-country comparisons. Potential sources of data for estimating HDGI have been suggested. The Governance indices for individual sub-functions can aid policy-makers to establish the sources of weak health governance and subsequently develop appropriate interventions for ameliorating the situation.

The essence of governance in health development

PubMed Central

2011-01-01

Background Governance and leadership in health development are critically important for the achievement of the health Millennium Development Goals (MDGs) and other national health goals. Those two factors might explain why many countries in Africa are not on track to attain the health MDGs by 2015. This paper debates the meaning of 'governance in health development', reviews briefly existing governance frameworks, proposes a modified framework on health development governance (HDG), and develops a HDG index. Discussion We argue that unlike 'leadership in health development', 'governance in health development' is the sole prerogative of the Government through the Ministry of Health, which can choose to delegate (but not abrogate) some of the governance tasks. The general governance domains of the UNDP and the World Bank are very pertinent but not sufficient for assessment of health development governance. The WHO six domains of governance do not include effective external partnerships for health, equity in health development, efficiency in resource allocation and use, ethical practises in health research and service provision, and macroeconomic and political stability. The framework for assessing health systems governance developed by Siddiqi et al also does not include macroeconomic and political stability as a separate principle. The Siddiqi et al framework does not propose a way of scoring the various governance domains to facilitate aggregation, inter-country comparisons and health development governance tracking over time. This paper argues for a broader health development governance framework because other sectors that assure human rights to education, employment, food, housing, political participation, and security combined have greater impact on health development than the health systems. It also suggests some amendments to Siddigi et al's framework to make it more relevant to the broader concept of 'governance in health development' and to the WHO African Region context. Summary A strong case for broader health development governance framework has been made. A health development governance index with 10 functions and 42 sub-functions has been proposed to facilitate inter-country comparisons. Potential sources of data for estimating HDGI have been suggested. The Governance indices for individual sub-functions can aid policy-makers to establish the sources of weak health governance and subsequently develop appropriate interventions for ameliorating the situation. PMID:21443766

A critique of the Uganda district league table using a normative health system performance assessment framework.

PubMed

KirungaTashobya, Christine; Ssengooba, Freddie; Nabyonga-Orem, Juliet; Bataringaya, Juliet; Macq, Jean; Marchal, Bruno; Musila, Timothy; Criel, Bart

2018-05-10

In 2003 the Uganda Ministry of Health (MoH) introduced the District League Table (DLT) to track district performance. This review of the DLT is intended to add to the evidence base on Health Systems Performance Assessment (HSPA) globally, with emphasis on Low and Middle Income Countries (LMICs), and provide recommendations for adjustments to the current Ugandan reality. A normative HSPA framework was used to inform the development of a Key Informant Interview (KII) tool. Thirty Key Informants were interviewed, purposively selected from the Ugandan health system on the basis of having developed or used the DLT. KII data and information from published and grey literature on the Uganda health system was analyzed using deductive analysis. Stakeholder involvement in the development of the DLT was limited, including MoH officials and development partners, and a few district technical managers. Uganda policy documents articulate a conceptually broad health system whereas the DLT focuses on a healthcare system. The complexity and dynamism of the Uganda health system was insufficiently acknowledged by the HSPA framework. Though DLT objectives and indicators were articulated, there was no conceptual reference model and lack of clarity on the constitutive dimensions. The DLT mechanisms for change were not explicit. The DLT compared markedly different districts and did not identify factors behind observed performance. Uganda lacks a designated institutional unit for the analysis and presentation of HSPA data, and there are challenges in data quality and range. The critique of the DLT using a normative model supported the development of recommendation for Uganda district HSPA and provides lessons for other LMICs. A similar approach can be used by researchers and policy makers elsewhere for the review and development of other frameworks. Adjustments in Uganda district HSPA should consider: wider stakeholder involvement with more district managers including political, administrative and technical; better anchoring within the national health system framework; integration of the notion of complexity in the design of the framework; and emphasis on facilitating district decision-making and learning. There is need to improve data quality and range and additional approaches for data analysis and presentation.

Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers.

PubMed

Shaikh, Babar T; Hatcher, Juanita

2005-03-01

There is a growing literature on health seeking behaviours and the determinants of health services utilization especially in the context of developing countries. However, very few focused studies have been seen in Pakistan in this regard. This paper presents an extensive literature review of the situation in developing countries and relates the similar factors responsible for shaping up of a health seeking behaviour and health service utilization in Pakistan. The factors determining the health behaviours may be seen in various contexts: physical, socio-economic, cultural and political. Therefore, the utilization of a health care system, public or private, formal or non-formal, may depend on socio-demographic factors, social structures, level of education, cultural beliefs and practices, gender discrimination, status of women, economic and political systems environmental conditions, and the disease pattern and health care system itself. Policy makers need to understand the drivers of health seeking behaviour of the population in an increasingly pluralistic health care system. Also a more concerted effort is required for designing behavioural health promotion campaigns through inter-sectoral collaboration focusing more on disadvantaged segments of the population.

Health information technology in primary health care in developing countries: a literature review.

PubMed Central

Tomasi, Elaine; Facchini, Luiz Augusto; Maia, Maria de Fatima Santos

2004-01-01

This paper explores the debate and initiatives concerning the use of information technology (IT) in primary health care in developing countries. The literature from 1992-2002 was identified from searches of the MEDLINE, Latin American and Caribbean Health Science Literature Database (LILACS), Cochrane Library and Web of Science databases. The search identified 884 references, 350 of which were classified according to the scheme described by the Pan American Health Organization (PAHO). For the analysis of advantages, problems and perspectives of IT applications and systems, 52 articles were selected according to their potential contribution to the primary health-care processes in non-developed countries. These included: 10 on electronic patient registries (EPR), 22 on process and programmatic action evaluation and management systems (PPAEM) and 20 on clinical decision-support systems (CDS). The main advantages, limitations and perspectives are discussed. PMID:15640923

Architectural approaches for HL7-based health information systems implementation.

PubMed

López, D M; Blobel, B

2010-01-01

Information systems integration is hard, especially when semantic and business process interoperability requirements need to be met. To succeed, a unified methodology, approaching different aspects of systems architecture such as business, information, computational, engineering and technology viewpoints, has to be considered. The paper contributes with an analysis and demonstration on how the HL7 standard set can support health information systems integration. Based on the Health Information Systems Development Framework (HIS-DF), common architectural models for HIS integration are analyzed. The framework is a standard-based, consistent, comprehensive, customizable, scalable methodology that supports the design of semantically interoperable health information systems and components. Three main architectural models for system integration are analyzed: the point to point interface, the messages server and the mediator models. Point to point interface and messages server models are completely supported by traditional HL7 version 2 and version 3 messaging. The HL7 v3 standard specification, combined with service-oriented, model-driven approaches provided by HIS-DF, makes the mediator model possible. The different integration scenarios are illustrated by describing a proof-of-concept implementation of an integrated public health surveillance system based on Enterprise Java Beans technology. Selecting the appropriate integration architecture is a fundamental issue of any software development project. HIS-DF provides a unique methodological approach guiding the development of healthcare integration projects. The mediator model - offered by the HIS-DF and supported in HL7 v3 artifacts - is the more promising one promoting the development of open, reusable, flexible, semantically interoperable, platform-independent, service-oriented and standard-based health information systems.

Towards a sustainable framework for computer based health information systems (CHIS) for least developed countries (LDCs).

PubMed

Gordon, Abekah Nkrumah; Hinson, Robert Ebo

2007-01-01

The purpose of this paper is to argue for a theoretical framework by which development of computer based health information systems (CHIS) can be made sustainable. Health Management and promotion thrive on well-articulated CHIS. There are high levels of risk associated with the development of CHIS in the context of least developed countries (LDC), thereby making them unsustainable. This paper is based largely on literature survey on health promotion and information systems. The main factors accounting for the sustainability problem in less developed countries include poor infrastructure, inappropriate donor policies and strategies, poor infrastructure and inadequate human resource capacity. To counter these challenges and to ensure that CHIS deployment in LDCs is sustainable, it is proposed that the activities involved in the implementation of these systems be incorporated into organizational routines. This will ensure and secure the needed resources as well as the relevant support from all stakeholders of the system; on a continuous basis. This paper sets out to look at the issue of CHIS sustainability in LDCs, theoretically explains the factors that account for the sustainability problem and develops a conceptual model based on theoretical literature and existing empirical findings.

NGOs and government partnership for health systems strengthening: A qualitative study presenting viewpoints of government, NGOs and donors in Pakistan

PubMed Central

2011-01-01

Background Health systems are expected to serve the population needs in an effective, efficient and equitable manner. Therefore, the importance of strengthening of public, private and community health systems has been emphasized time and again. In most of the developing countries, certain weaknesses and gaps in the government health systems have been hampering the achievement of improved health outcomes. Public sector in Pakistan has been deficient in the capacity to deliver equitable and quality health services and thus has been grossly underutilized. Methods A qualitative study comprising in-depth interviews was conducted capturing the perceptions of the government functionaries, NGO representatives and donor community about the role and position of NGOs in health systems strengthening in Pakistan's context. Analysis of the data was done manually to generate nodes, sub-nodes and themes. Results Since many years, international and local non-governmental organizations (NGOs) have endeavored to fill the gaps in health service delivery, research and advocacy. NGOs have relatively performed better and achieved the results because of the flexible planning and the ability to design population based projects on health education, health promotion, social marketing, community development and advocacy. This paper captures the need and the opportunity of public private partnership in Pakistan and presents a framework for a meaningful engagement of the government and the private and nonprofit NGOs. Conclusion Involving the NGOs for health system strengthening may eventually contribute to create a healthcare system reflecting an increased efficiency, more equity and good governance in the wake of the Millennium Development Goals. Nevertheless, few questions need to be answered and pre-requisites have to be fulfilled before moving on. PMID:21609480

Lumping and splitting: the health policy agenda in India.

PubMed

Peters, David H; Rao, K Sujatha; Fryatt, Robert

2003-09-01

India's health system was designed in a different era, when expectations of the public and private sectors were quite different. India's population is also undergoing transitions in the demographic, epidemiologic and social aspects of health. Disparities in life expectancy, disease, access to health care and protection from financial risks have increased. These factors are challenging the health system to respond in new ways. The old approach to national health policies and programmes is increasingly inappropriate. By analyzing inter- and intra-state differences in contexts and processes, we argue that the content of national health policy needs to be more diverse and accommodating to specific states and districts. More 'splitting' of India's health policy at the state level would better address their health problems, and would open the way to innovation and local accountability. States further along the health transition would be able to develop policies to deal with the emerging epidemic of non-communicable diseases and more appropriate health financing systems. States early in the transition would need to focus on improving the quality and access of essential public health services, and empowering communities to take more ownership. Better 'lumping' of policy issues at the central level is also needed, but not in ways that have been done in the past. The central government needs to focus on overcoming the large inequalities in health outcomes across India, tackle growing challenges to health such as the HIV epidemic, and provide the much needed leadership on systemic issues such as the development of systems for quality assurance and regulation of the private sector. It also needs to support and facilitate states and districts to develop critical capacities rather than directly manage programmes. As India develops a more diverse set of state health policies, there will be more opportunities to learn what works in different policy environments.

Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis)

PubMed Central

Tekola, Fasil; Ayele, Zewdu; HaileMariam, Dereje; Fuller, Claire; Davey, Gail

2010-01-01

Summary Background Podoconiosis (endemic non-filarial elephantiasis) is a geochemical disease in individuals exposed to red-clay soil. Despite the prevalence and public health importance of podoconiosis, there is as yet no accepted clinical staging system. Objective We aimed to develop and test a robust clinical staging system for podoconiosis. Methods We adapted the Dreyer system for staging filarial lymphoedema and tested it in four re-iterative field tests conducted in an area of high podoconiosis prevalence in Southern Ethiopia. The system finally arrived at has five stages according to proximal spread of disease and presence of dermal nodules, ridges and bands. We measured the one-week repeatability and the inter-observer agreement of the final staging system. Results We have developed a five-stage system that is readily understood by community workers with little health training. Kappa for one-week repeatability was 0.88 (95% CI 0.80 to 0.96), Kappa for agreement between health professionals was 0.71 (95% CI 0.60 to 0.82), while that between health professionals and community podoconiosis agents without formal health training averaged 0.64 (95% CI 0.52 to 0.78). Conclusions A simple staging system with good inter-observer agreement and repeatability has been developed to assist in the management and further study of podoconiosis. PMID:18721188

Heath Monitoring of Thermal Protection Systems - Preliminary Measurements and Design Specifications

NASA Technical Reports Server (NTRS)

Scott, D. A.; Price, D. C.

2007-01-01

The work reported here is the first stage of a project that aims to develop a health monitoring system for Thermal Protection Systems (TPS) that enables a vehicle to safely re-enter the Earth's atmosphere. The TPS health monitoring system is to be integrated into an existing acoustic emissions-based Concept Demonstrator, developed by CSIRO, which has been previously demonstrated for evaluating impact damage of aerospace systems.

Developing child mental health services in resource-poor countries.

PubMed

Omigbodun, Olayinka

2008-06-01

Despite significant gains in tackling the major causes of child mortality and evidence of an urgent need for child mental health services, resource-poor countries continue to lag behind in child and adolescent mental health service development. This paper analyses possible barriers to the development of child mental health services in resource-poor countries and attempts to proffer solutions. Obstacles identified are the magnitude of child mental health problems that remain invisible to policy makers, an absence of child mental policies to guide the process of service development, and overburdened child mental health professionals. The belief systems about mental illness also prompt help seeking in alternative health systems, thereby reducing the evidence for the burden associated with health seeking. Solutions that may support child mental health service development are the provision of adequate advocacy tools to reveal the burden, poverty alleviation, health awareness programmes, enforcing legislation, training centred within the region, and partnerships with professionals in developed countries. These solutions require simultaneous approaches to encourage service development and utilization. Reductions in child mortality in resource-poor countries will be even more dramatic in the years to come and preparations need to be made to take care of the mental health needs of the children who will survive.

Can health systems be enhanced for optimal health services through disease-specific programs? Results of field studies in Viet Nam and Cambodia.

PubMed

Egami, Y; Fujita, N; Akashi, H; Matsumoto, Y; Ohara, H; Takeuchi, M

2012-02-01

Developing better health systems is the key to delivering optimal health services, although more evidence of effective strategies to do so is needed. Field surveys were conducted in Viet Nam and Cambodia to identify best practices in addressing health system bottlenecks to scale up disease control programs. The two countries were compared over time using a framework for analysis developed by the authors. In Viet Nam, a health system was in place for decades at the central to municipal levels, although it was fragile until the 1990s, when the government started taking measures. In Cambodia, the previous health system had been destroyed during previous internal conflict. In the post-conflict period, the health system was rebuilt with support for programs followed by centralization of health services. In different settings, different measures were taken to deal with similar bottlenecks. In Cambodia, vertical programs were dominant, so the government sought to centralize drug management to deal with shortages of essential drugs, while Viet Nam sought to mobilize resources to ensure drug distribution at all levels. This study shows there is no single successful approach to health systems, and a systemic approach needs to be taken because elimination of one bottleneck may reveal another. Efforts to enhance disease-specific programs may not always contribute to overall enhancement of the health system, and the best possible approach may not be the same in different countries. Further study is needed to explore common issues and principles for effective strategies to enhance health systems in different contexts.

A National Initiative to Advance School Mental Health Performance Measurement in the US

ERIC Educational Resources Information Center

Connors, Elizabeth Halsted; Stephan, Sharon Hoover; Lever, Nancy; Ereshefsky, Sabrina; Mosby, Amanda; Bohnenkamp, Jill

2016-01-01

Standardized health performance measurement has increasingly become an imperative for assuring quality standards in national health care systems. As compared to somatic health performance measures, behavioral health performance measures are less developed. There currently is no national standardized performance measurement system for monitoring…

'Knowledge for better health' revisited - the increasing significance of health research systems: a review by departing Editors-in-Chief.

PubMed

Hanney, Stephen R; González-Block, Miguel A

2017-10-02

How can nations organise research investments to obtain the best bundle of knowledge and the maximum level of improved health, spread as equitably as possible? This question was the central focus of a major initiative from WHO led by Prof Tikki Pang, which resulted in a range of developments, including the publication of a conceptual framework for national health research systems - Knowledge for better health - in 2003, and in the founding of the journal Health Research Policy and Systems (HARPS). As Editors-in-Chief of the journal since 2006, we mark our retirement by tracking both the progress of the journal and the development of national health research systems. HARPS has maintained its focus on a range of central themes that are key components of a national health research system in any country. These include building capacity to conduct and use health research, identifying appropriate priorities, securing funds and allocating them accountably, producing scientifically valid research outputs, promoting the use of research in polices and practice in order to improve health, and monitoring and evaluating the health research system. Some of the themes covered in HARPS are now receiving increased attention and, for example, with the assessment of research impact and development of knowledge translation platforms, the journal has covered their progress throughout that expansion of interest. In addition, there is increasing recognition of new imperatives, including the importance of promoting gender equality in health research if benefits are to be maximised. In this Editorial, we outline some of the diverse and developing perspectives considered within each theme, as well as considering how they are held together by the growing desire to build effective health research systems in all countries.From 2003 until mid-June 2017, HARPS published 590 articles on the above and related themes, with authors being located in 76 countries. We present quantitative data tracing the journal's growth and the increasing external recognition of its role. We thank the many colleagues who have kindly contributed to the journal's success, and finish on an exciting note by welcoming the new Editors-in-Chief who will take HARPS forward.

The State of Open Source Electronic Health Record Projects: A Software Anthropology Study.

PubMed

Alsaffar, Mona; Yellowlees, Peter; Odor, Alberto; Hogarth, Michael

2017-02-24

Electronic health records (EHR) are a key tool in managing and storing patients' information. Currently, there are over 50 open source EHR systems available. Functionality and usability are important factors for determining the success of any system. These factors are often a direct reflection of the domain knowledge and developers' motivations. However, few published studies have focused on the characteristics of free and open source software (F/OSS) EHR systems and none to date have discussed the motivation, knowledge background, and demographic characteristics of the developers involved in open source EHR projects. This study analyzed the characteristics of prevailing F/OSS EHR systems and aimed to provide an understanding of the motivation, knowledge background, and characteristics of the developers. This study identified F/OSS EHR projects on SourceForge and other websites from May to July 2014. Projects were classified and characterized by license type, downloads, programming languages, spoken languages, project age, development status, supporting materials, top downloads by country, and whether they were "certified" EHRs. Health care F/OSS developers were also surveyed using an online survey. At the time of the assessment, we uncovered 54 open source EHR projects, but only four of them had been successfully certified under the Office of the National Coordinator for Health Information Technology (ONC Health IT) Certification Program. In the majority of cases, the open source EHR software was downloaded by users in the United States (64.07%, 148,666/232,034), underscoring that there is a significant interest in EHR open source applications in the United States. A survey of EHR open source developers was conducted and a total of 103 developers responded to the online questionnaire. The majority of EHR F/OSS developers (65.3%, 66/101) are participating in F/OSS projects as part of a paid activity and only 25.7% (26/101) of EHR F/OSS developers are, or have been, health care providers in their careers. In addition, 45% (45/99) of developers do not work in the health care field. The research presented in this study highlights some challenges that may be hindering the future of health care F/OSS. A minority of developers have been health care professionals, and only 55% (54/99) work in the health care field. This undoubtedly limits the ability of functional design of F/OSS EHR systems from being a competitive advantage over prevailing commercial EHR systems. Open source software seems to be a significant interest to many; however, given that only four F/OSS EHR systems are ONC-certified, this interest is unlikely to yield significant adoption of these systems in the United States. Although the Health Information Technology for Economic and Clinical Health (HITECH) act was responsible for a substantial infusion of capital into the EHR marketplace, the lack of a corporate entity in most F/OSS EHR projects translates to a marginal capacity to market the respective F/OSS system and to navigate certification. This likely has further disadvantaged F/OSS EHR adoption in the United States. ©Mona Alsaffar, Peter Yellowlees, Alberto Odor, Michael Hogarth. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 24.02.2017.

Design and Implementation of e-Health System Based on Semantic Sensor Network Using IETF YANG.

PubMed

Jin, Wenquan; Kim, Do Hyeun

2018-02-20

Recently, healthcare services can be delivered effectively to patients anytime and anywhere using e-Health systems. e-Health systems are developed through Information and Communication Technologies (ICT) that involve sensors, mobiles, and web-based applications for the delivery of healthcare services and information. Remote healthcare is an important purpose of the e-Health system. Usually, the eHealth system includes heterogeneous sensors from diverse manufacturers producing data in different formats. Device interoperability and data normalization is a challenging task that needs research attention. Several solutions are proposed in the literature based on manual interpretation through explicit programming. However, programmatically implementing the interpretation of the data sender and data receiver in the e-Health system for the data transmission is counterproductive as modification will be required for each new device added into the system. In this paper, an e-Health system with the Semantic Sensor Network (SSN) is proposed to address the device interoperability issue. In the proposed system, we have used IETF YANG for modeling the semantic e-Health data to represent the information of e-Health sensors. This modeling scheme helps in provisioning semantic interoperability between devices and expressing the sensing data in a user-friendly manner. For this purpose, we have developed an ontology for e-Health data that supports different styles of data formats. The ontology is defined in YANG for provisioning semantic interpretation of sensing data in the system by constructing meta-models of e-Health sensors. The proposed approach assists in the auto-configuration of eHealth sensors and querying the sensor network with semantic interoperability support for the e-Health system.

Design and Implementation of e-Health System Based on Semantic Sensor Network Using IETF YANG

PubMed Central

Kim, Do Hyeun

2018-01-01

Recently, healthcare services can be delivered effectively to patients anytime and anywhere using e-Health systems. e-Health systems are developed through Information and Communication Technologies (ICT) that involve sensors, mobiles, and web-based applications for the delivery of healthcare services and information. Remote healthcare is an important purpose of the e-Health system. Usually, the eHealth system includes heterogeneous sensors from diverse manufacturers producing data in different formats. Device interoperability and data normalization is a challenging task that needs research attention. Several solutions are proposed in the literature based on manual interpretation through explicit programming. However, programmatically implementing the interpretation of the data sender and data receiver in the e-Health system for the data transmission is counterproductive as modification will be required for each new device added into the system. In this paper, an e-Health system with the Semantic Sensor Network (SSN) is proposed to address the device interoperability issue. In the proposed system, we have used IETF YANG for modeling the semantic e-Health data to represent the information of e-Health sensors. This modeling scheme helps in provisioning semantic interoperability between devices and expressing the sensing data in a user-friendly manner. For this purpose, we have developed an ontology for e-Health data that supports different styles of data formats. The ontology is defined in YANG for provisioning semantic interpretation of sensing data in the system by constructing meta-models of e-Health sensors. The proposed approach assists in the auto-configuration of eHealth sensors and querying the sensor network with semantic interoperability support for the e-Health system. PMID:29461493

[Experience of the Mexican National Health System in the development of clinical practice guidelines].

PubMed

Sosa-García, Jesús Ojino; Nieves-Hernández, Pedro; Puentes-Rosas, Esteban; Pineda-Pérez, Dayana; Viniegra-Osorio, Arturo; Torres-Arreola, Laura del Pilar; Valenzuela-Flores, Adriana Abigail; Barragán-Padilla, Sergio Baltazar; Díaz-González, Ruth; Chávez-Valdez, Lizbeth; Ramírez-López, Juan Carlos

2016-01-01

Clinical practice guidelines are tools that have been able to streamline decisions made in health issues and to decrease the gap between clinical action and scientific evidence. The objective of the study is to share the experience in the development and to update the guidelines by the National Health System of Mexico. The methodology in the development of the guidelines consists of 5 phases: prioritisation, establishment of work groups, development by adoption of international guidelines of de novo, validation and integration in the Master catalogue of clinical practice guidelines for its dissemination. The Master catalogue of clinical practice guidelines contains 664 guidelines, distributed in 42% Internal Medicine, 22% Surgery, 24% Pediatrics and 12% Gynecology. From the total of guidelines coverage is granted at an 85% of the Universal catalogue of health services, an 84% of the Catastrophic expenses protection fund and a 61% of the XXI Century Medical Insurance of the National Commission of Social Protection in Health. The result is the sum of a great effort of coordination and cooperation between the institutions of the National Health System, political wills and a commitment of 3,477 health professionals that participate in guidelines' development and update. Master catalogue guidelines' integration, diffusion and implantation improve quality of attention and security of the users of the National Health System. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Health care organizations as complex systems: new perspectives on design and management.

PubMed

McDaniel, Reuben R; Driebe, Dean J; Lanham, Holly Jordan

2013-01-01

We discuss the impact of complexity science on the design and management of health care organizations over the past decade. We provide an overview of complexity science issues and their impact on thinking about health care systems, particularly with the rising importance of information systems. We also present a complexity science perspective on current issues in today's health care organizations and suggest ways that this perspective might help in approaching these issues. We review selected research, focusing on work in which we participated, to identify specific examples of applications of complexity science. We then take a look at information systems in health care organizations from a complexity viewpoint. Complexity science is a fundamentally different way of understanding nature and has influenced the thinking of scholars and practitioners as they have attempted to understand health care organizations. Many scholars study health care organizations as complex adaptive systems and through this perspective develop new management strategies. Most important, perhaps, is the understanding that attention to relationships and interdependencies is critical for developing effective management strategies. Increased understanding of complexity science can enhance the ability of researchers and practitioners to develop new ways of understanding and improving health care organizations. This analysis opens new vistas for scholars and practitioners attempting to understand health care organizations as complex adaptive systems. The analysis holds value for those already familiar with this approach as well as those who may not be as familiar.

Health services for children in western Europe.

PubMed

Wolfe, Ingrid; Thompson, Matthew; Gill, Peter; Tamburlini, Giorgio; Blair, Mitch; van den Bruel, Ann; Ehrich, Jochen; Pettoello-Mantovani, Massimo; Janson, Staffan; Karanikolos, Marina; McKee, Martin

2013-04-06

Western European health systems are not keeping pace with changes in child health needs. Non-communicable diseases are increasingly common causes of childhood illness and death. Countries are responding to changing needs by adapting child health services in different ways and useful insights can be gained through comparison, especially because some have better outcomes, or have made more progress, than others. Although overall child health has improved throughout Europe, wide inequities remain. Health services and social and cultural determinants contribute to differences in health outcomes. Improvement of child health and reduction of suffering are achievable goals. Development of systems more responsive to evolving child health needs is likely to necessitate reconfiguring of health services as part of a whole-systems approach to improvement of health. Chronic care services and first-contact care systems are important aspects. The Swedish and Dutch experiences of development of integrated systems emphasise the importance of supportive policies backed by adequate funding. France, the UK, Italy, and Germany offer further insights into chronic care services in different health systems. First-contact care models and the outcomes they deliver are highly variable. Comparisons between systems are challenging. Important issues emerging include the organisation of first-contact models, professional training, arrangements for provision of out-of-hours services, and task-sharing between doctors and nurses. Flexible first-contact models in which child health professionals work closely together could offer a way to balance the need to provide expertise with ready access. Strategies to improve child health and health services in Europe necessitate a whole-systems approach in three interdependent systems-practice (chronic care models, first-contact care, competency standards for child health professionals), plans (child health indicator sets, reliable systems for capture and analysis of data, scale-up of child health research, anticipation of future child health needs), and policy (translation of high-level goals into actionable policies, open and transparent accountability structures, political commitment to delivery of improvements in child health and equity throughout Europe). Copyright © 2013 Elsevier Ltd. All rights reserved.

Chinese health care system and clinical epidemiology

PubMed Central

Sun, Yuelian; Gregersen, Hans; Yuan, Wei

2017-01-01

China has gone through a comprehensive health care insurance reform since 2003 and achieved universal health insurance coverage in 2011. The new health care insurance system provides China with a huge opportunity for the development of health care and medical research when its rich medical resources are fully unfolded. In this study, we review the Chinese health care system and its implication for medical research, especially within clinical epidemiology. First, we briefly review the population register system, the distribution of the urban and rural population in China, and the development of the Chinese health care system after 1949. In the following sections, we describe the current Chinese health care delivery system and the current health insurance system. We then focus on the construction of the Chinese health information system as well as several existing registers and research projects on health data. Finally, we discuss the opportunities and challenges of the health care system in regard to clinical epidemiology research. China now has three main insurance schemes. The Urban Employee Basic Medical Insurance (UEBMI) covers urban employees and retired employees. The Urban Residence Basic Medical Insurance (URBMI) covers urban residents, including children, students, elderly people without previous employment, and unemployed people. The New Rural Cooperative Medical Scheme (NRCMS) covers rural residents. The Chinese Government has made efforts to build up health information data, including electronic medical records. The establishment of universal health care insurance with linkage to medical records will provide potentially huge research opportunities in the future. However, constructing a complete register system at a nationwide level is challenging. In the future, China will demand increased capacity of researchers and data managers, in particular within clinical epidemiology, to explore the rich resources. PMID:28356772

Understanding global health and development partnerships: Perspectives from African and global health system professionals.

PubMed

Barnes, Amy; Brown, Garrett W; Harman, Sophie

2016-06-01

Partnership is a key idea in current debates about global health and development assistance, yet little is known about what partnership means to those who are responsible for operationalising it or how it is experienced in practice. This is particularly the case in the context of African health systems. This paper explores how health professionals working in global health hubs and the health systems of South Africa, Tanzania and Zambia understand and experience partnership. Drawing on semi-structured interviews with 101 professionals based in each country, Washington DC and Geneva between October 2012 and June 2013, the paper makes four key arguments. First, partnership has a legitimating function in global health policy processes for international development institutions, government agencies and civil society organisations alike. Second, the practice of partnership generates idiosyncratic and complicated relationships that health professionals have to manage and navigate, often informally. Third, partnership is shaped by historical legacies, critical events, and independent consultants. Fourth, despite being an accepted part of global health policy, there is little shared understanding of what good partnership is meant to include or resemble in practice. Knowing more about the specific socio-cultural and political dynamics of partnership in different health system contexts is critical to equip health professionals with the skills to build the informal relations that are essential to effective partnership engagement. Copyright © 2016 Elsevier Ltd. All rights reserved.

Trust-based information system architecture for personal wellness.

PubMed

Ruotsalainen, Pekka; Nykänen, Pirkko; Seppälä, Antto; Blobel, Bernd

2014-01-01

Modern eHealth, ubiquitous health and personal wellness systems take place in an unsecure and ubiquitous information space where no predefined trust occurs. This paper presents novel information model and an architecture for trust based privacy management of personal health and wellness information in ubiquitous environment. The architecture enables a person to calculate a dynamic and context-aware trust value for each service provider, and using it to design personal privacy policies for trustworthy use of health and wellness services. For trust calculation a novel set of measurable context-aware and health information-sensitive attributes is developed. The architecture enables a person to manage his or her privacy in ubiquitous environment by formulating context-aware and service provider specific policies. Focus groups and information modelling was used for developing a wellness information model. System analysis method based on sequential steps that enable to combine results of analysis of privacy and trust concerns and the selection of trust and privacy services was used for development of the information system architecture. Its services (e.g. trust calculation, decision support, policy management and policy binding services) and developed attributes enable a person to define situation-aware policies that regulate the way his or her wellness and health information is processed.

Towards Evidence-Based, Quality-Controlled Health Promotion: The Dutch Recognition System for Health Promotion Interventions

ERIC Educational Resources Information Center

Brug, Johannes; van Dale, Djoeke; Lanting, Loes; Kremers, Stef; Veenhof, Cindy; Leurs, Mariken; van Yperen, Tom; Kok, Gerjo

2010-01-01

Registration or recognition systems for best-practice health promotion interventions may contribute to better quality assurance and control in health promotion practice. In the Netherlands, such a system has been developed and is being implemented aiming to provide policy makers and professionals with more information on the quality and…

Administrative skills for academy physicians.

PubMed

Aluise, J J; Schmitz, C C; Bland, C J; McArtor, R E

To function effectively within the multifaceted environment of the academic medical center, academic physicians need to heighten their understanding of the economics of the health care system, and further develop their leadership and managerial skills. A literature base on organizational development and management education is now available, which addresses the unique nature of the professional organization, including academic medical centers. This article describes an administration development curriculum for academic physicians. Competency statements, instructional strategies, and references provide health care educators with a model for developing administrative skills programs for academic physicians and other health care professionals. The continuing success of the academic medical center as a responsive health care system may depend on the degree to which academic physicians and their colleagues in other fields gain sophistication in self-management and organizational administration. Health care educators can apply the competencies and instructional strategies offered in this article to administrative development programs for physicians and other health professionals in their institutions.

A new performance measurement system for maternal and child health in the United States.

PubMed

Kogan, Michael D; Dykton, Christopher; Hirai, Ashley H; Strickland, Bonnie B; Bethell, Christina D; Naqvi, Iran; Cano, Carlos E; Downing-Futrell, Sheri L; Lu, Michael C

2015-05-01

The Title V Maternal and Child Health (MCH) Block Grant is the linchpin for US MCH services. The first national performance measures (NPMs) for MCH were instituted in 1997. Changing trends in MCH risk factors, outcomes, health services, data sources, and advances in scientific knowledge, in conjunction with budgetary constraints led the Maternal and Child Health Bureau (MCHB) to design a new performance measurement system. A workgroup was formed to develop a new system. The following guiding principles were used: (1) Afford States more flexibility and reduce the overall reporting burden; (2) Improve accountability to better document Title V's impact; (3) Develop NPMs that encompass measures in: maternal and women's health, perinatal health, child health, children with special health care needs, adolescent health, and cross-cutting areas. A three-tiered performance measurement system was proposed with national outcome measures (NOMs), NPMs and evidence-based/informed strategy measures (ESMs). NOMs are the ultimate goals that MCHB and States are attempting to achieve. NPMs are measures, generally associated with processes or programs, shown to affect NOMs. ESMs are evidence-based or informed measures that each State Title V program develops to affect the NPMs. There are 15 NPMs from which States select eight, with at least one from each population area. MCHB will provide the data for the NOMs and NPMs, when possible. The new performance measurement system increases the flexibility and reduces the reporting burden for States by allowing them to choose 8 NPMs to target, and increases accountability by having States develop actionable ESMs. The new national performance measure framework for maternal and child health will allow States more flexibility to address their areas of greatest need, reduce their data reporting burden by having the Maternal and Child Health Bureau provide data for the National Outcome and Performance Measures, yet afford States the opportunity to develop measurable strategies to address their selected performance measures.

Application of ubiquitous computing in personal health monitoring systems.

PubMed

Kunze, C; Grossmann, U; Stork, W; Müller-Glaser, K D

2002-01-01

A possibility to significantly reduce the costs of public health systems is to increasingly use information technology. The Laboratory for Information Processing Technology (ITIV) at the University of Karlsruhe is developing a personal health monitoring system, which should improve health care and at the same time reduce costs by combining micro-technological smart sensors with personalized, mobile computing systems. In this paper we present how ubiquitous computing theory can be applied in the health-care domain.

[The health system of Ecuador].

PubMed

Lucio, Ruth; Villacrés, Nilhda; Henríquez, Rodrigo

2011-01-01

This paper describes the health conditions in Ecuador and, in more detail, the characteristics of the Ecuadorian health system, including its structure and coverage, its financial sources, the physical, material and human resources available, and the stewardship activities developed by the Ministry of Public Health. It also describes the structure and content of its health information system, and the participation of citizens in the operation and evaluation of the health system. The paper ends with a discussion of the most recent policy innovations implemented in the Ecuadorian system, including the incorporation of a chapter on health into the new Constitution which recognizes the protection of health as a human right, and the construction of the Comprehensive Public Health Network.

[The health system of Peru].

PubMed

Alcalde-Rabanal, Jacqueline Elizabeth; Lazo-González, Oswaldo; Nigenda, Gustavo

2011-01-01

This paper describes the health conditions in Peru and, with greater detail, the Peruvian health system, including its structure and coverage, its financial sources, its physical, material and human resources, and its stewardship functions. It also discusses the activities developed in the information and research areas, as well as the participation of citizens in the operation and evaluation of the health system. The article concludes with a discussion of the most recent innovations, including the Comprehensive Health Insurance, the Health Care Enterprises system, the decentralization process and the Local Committees for Health Administration. The main challenge confronted by the Peruvian health system is the extension of coverage to more than I0% of the population presently lacking access to basic health care.

Portable Health Algorithms Test System

NASA Technical Reports Server (NTRS)

Melcher, Kevin J.; Wong, Edmond; Fulton, Christopher E.; Sowers, Thomas S.; Maul, William A.

2010-01-01

A document discusses the Portable Health Algorithms Test (PHALT) System, which has been designed as a means for evolving the maturity and credibility of algorithms developed to assess the health of aerospace systems. Comprising an integrated hardware-software environment, the PHALT system allows systems health management algorithms to be developed in a graphical programming environment, to be tested and refined using system simulation or test data playback, and to be evaluated in a real-time hardware-in-the-loop mode with a live test article. The integrated hardware and software development environment provides a seamless transition from algorithm development to real-time implementation. The portability of the hardware makes it quick and easy to transport between test facilities. This hard ware/software architecture is flexible enough to support a variety of diagnostic applications and test hardware, and the GUI-based rapid prototyping capability is sufficient to support development execution, and testing of custom diagnostic algorithms. The PHALT operating system supports execution of diagnostic algorithms under real-time constraints. PHALT can perform real-time capture and playback of test rig data with the ability to augment/ modify the data stream (e.g. inject simulated faults). It performs algorithm testing using a variety of data input sources, including real-time data acquisition, test data playback, and system simulations, and also provides system feedback to evaluate closed-loop diagnostic response and mitigation control.

Research Fellowships Program of the National Center for Health Services Research and Development. Policies and Guidelines for Applicants.

ERIC Educational Resources Information Center

Health Services and Mental Health Administration (DHEW), Bethesda, MD.

The National Center for Health Services Research and Development supports individual research training in an institutional setting for the development of competence in research techniques relevant to the organization, delivery, quality, financing, utilization, and evaluation of health delivery systems. The evolution of health services science…

Delivery of nutrition services in health systems in sub-Saharan Africa: opportunities in Burkina Faso, Mozambique and Niger.

PubMed

Hampshire, Rachel D; Aguayo, Victor M; Harouna, Hamani; Roley, Julie A; Tarini, Ann; Baker, Shawn K

2004-12-01

In sub-Saharan Africa, underweight and micronutrient deficiencies account for an estimated 25% of the burden of disease. As the coverage of national health systems expands, increased opportunities exist to address the needs of children and women, the most vulnerable to these deficiencies, through high-quality nutrition services. To assess health providers' knowledge and practice with regard to essential nutrition services for women and children in Burkina Faso, Mozambique and Niger, in order to assist the development of a standard guide and tools to assess and monitor the quality of the nutrition services delivered through national health systems. The three surveys reveal the extent of missed opportunities to deliver nutrition services during routine prenatal, postnatal and child-care consultations for the prevention and treatment of highly prevalent nutritional deficiencies. A commitment to improving the quality of facility-based nutrition services is necessary to impact on the health outcomes of women and children 'covered' by national health systems. Rigorous assessment and monitoring of the quality of nutrition services should inform health programme and policy development. Building on the lessons learned in these three assessments, Helen Keller International has developed a standard Guide and Tools to assess the quality of the nutrition services delivered through national health systems. These tools can be adapted to assess ongoing nutrition services in health facilities, provide a framework for nutrition programming, inform the development of pre-service as well as in-service nutrition training curricula for providers, and evaluate the impact of nutrition training on providers' practices.

The Open System Interconnection as a building block in a health sciences information network.

PubMed Central

Boss, R W

1985-01-01

The interconnection of integrated health sciences library systems with other health sciences computer systems to achieve information networks will require either custom linkages among specific devices or the adoption of standards that all systems support. The most appropriate standards appear to be those being developed under the Open System Interconnection (OSI) reference model, which specifies a set of rules and functions that computers must follow to exchange information. The protocols have been modularized into seven different layers. The lowest three layers are generally available as off-the-shelf interfacing products. The higher layers require special development for particular applications. This paper describes the OSI, its application in health sciences networks, and specific tasks that remain to be undertaken. PMID:4052672

Harnessing pluralism for better health in Bangladesh.

PubMed

Ahmed, Syed Masud; Evans, Timothy G; Standing, Hilary; Mahmud, Simeen

2013-11-23

How do we explain the paradox that Bangladesh has made remarkable progress in health and human development, yet its achievements have taken place within a health system that is frequently characterised as weak, in terms of inadequate physical and human infrastructure and logistics, and low performing? We argue that the development of a highly pluralistic health system environment, defined by the participation of a multiplicity of different stakeholders and agents and by ad hoc, diffused forms of management has contributed to these outcomes by creating conditions for rapid change. We use a combination of data from official sources, research studies, case studies of specific innovations, and in-depth knowledge from our own long-term engagement with health sector issues in Bangladesh to lay out a conceptual framework for understanding pluralism and its outcomes. Although we argue that pluralism has had positive effects in terms of stimulating change and innovation, we also note its association with poor health systems governance and regulation, resulting in endemic problems such as overuse and misuse of drugs. Pluralism therefore requires active management that acknowledges and works with its polycentric nature. We identify four key areas where this management is needed: participatory governance, accountability and regulation, information systems, and capacity development. This approach challenges some mainstream frameworks for managing health systems, such as the building blocks approach of the WHO Health Systems Framework. However, as pluralism increasingly defines the nature and the challenge of 21st century health systems, the experience of Bangladesh is relevant to many countries across the world. Copyright © 2013 Elsevier Ltd. All rights reserved.

Migration of health workers: a challenge for health care system.

PubMed

Afzal, Shaista; Masroor, Imrana; Shafqat, Gulnaz

2012-09-01

The migration of health workers has resulted in a growing apprehension universally because of its impact on health system of the developing countries. Although the choice to migrate is basically a personal one, however, the overall social and economic circumstances have important impact on the decision to migrate. The "push and pull" factors for migration are disparity in working conditions, pay, lack of promotion opportunities, poor living conditions, desire to gain experience, professional development, family background and family wealth. A strategic approach by the government and other agencies is mandatory for regulating the flow of health workers between countries. A range of policies and interventions are needed to deal with the broader health system issue and problems of health workers that influence their recruitment, retention, deployment and progress.

Development of a Master Health Facility List in Nigeria

PubMed Central

Azeez, Aderemi; Bamidele, Samson; Oyemakinde, Akin; Oyediran, Kolawole Azeez; Adebayo, Wura; Fapohunda, Bolaji; Abioye, Abimbola; Mullen, Stephanie

2014-01-01

Abstract Introduction Routine Health Information Systems (RHIS) are increasingly transitioning to electronic platforms in several developing countries. Establishment of a Master Facility List (MFL) to standardize the allocation of unique identifiers for health facilities can overcome identification issues and support health facility management. The Nigerian Federal Ministry of Health (FMOH) recently developed a MFL, and we present the process and outcome. Methods The MFL was developed from the ground up, and includes a state code, a local government area (LGA) code, health facility ownership (public or private), the level of care, and an exclusive LGA level health facility serial number, as part of the unique identifier system in Nigeria. To develop the MFL, the LGAs sent the list of all health facilities in their jurisdiction to the state, which in turn collated for all LGAs under them before sending to the FMOH. At the FMOH, a group of RHIS experts verified the list and identifiers for each state. Results The national MFL consists of 34,423 health facilities uniquely identified. The list has been published and is available for worldwide access; it is currently used for planning and management of health services in Nigeria. Discussion Unique identifiers are a basic component of any information system. However, poor planning and execution of implementing this key standard can diminish the success of the RHIS. Conclusion Development and adherence to standards is the hallmark for a national health information infrastructure. Explicit processes and multi-level stakeholder engagement is necessary to ensuring the success of the effort. PMID:25422720

Security and privacy of EHR systems--ethical, social and legal requirements.

PubMed

Kluge, Eike-Henner W

2003-01-01

This paper addresses social, ethical and legal concerns about security and privacy that arise in the development of international interoperable health information systems. The paper deals with these concerns under four rubrics: the ethical status of electronic health records, the social and legal embedding of interoperable health information systems, the overall information-requirements healthcare as such, and the role of health information professionals as facilitators. It argues that the concerns that arise can be met if the development of interoperability protocols is guided by the seven basic principles of information ethics that have been enunciated in the IMIA Code of Ethics for Health Information Professionals and that are central to the ethical treatment of electronic health records.

What must be the Pillars of Iran’s Health System in 2025? Values and Principles of Health System Reform Plan

PubMed Central

RAJABI, Fateme; ESMAILZADEH, Hamid; ROSTAMIGOORAN, Narges; MAJDZADEH, Reza

2013-01-01

Background: Preparing long term reformatory plan for the health system, like other macro plans, requires guiding principles which is according to the values, and as a bridge, connect the ideals and values to the goals. This study was designed with the purpose of explaining the values and principles of health system, and as a pre-requisite to compilation of Iran’s health system reform plan at 2025. Method: The document of values and principles of health system reform plan for 2025 was developed by reviewing the literature and receiving the opinions of senior experts of health system, and was criticized in focus group discussion sessions of experts and decision makers. Results: The values of Iran are: dignity of human, the right to maximum attainable level of health, comprehensive health, equity and social cohesion. The principles of this health system include: institutionalizing the ethical values, responsiveness and accountability, equitable access (utilization), prevention and health promotion, community participation, inter-sectoral collaboration, integrated stewardship, benefit from innovation and desired technology, human resources promotion and excellence and harmony. Conclusion: Based on the perception of cultural and religious teachings in Iran, protecting of human dignity and human prosperity are the ultimate social goal. In this sense, health and healthy humans, in its holistic concept (physical, mental, social health and spiritual) are the center and development in any form should lead to the human prosperity in a way that each of the individuals could enjoy the maximum attainable level of health in its holistic meaning and in a faire manner. PMID:23515322

Leadership for health improvement--implementation and evaluation.

PubMed

Carr, Susan M; Carr, Sue; Lhussier, Monique; Reynolds, Joanna; Hunter, David J; Hannaway, Catherine

2009-01-01

The purpose of this paper is to present a co-authored reflection on the health improvement leadership development programme and the key evaluation messages derived from piloting in an English National Health Service region. It highlights the specific attributes of this approach to health improvement leadership development and clarifies health improvement development issues. Appreciative inquiry and soft systems methodology are combined in an evaluation approach designed to capture individual as well as organisation learning and how it impacts on leadership in specific contexts. The evaluation exposes the health improvement leadership needs of a multi-organisation cohort, offers some explanations for successful achievement of learning needs while also exposing of the challenges and paradoxes faced in this endeavour. There are limited reported templates of how to develop leadership for health improvement. This paper details a whole systems approach, acknowledging the impact of context on leadership and an approach to evaluating such complex initiatives.

Mental health policy in Kenya -an integrated approach to scaling up equitable care for poor populations.

PubMed

Kiima, David; Jenkins, Rachel

2010-06-28

Although most donor and development agency attention is focussed on communicable diseases in Kenya, the importance of non-communicable diseases including mental health and mental illness is increasingly apparent, both in their own right and because of their influence on health, education and social goals. Mental illness is common but the specialist service is extremely sparse and primary care is struggling to cope with major health demands. Non health sectors e.g. education, prisons, police, community development, gender and children, regional administration and local government have significant concerns about mental health, but general health programmes have been surprisingly slow to appreciate the significance of mental health for physical health targets. Despite a people centred post colonial health delivery system, poverty and global social changes have seriously undermined equity. This project sought to meet these challenges, aiming to introduce sustainable mental health policy and implementation across the country, within the context of extremely scarce resources. A multi-faceted and comprehensive programme which combined situation appraisal to inform planning, sustained intersectoral policy dialogue at national and regional level; establishment of a health sector system for coordination, supervision and training of at each level (national, regional, district and primary care); development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at national, regional, district and local levels; public education; and integration of mental health into health management systems. The programme has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, annual operational plans, mental health policy guidelines to accompany the general health policy, tobacco legislation, adaptation of the WHO primary care guidelines for Kenya, primary care training, construction of a quality system of roles and responsibilities, availability of medicines at primary care level, some strengthening of intersectoral liaison with police, prisons and schools, and public education about mental health. The project has demonstrated the importance of using a multi-faceted and comprehensive programme to promote sustainable system change, key elements of which include a focus on the use of rapid appropriate assessment and treatment at primary care level, strengthening the referral system, interministerial and intersectoral liaison, rehabilitation, social inclusion, promotion and advocacy to mobilize community engagement.

Frameworks to assess health systems governance: a systematic review.

PubMed

Pyone, Thidar; Smith, Helen; van den Broek, Nynke

2017-06-01

Governance of the health system is a relatively new concept and there are gaps in understanding what health system governance is and how it could be assessed. We conducted a systematic review of the literature to describe the concept of governance and the theories underpinning as applied to health systems; and to identify which frameworks are available and have been applied to assess health systems governance. Frameworks were reviewed to understand how the principles of governance might be operationalized at different levels of a health system. Electronic databases and web portals of international institutions concerned with governance were searched for publications in English for the period January 1994 to February 2016. Sixteen frameworks developed to assess governance in the health system were identified and are described. Of these, six frameworks were developed based on theories from new institutional economics; three are primarily informed by political science and public management disciplines; three arise from the development literature and four use multidisciplinary approaches. Only five of the identified frameworks have been applied. These used the principal-agent theory, theory of common pool resources, North's institutional analysis and the cybernetics theory. Governance is a practice, dependent on arrangements set at political or national level, but which needs to be operationalized by individuals at lower levels in the health system; multi-level frameworks acknowledge this. Three frameworks were used to assess governance at all levels of the health system. Health system governance is complex and difficult to assess; the concept of governance originates from different disciplines and is multidimensional. There is a need to validate and apply existing frameworks and share lessons learnt regarding which frameworks work well in which settings. A comprehensive assessment of governance could enable policy makers to prioritize solutions for problems identified as well as replicate and scale-up examples of good practice. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Frameworks to assess health systems governance: a systematic review

PubMed Central

Smith, Helen; van den Broek, Nynke

2017-01-01

Abstract Governance of the health system is a relatively new concept and there are gaps in understanding what health system governance is and how it could be assessed. We conducted a systematic review of the literature to describe the concept of governance and the theories underpinning as applied to health systems; and to identify which frameworks are available and have been applied to assess health systems governance. Frameworks were reviewed to understand how the principles of governance might be operationalized at different levels of a health system. Electronic databases and web portals of international institutions concerned with governance were searched for publications in English for the period January 1994 to February 2016. Sixteen frameworks developed to assess governance in the health system were identified and are described. Of these, six frameworks were developed based on theories from new institutional economics; three are primarily informed by political science and public management disciplines; three arise from the development literature and four use multidisciplinary approaches. Only five of the identified frameworks have been applied. These used the principal–agent theory, theory of common pool resources, North’s institutional analysis and the cybernetics theory. Governance is a practice, dependent on arrangements set at political or national level, but which needs to be operationalized by individuals at lower levels in the health system; multi-level frameworks acknowledge this. Three frameworks were used to assess governance at all levels of the health system. Health system governance is complex and difficult to assess; the concept of governance originates from different disciplines and is multidimensional. There is a need to validate and apply existing frameworks and share lessons learnt regarding which frameworks work well in which settings. A comprehensive assessment of governance could enable policy makers to prioritize solutions for problems identified as well as replicate and scale-up examples of good practice. PMID:28334991

The GRADE Evidence to Decision (EtD) framework for health system and public health decisions.

PubMed

Moberg, Jenny; Oxman, Andrew D; Rosenbaum, Sarah; Schünemann, Holger J; Guyatt, Gordon; Flottorp, Signe; Glenton, Claire; Lewin, Simon; Morelli, Angela; Rada, Gabriel; Alonso-Coello, Pablo

2018-05-29

To describe a framework for people making and using evidence-informed health system and public health recommendations and decisions. We developed the GRADE Evidence to Decision (EtD) framework for health system and public health decisions as part of the DECIDE project, in which we simultaneously developed frameworks for these and other types of healthcare decisions, including clinical recommendations, coverage decisions and decisions about diagnostic tests. Building on GRADE EtD tables, we used an iterative approach, including brainstorming, consultation of the literature and with stakeholders, and an international survey of policy-makers. We applied the framework to diverse examples, conducted workshops and user testing with health system and public health guideline developers and policy-makers, and observed and tested its use in real-life guideline panels. All the GRADE EtD frameworks share the same basic structure, including sections for formulating the question, making an assessment and drawing conclusions. Criteria listed in the assessment section of the health system and public health framework cover the important factors for making these types of decisions; in addition to the effects and economic impact of an option, the priority of the problem, the impact of the option on equity, and its acceptability and feasibility are important considerations that can inform both whether and how to implement an option. Because health system and public health interventions are often complex, detailed implementation considerations should be made when making a decision. The certainty of the evidence is often low or very low, but decision-makers must still act. Monitoring and evaluation are therefore often important considerations for these types of decisions. We illustrate the different components of the EtD framework for health system and public health decisions by presenting their application in a framework adapted from a real-life guideline. This framework provides a structured and transparent approach to support policy-making informed by the best available research evidence, while making the basis for decisions accessible to those whom they will affect. The health system and public health EtD framework can also be used to facilitate dissemination of recommendations and enable decision-makers to adopt, and adapt, recommendations or decisions.

Preparing a health care delivery system for Space Station

NASA Technical Reports Server (NTRS)

Logan, J. S.; Stewart, G. R.

1985-01-01

NASA's Space Station is viewed as the beginning of man's permanent presence in space. This paper presents the guidelines being developed by NASA's medical community in preparing a quality, permanent health care delivery system for Space Station. The guidelines will be driven by unique Space Station requirements such as mission duration, crew size, orbit altitude and inclination, EVA frequency and rescue capability. The approach will emphasize developing a health care system that is modular and flexible. It will also incorporate NASA's requirements for growth capability, commonality, maintainability, and advanced technology development. Goals include preventing unnecessary rescue attempts, as well as maintaining the health and safety of the crew. Proper planning will determine the levels of prevention, diagnosis, and treatment necessary to achieve these goals.

[The health system of Dominican Republic].

PubMed

Rathe, Magdalena; Moliné, Alejandro

2011-01-01

This paper describes the health conditions in Dominican Republic and the characteristics of the Dominican health system, including its structure and coverage, its financial sources, the health expenditure, the physical, material and human resources available, the stewardship functions developed by the Ministry of Public Health and the generation of health information. The participation of health care users in the operation and evaluation of the system and the most recent policy innovations, including the new General Health Law, the new Social Security Law and the Decennial Health Plan are also discussed.

Rapid assessment of infrastructure of primary health care facilities - a relevant instrument for health care systems management.

PubMed

Scholz, Stefan; Ngoli, Baltazar; Flessa, Steffen

2015-05-01

Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.

Navigating systems ideas for health practice: Towards a common learning device.

PubMed

Reynolds, Martin; Sarriot, Eric; Swanson, Robert Chad; Rusoja, Evan

2018-06-01

Systems thinking and reference to complexity science have gained currency in health sector practice and research. The extent to which such ideas might represent a mere passing fad or might more usefully be mobilized to tackle wicked problems in health systems is a concern underpinning this paper. Developing the usefulness of the systems idea requires appreciating how systems ideas are used essentially as constructs conceptually bounded by practitioners. Systems are used for purposes of understanding and engaging the reality of health issues, with the intent of transforming the reality into one that is more manageable, equitable, and sustainable. We examine some manifestations of the systems idea in health practice and the traditions of systems practice that variously make use of them. This provides a platform for proposing a systems thinking in (health) practice heuristic: a learning device supporting how different tools and methods can address "wicked problems" in health praxis. The device is built on the use of "conversation" as a metaphor to help practitioners use systems ideas in tandem with existing disciplinary and professional skills and methods. We consider how the application of the heuristic requires, and helps to develop, human characteristics of humility, empathy, and recognition of fallibility. © 2018 John Wiley & Sons, Ltd.

Navy Occupational Health Information Management System (NOHIMS). Medical Exam Scheduling Module. Program Maintenance Manual

DTIC Science & Technology

1987-06-01

NAVY OCCUPATIONAL HEALTH INFORMATION MANAGEMENT SYSTEM NOH I MS MEDICAL EXAM SCHEDULING MODULE PROGRAM MAINTENANCE MANUAL S JUNE 1987 DT11C 00... Information Management System (NOHIMS) ~ Medical Examination Scheduling (MES) Program Maintenance Manual 7. Author(s) 8. Performing Organization Rapt. No...the Navy Occupational Health Information Management System (NOHIMS). NOHIMS, whose initial version was developed at the Naval Health Research Center

A university system's approach to enhancing the educational mission of health science schools and institutions: the University of Texas Academy of Health Science Education

PubMed Central

Buja, L. Maximilian; Cox, Susan M.; Lieberman, Steven A.; MacClements, Jonathan; Williams, Janet F.; Esterl, Robert M.; Shine, Kenneth I.

2013-01-01

Background The academy movement developed in the United States as an important approach to enhance the educational mission and facilitate the recognition and work of educators at medical schools and health science institutions. Objectives Academies initially formed at individual medical schools. Educators and leaders in The University of Texas System (the UT System, UTS) recognized the academy movement as a means both to address special challenges and pursue opportunities for advancing the educational mission of academic health sciences institutions. Methods The UTS academy process was started by the appointment of a Chancellor's Health Fellow for Education in 2004. Subsequently, the University of Texas Academy of Health Science Education (UTAHSE) was formed by bringing together esteemed faculty educators from the six UTS health science institutions. Results Currently, the UTAHSE has 132 voting members who were selected through a rigorous, system-wide peer review and who represent multiple professional backgrounds and all six campuses. With support from the UTS, the UTAHSE has developed and sustained an annual Innovations in Health Science Education conference, a small grants program and an Innovations in Health Science Education Award, among other UTS health science educational activities. The UTAHSE represents one university system's innovative approach to enhancing its educational mission through multi- and interdisciplinary as well as inter-institutional collaboration. Conclusions The UTAHSE is presented as a model for the development of other consortia-type academies that could involve several components of a university system or coalitions of several institutions. PMID:23490406

Creating a Longitudinal Integrated Clerkship with Mutual Benefits for an Academic Medical Center and a Community Health System

PubMed Central

Poncelet, Ann Noelle; Mazotti, Lindsay A; Blumberg, Bruce; Wamsley, Maria A; Grennan, Tim; Shore, William B

2014-01-01

The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills. Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment. Success factors include continued support and investment from both organizations’ leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers. PMID:24867551

Creating a longitudinal integrated clerkship with mutual benefits for an academic medical center and a community health system.

PubMed

Poncelet, Ann Noelle; Mazotti, Lindsay A; Blumberg, Bruce; Wamsley, Maria A; Grennan, Tim; Shore, William B

2014-01-01

The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills.Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment.Success factors include continued support and investment from both organizations' leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers.

Building Sustainable Capacity for Cardiovascular Care at a Public Hospital in Western Kenya

PubMed Central

Binanay, Cynthia A.; Akwanalo, Constantine O.; Aruasa, Wilson; Barasa, Felix A.; Corey, G. Ralph; Crowe, Susie; Esamai, Fabian; Einterz, Robert; Foster, Michael C.; Gardner, Adrian; Kibosia, John; Kimaiyo, Sylvester; Koech, Myra; Korir, Belinda; Lawrence, John E.; Lukas, Stephanie; Manji, Imran; Maritim, Peris; Ogaro, Francis; Park, Peter; Pastakia, Sonak; Sugut, Wilson; Vedanthan, Rajesh; Yanoh, Reuben; Velazquez, Eric J.; Bloomfield, Gerald S.

2015-01-01

Cardiovascular disease deaths are increasing in low- and middle-income countries and are exacerbated by health care systems that are ill-equipped to manage chronic diseases. Global health partnerships, which have stemmed the tide of infectious diseases in low- and middle-income countries, can be similarly applied to address cardiovascular diseases. In this review, we present the experiences of an academic partnership between North American and Kenyan medical centers to improve cardiovascular health in a national public referral hospital. We highlight our stepwise approach to developing sustainable cardiovascular services using the health system strengthening World Health Organization Framework for Action. The building blocks of this framework (leadership and governance, health workforce, health service delivery, health financing, access to essential medicines, and health information system) guided our comprehensive and sustainable approach to delivering subspecialty care in a resource limited setting. Our experiences may guide the development of similar collaborations in other settings. PMID:26653630

Integration of the enterprise electronic health record and anesthesia information management systems.

PubMed

Springman, Scott R

2011-09-01

Fewer than 5% of anesthesia departments use an electronic medical record (EMR) that is anesthesia specific. Many anesthesia information management systems (AIMS) have been developed with a focus only on the unique needs of anesthesia providers, without being fully integrated into other electronic health record components of the entire enterprise medical system. To understand why anesthesia providers should embrace health information technology (HIT) on a health system-wide basis, this article reviews recent HIT history and reviews HIT concepts. The author explores current developments in efforts to expand enterprise HIT, and the pros and cons of full enterprise integration with an AIMS. Copyright © 2011 Elsevier Inc. All rights reserved.

76 FR 60842 - Announcement of Requirements and Registration for “popHealth Tools Development Challenge”

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-30

... selections based upon the following criteria: 1. Ability to integrate with popHealth system and build upon... DEPARTMENT OF HEALTH AND HUMAN SERVICES Announcement of Requirements and Registration for ``popHealth Tools Development Challenge'' AGENCY: Office of the National Coordinator for Health Information...

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.

["Hannibal ante portas" -- technical development and health care reorganization].

PubMed

Fülesdi, Béla; Velkey, György

2011-11-20

Authors intend to analyze the impact of medical technical development on the Hungarian health care system and try to draw attention to potentially necessary measures for professional and structural health care reorganization.

Oman Vision 2050 for Health Research: A Strategic Plan for the Future Based on the Past and Present Experience

PubMed Central

Al Mawali, Adhra Hilal Nasser; Al Qasmi, Ahmed Mohamed; Al Sabahi, Sultana Mohamed Saif; Idikula, John; Elaty, Mahmoud Attia Abd; Morsi, Magdi; Al Hinai, Ali Talib

2017-01-01

Health care delivery in Oman has attained great heights since the modern renaissance in 1970. Although the health service had the main impetus all these years, the importance of health research began to take place by mid 1990’s and is now gaining momentum as an important responsibility and activity of the Ministry of Health (MoH). Although there has been progressively increasing investment and commitment to research activities in the recent Five Year Plan for Health Development, it still lags behind in the quality and quantity of research output. Lack of factors like adequate infrastructure, dedicated human resources, empowerment of existing systems, and societal support for research have adversely affected research output. Centre of Studies and Research in MoH has proposed a strategic plan, the ‘Health Vision 2050 for Health Research’ with aim of making Oman the regional leader and a research hub of world standards in health research. The mission is to promote, facilitate, and conduct high quality health research addressing national health priorities to improve health care services and enhance the efficiency and effectiveness of the health system, reduce health inequity, and contribute to socioeconomic development. The strategy includes setting health research priorities, strengthening the health research capacity, defining and implementing norms and standards, developing health research (quality and quantity), translating evidence into policy, strategy and practice, monitoring and coordinating research, financing health research, and evaluating the effectiveness of the health research system. It should generate a multifold increase in the quality and quantity of health research in Oman, positively impacting the health system and health care service. PMID:28439378

Mental health system in Saudi Arabia: an overview

PubMed Central

Qureshi, Naseem Akhtar; Al-Habeeb, Abdulhameed Abdullah; Koenig, Harold G

2013-01-01

Background There is evidence that mapping mental health systems (MHSs) helps in planning and developing mental health care services for users, families, and other caregivers. The General Administration of Mental Health and Social Services of the Ministry of Health over the past 4 years has sought to streamline the delivery of mental health care services to health consumers in Saudi Arabia. Objective We overview here the outcome of a survey that assessed the Saudi MHS and suggest strategic steps for its further improvement. Method The World Health Organization Assessment Instrument for Mental Health Systems was used systematically to collect information on the Saudi MHS in 2009–2010, 4 years after a baseline assessment. Results Several mental health care milestones, especially provision of inpatient mental health services supported by a ratified Mental Health Act, were achieved during this period. However, community mental health care services are needed to match international trends evident in developed countries. Similarly, a larger well-trained mental health workforce is needed at all levels to meet the ever-increasing demand of Saudi society. Conclusion This updated MHS information, discussed in light of international data, will help guide further development of the MHS in Saudi Arabia in the future, and other countries in the Eastern Mediterranean region may also benefit from Saudi experience. PMID:23966783

Equity in access to maternal and child health services in five developing countries: what works.

PubMed

Talukder, M D Noorunnabi; Rob, Ubaidur

2010-01-01

People living in rural areas are yet to have equitable access to maternal and child health services in many developing countries. This article examines selected health service delivery models that improved access to services in five developing countries. The article is based on the review of background papers on Bangladesh, Pakistan, Cambodia, Ghana, and Tanzania, prepared as part of a multi-country study on health systems and maternal and child health. Findings suggest that equity in access to health services largely depends on a system that ensures a combination of facility-based service delivery and outreach services with a functioning referral network. A key factor is the availability of health workforce at the community level. Community-based deployment of service providers or recruitment and training of community health workers is critical in enhancing service coverage and linking local populations to a health facility. Incentive is necessary to keep community health workers' interest in providing services. However, health workforce alone cannot ensure good health outcomes. They must be embedded in a functioning service delivery network to transform structural inputs into outcomes. Moreover, local-level health systems should have the ability to allocate resources in strategic ways addressing the pressing health needs of the people.

Development of assessment tools to measure organizational support for employee health.

PubMed

Golaszewski, Thomas; Barr, Donald; Pronk, Nico

2003-01-01

To develop systems that measure and effect organizational support for employee health. Multiple studies and developmental projects were reviewed that show the process of instrument development, metric quality testing, utilization within intervention studies, and prediction modeling efforts. Demographic patterns indicate high support levels and relationships of subsections to various employee health risks. Successes with the initial version have given rise to 2 additional evaluation tools. The availability of these systems illustrates how ecological models can be practically applied. Such efforts contribute to the paradigm shift in worksite health promotion that focuses on the organization as the target of intervention.

Limits to health adaptation in a changing climate

NASA Astrophysics Data System (ADS)

Ebi, K. L.

2015-12-01

Introduction: Because the health risks of climate variability and change are not new, it has been assumed that health systems have the capacity, experience, and tools to effectively adapt to changing burdens of climate-sensitive health outcomes with additional climate change. However, as illustrated in the Ebola crisis, health systems in many low-income countries have insufficient capacity to manage current health burdens. These countries also are those most vulnerable to climate change, including changes in food and water safety and security, increases in extreme weather and climate events, and increases in the geographic range, incidence, and seasonality of a variety of infectious diseases. The extent to which they might be able to keep pace with projected risks depends on assumptions of the sustainability of development pathways. At the same time, the magnitude and pattern of climate change will depend on greenhouse gas emission pathways. Methods: Review of the success of health adaptation projects and expert judgment assessment of the degree to which adaptation efforts will be able to keep pace with projected changes in climate variability and change. Results: Health adaptation can reduce the current and projected burdens of climate-sensitive health outcomes over the short term in many countries, but the extent to which it could do so past mid-century will depend on emission and development pathways. Under high emission scenarios, climate change will be rapid and extensive, leading to fundamental shifts in the burden of climate-sensitive health outcomes that will challenging for many countries to manage. Sustainable development pathways could delay but not eliminate associated health burdens. Conclusions: To prepare for and cope with the Anthropocene, health systems need additional adaptation policies and measures to develop more robust health systems, and need to advocate for rapid and significant reductions in greenhouse gas emissions.

Health in the 5th 5-years Development Plan of Iran: Main Challenges, General Policies and Strategies

PubMed Central

Vosoogh Moghaddam, A; Damari, B; Alikhani, S; Salarianzedeh, MH; Rostamigooran, N; Delavari, A; Larijani, B

2013-01-01

Access to the right to the highest attainable level of health is a constitutional right that obliges governments and other players to take step to increase all individuals’ chances of obtaining good health. At the least, health and education are two crucial requirements for this as well. Iran’s vision 2025 is going to lead the country to a developed state with the highest rank of economic, scientific and technological status in the region. Enjoying health, welfare, food security, social security, equal opportunities, etc, are also considered as part of characteristics of Iranian society in 2025. Although health system of Iran has many achievements in providing health services specially for the poor following the Islamic Revolution of 1979, but the evidences gathered to develop the 5th 5-years economical, social and cultural plan (5th5YDP:2011–2015), listed a variety of main challenges in stewardship, financing, resources generation and service provision functions of the existing health system. Thus, to overcome the main challenges, about 11% of general policies of 5th5YDP are directly address health related issues with emphasizing on healthy human and comprehensive health approach with considering: Integration of policy making, planning, evaluation, supervision and public financing; Developing both quantity and quality of health insurance system and reducing out-of-pocket expenditures for health services to 30% by the end of the 5th plan. The strategies of 5th5YDP adopted by the parliament as an Act will change the health system fundamentally through tuning the main drivers; so, its implementation needs brave leaders, capable managers, motivated technical staff and social mobilization. PMID:23865015

Application of systems thinking in health: opportunities for translating theory into practice Comment on "Constraints to applying systems thinking concepts in health systems: a regional perspective from surveying stakeholders in Eastern Mediterranean countries".

PubMed

Malik, Asmat Ullah

2015-03-19

Systems thinking is not a new concept to health system strengthening; however, one question remains unanswered: How policy-makers, system designers and consultants with a system thinking philosophy should act (have acted) as potential change agents in actually gaining opportunities to introduce systems thinking? Development of Comprehensive Multi-Year Plans (cMYPs) for Immunization System is one such opportunity because almost all Low- and Middle-Income Countries (LMICs) develop and implement cMYPs every five years. Without building upon examples and showing practical application, the discussions and deliberations on systems thinking may fade away with passage of time. There are opportunities that exist around us in our existing health systems that we can benefit from starting with an incremental approach and generating evidence for longer lasting system-wide changes. © 2015 by Kerman University of Medical Sciences.

Mental health interventions in schools 1

PubMed Central

Fazel, Mina; Hoagwood, Kimberly; Stephan, Sharon; Ford, Tamsin

2015-01-01

Mental health services embedded within school systems can create a continuum of integrative care that improves both mental health and educational attainment for children. To strengthen this continuum, and for optimum child development, a reconfiguration of education and mental health systems to aid implementation of evidence-based practice might be needed. Integrative strategies that combine classroom-level and student-level interventions have much potential. A robust research agenda is needed that focuses on system-level implementation and maintenance of interventions over time. Both ethical and scientific justifications exist for integration of mental health and education: integration democratises access to services and, if coupled with use of evidence-based practices, can promote the healthy development of children. PMID:26114092

Public health nurses' vision of their future reflects changing paradigms.

PubMed

Clarke, H F; Beddome, G; Whyte, N B

1993-01-01

Health care over the past decade has undergone important changes that have implications for public health nursing. The focus of public health has expanded, as a result of the World Health Organization establishing the goal of "Health for All by the Year 2000," with its strategy of primary health care. To be active participants in this expansion, public health nurses must be more explicit about their current contributions to health care systems; develop nursing frameworks consistent with the systems' changing goals; and articulate their visions of the future. It is clear that the medical paradigm of health care services needs to change to one of primary health care. Based on results of a recent public health nursing research study, a conceptual framework for the future practice of public health nursing was developed.

A call for integrating a mental health perspective into systems of care for abused and neglected infants and young children.

PubMed

Osofsky, Joy D; Lieberman, Alicia F

2011-01-01

A system of care for abused and neglected infants and young children should adopt a comprehensive perspective, with mental health considerations systematically incorporated into policies and decisions affecting children and their families. Children age birth to 5 years have disproportionately high rates of maltreatment, with long-term consequences for their mental and physical health. Research on normal development and developmental psychopathology has shown that early development unfolds in an ecology of transactional influences among biological, interpersonal, and environmental domains. Psychologists should collaborate with other early intervention disciplines to create systems of care based on an ecological-transactional model of development that includes early mental health principles in order to serve the needs of these young children. Didactic courses, practicums, and internships in infant and early childhood mental health should become integral components of undergraduate and graduate curricula in psychology in order to build capacity to achieve this goal. Recommendations are offered for systemic change by integrating infant and early childhood mental health principles into existing systems of care for young children and their families. PsycINFO Database Record (c) 2010 APA, all rights reserved.

Health System Vision of Iran in 2025

PubMed Central

Rostamigooran, N; Esmailzadeh, H; Rajabi, F; Majdzadeh, R; Larijani, B; Dastgerdi, M Vahid

2013-01-01

Background: Vast changes in disease features and risk factors and influence of demographic, economical, and social trends on health system, makes formulating a long term evolutionary plan, unavoidable. In this regard, to determine health system vision in a long term horizon is a primary stage. Method: After narrative and purposeful review of documentaries, major themes of vision statement were determined and its context was organized in a work group consist of selected managers and experts of health system. Final content of the statement was prepared after several sessions of group discussions and receiving ideas of policy makers and experts of health system. Results: Vision statement in evolutionary plan of health system is considered to be :“a progressive community in the course of human prosperity which has attained to a developed level of health standards in the light of the most efficient and equitable health system in visionary region1 and with the regarding to health in all policies, accountability and innovation”. An explanatory context was compiled either to create a complete image of the vision. Conclusion: Social values and leaders’ strategic goals, and also main orientations are generally mentioned in vision statement. In this statement prosperity and justice are considered as major values and ideals in society of Iran; development and excellence in the region as leaders’ strategic goals; and also considering efficiency and equality, health in all policies, and accountability and innovation as main orientations of health system. PMID:23865011

Space Shuttle Main Engine: Advanced Health Monitoring System

NASA Technical Reports Server (NTRS)

Singer, Chirs

1999-01-01

The main gola of the Space Shuttle Main Engine (SSME) Advanced Health Management system is to improve flight safety. To this end the new SSME has robust new components to improve the operating margen and operability. The features of the current SSME health monitoring system, include automated checkouts, closed loop redundant control system, catastropic failure mitigation, fail operational/ fail-safe algorithms, and post flight data and inspection trend analysis. The features of the advanced health monitoring system include: a real time vibration monitor system, a linear engine model, and an optical plume anomaly detection system. Since vibration is a fundamental measure of SSME turbopump health, it stands to reason that monitoring the vibration, will give some idea of the health of the turbopumps. However, how is it possible to avoid shutdown, when it is not necessary. A sensor algorithm has been developed which has been exposed to over 400 test cases in order to evaluate the logic. The optical plume anomaly detection (OPAD) has been developed to be a sensitive monitor of engine wear, erosion, and breakage.

The need to incorporate health information technology into physicians' education and professional development.

PubMed

Graham-Jones, Pierce; Jain, Sachin H; Friedman, Charles P; Marcotte, Leah; Blumenthal, David

2012-03-01

Nationwide, as physicians and health care systems adopt electronic health records, health information technology is becoming integral to the practice of medicine. But current medical education and professional development curricula do not systematically prepare physicians to use electronic health records and the data these systems collect. We detail how training in meaningful use of electronic health records could be incorporated into physician training, from medical school, through licensure and board certification, to continuing medical education and the maintenance of licensure and board certification. We identify six near-term opportunities for professional organizations to accelerate the integration of health information technology into their requirements.

[The theoretical aspects of development of health economics].

PubMed

Nechaev, V S; Markun, E R

2009-01-01

The article discusses several theoretical characteristics in the development of health economics. Particularly, the need of adequate health financing to implement sector functioning in satisfying the needs of population in medical services is emphasized. The consideration is given to the specificity of medical needs and conclusion is made that particular conditions are to be established for adequate resources support of public health system. The changeable health needs of population can be comprehensively considered only in the public health system with flexible accounting of this kind of changes as related to the health services with operational bringing the amount of financial flows in correspondence with the mentioned alterations.

Basic charasteristics of information system of health insurance in FB&H.

PubMed

Dzubur, Amela; Besić, Asim; Omanić, Ajnija; Dzubur, Alen; Niksić, Dragana

2004-10-01

Due to the territorial and administrative division in the war period, information system of health protection after the war was divided in two systems, what matched organisation of health insurance in that period. Those information systems were incompatible, developed on different, both, hardware and software. Therefore, Ministry of Health, within the project "Basic hospital services", financed through the World Bank loan, applied new, common information system in health insurance. Goal of this paper is to present basic features of information system of health insurance in FB&H, as well as the way of its functioning in respect to other institutions included in the system, respective data bases, sites of entering and updating data, while using data available with Federal Bureau of Health Insurance.

Information technology law and health systems in the European Union.

PubMed

Mossialos, Elias; Thomson, Sarah; Ter Linden, Annemarie

2004-01-01

This study aims to examine the impact of European Union (EU) law relating to information technology (IT) on health systems. The study identifies EU directives relating to IT, analyzes them in terms of their impact on the use of IT in health systems, and outlines their implications for health technology assessment (HTA). Analysis is based on a review of literature identified through relevant databases and Internet searches. Developments in IT have serious implications for EU health systems, presenting policy makers with new challenges. The European Commission has adopted a range of legal measures to protect consumers in the "information society" However, as few of them are health-specific, it is not evident that they have implications for health, health systems, or HTA, and they may not be effective in protecting consumers in the health sector. In light of the growing importance of IT in the health sector, legal and nonlegal measures need to be further developed at EU and international level. Where possible, future initiatives should pay attention to the particular characteristics of health goods and services and health systems. Although definitions of HTA usually recognize the importance of evaluating both the indirect, unintended consequences of health technologies and the legal aspects of their application, it seems that, in practice, HTA often overlooks or underestimates legislative matters. Those involved in HTA should be aware of the legal implications of using IT to provide health goods and services and compile, store, transfer, and disseminate health information electronically.

Policy experimentation and innovation as a response to complexity in China's management of health reforms.

PubMed

Husain, Lewis

2017-08-03

There are increasing criticisms of dominant models for scaling up health systems in developing countries and a recognition that approaches are needed that better take into account the complexity of health interventions. Since Reform and Opening in the late 1970s, Chinese government has managed complex, rapid and intersecting reforms across many policy areas. As with reforms in other policy areas, reform of the health system has been through a process of trial and error. There is increasing understanding of the importance of policy experimentation and innovation in many of China's reforms; this article argues that these processes have been important in rebuilding China's health system. While China's current system still has many problems, progress is being made in developing a functioning system able to ensure broad population access. The article analyses Chinese thinking on policy experimentation and innovation and their use in management of complex reforms. It argues that China's management of reform allows space for policy tailoring and innovation by sub-national governments under a broad agreement over the ends of reform, and that shared understandings of policy innovation, alongside informational infrastructures for the systemic propagation and codification of useful practices, provide a framework for managing change in complex environments and under conditions of uncertainty in which 'what works' is not knowable in advance. The article situates China's use of experimentation and innovation in management of health system reform in relation to recent literature which applies complex systems thinking to global health, and concludes that there are lessons to be learnt from China's approaches to managing complexity in development of health systems for the benefit of the poor.

Integrating Public Health and Personal Care in a Reformed US Health Care System

PubMed Central

Chernichovsky, Dov

2010-01-01

Compared with other developed countries, the United States has an inefficient and expensive health care system with poor outcomes and many citizens who are denied access. Inefficiency is increased by the lack of an integrated system that could promote an optimal mix of personal medical care and population health measures. We advocate a health trust system to provide core medical benefits to every American, while improving efficiency and reducing redundancy. The major innovation of this plan would be to incorporate existing private health insurance plans in a national system that rebalances health care spending between personal and population health services and directs spending to investments with the greatest long-run returns. PMID:20019310

Measurement of Sexual Health in the U.S.: An Inventory of Nationally Representative Surveys and Surveillance Systems

PubMed Central

Ivankovich, Megan B.; Leichliter, Jami S.; Douglas, John M.

2013-01-01

Objectives To identify opportunities within nationally representative surveys and surveillance systems to measure indicators of sexual health, we reviewed and inventoried existing data systems that include variables relevant to sexual health. Methods We searched for U.S. nationally representative surveys and surveillance systems that provided individual-level sexual health data. We assessed the methods of each data system and catalogued them by their measurement of the following domains of sexual health: knowledge, communication, attitudes, service access and utilization, sexual behaviors, relationships, and adverse health outcomes. Results We identified 18 U.S.-focused, nationally representative data systems: six assessing the general population, seven focused on special populations, and five addressing health outcomes. While these data systems provide a rich repository of information from which to assess national measures of sexual health, they present several limitations. Most importantly, apart from data on service utilization, routinely gathered, national data are currently focused primarily on negative aspects of sexual health (e.g., risk behaviors and adverse health outcomes) rather than more positive attributes (e.g., healthy communication and attitudes, and relationship quality). Conclusion Nationally representative data systems provide opportunities to measure a broad array of domains of sexual health. However, current measurement gaps indicate the need to modify existing surveys, where feasible and appropriate, and develop new tools to include additional indicators that address positive domains of sexual health of the U.S. population across the life span. Such data can inform the development of effective policy actions, services, prevention programs, and resource allocation to advance sexual health. PMID:23450886

Information Systems; Modern Health Care and Medical Information.

ERIC Educational Resources Information Center

Brandejs, J. F., And Others

1975-01-01

To effectively handle changes in health policy and health information, new designs and applications of automation are explored. Increased use of computer-based information systems in health care could serve as a means of control over the costs of developing more comprehensive health service, with applications increasing not only the automation of…

Institute of social justice and medicine: developing a think tank to promote policy formation.

PubMed

Boozary, Andrew; Dugani, Sagar B

2011-10-01

The World Health Organization (WHO) defines health as a "resource for everyday living, not the objective of living"; however, worldwide, there remains an unmistakable inequity in level of health and access to healthcare. The WHO has published documents on financing health systems towards universal health coverage [1], promoting healthy life [2], improving performance of health systems [3], and enriching humanity [4], highlighting our shared responsibility towards improving both national and global health and access to healthcare. These documents also recognize that, despite our local and regional priorities, there is a global desire to develop international strategies to improve healthcare. [1] WHO Report. Health systems financing and the path to universal coverage. 2010. http://www.who.int/bulletin/health_financing/en/index.html [2] WHO Report. Reducing risks, promoting healthy life. 2002. http://www.who.int/whr/2002/en/index.html [3] WHO Bulletin. Health systems: improving performance. 2000. http://www.who.int/whr/2000/en/index.html [4] WHO Bulletin. Conquering suffering, enriching humanity 1997. http://www.who.int/whr/1997/en/index.html.

The development of urban community health centres for strengthening primary care in China: a systematic literature review.

PubMed

Wang, Harry H X; Wang, Jia Ji; Wong, Samuel Y S; Wong, Martin C S; Mercer, Stewart W; Griffiths, Sian M

2015-01-01

This review outlines the development of China's primary care system, with implications for improving equitable health care. Government documents, official statistics, and recent literature identified through systematic searches performed on NCBI PubMed. Community health centres (CHCs) are being developed as the major primary care provider in urban China, with laudable achievements. The road towards a strong primary care-led system is promising but challenging. The effectiveness in improving equitable care through the expansion of primary care workforce and redesign of the social medical insurance system warrants further exploration. Healthcare disparities exist in the health system wherein universal health coverage and gatekeepers have not yet been established. Future prospective studies should aim to provide solutions for strengthening the leading role of CHCs in providing equitable care in response to population ageing and multimorbidity challenges. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Using realist review to inform intervention development: methodological illustration and conceptual platform for collaborative care in offender mental health.

PubMed

Pearson, M; Brand, S L; Quinn, C; Shaw, J; Maguire, M; Michie, S; Briscoe, S; Lennox, C; Stirzaker, A; Kirkpatrick, T; Byng, R

2015-09-28

This paper reports how we used a realist review, as part of a wider project to improve collaborative mental health care for prisoners with common mental health problems, to develop a conceptual platform. The importance of offenders gaining support for their mental health, and the need for practitioners across the health service, the criminal justice system, and the third sector to work together to achieve this is recognised internationally. However, the literature does not provide coherent analyses of how these ambitions can be achieved. This paper demonstrates how a realist review can be applied to inform complex intervention development that spans different locations, organisations, professions, and care sectors. We applied and developed a realist review for the purposes of intervention development, using a three-stage process. (1) An iterative database search strategy (extending beyond criminal justice and offender health) and groups of academics, practitioners, and people with lived experience were used to identify explanatory accounts (n = 347). (2) From these accounts, we developed consolidated explanatory accounts (n = 75). (3) The identified interactions between practitioners and offenders (within their organisational, social, and cultural contexts) were specified in a conceptual platform. We also specify, step by step, how these explanatory accounts were documented, consolidated, and built into a conceptual platform. This addresses an important methodological gap for social scientists and intervention developers about how to develop and articulate programme and implementation theory underpinning complex interventions. An integrated person-centred system is proposed to improve collaborative mental health care for offenders with common mental health problems (near to and after release) by achieving consistency between the goals of different sectors and practitioners, enabling practitioners to apply scientific and experiential knowledge in working judiciously and reflectively, and building systems and aligning resources that are centred on offenders' health and social care needs. As part of a broader programme of work, a realist review can make an important contribution to the specification of theoretically informed interventions that have the potential to improve health outcomes. Our conceptual platform has potential application in related systems of health and social care where integrated, and person-centred care is a goal.

Transforming Health Professionals into Population Health Change Agents

PubMed Central

Naccarella, Lucio; Butterworth, Iain; Moore, Timothy

2016-01-01

Background With the recognition that professional education has not kept pace with the challenges facing the health and human service system, there has been a move to transformative education and learning professional development designed to expand the number of enlightened and empowered change agents with the competence to implement changes at an individual, organisation and systems level. Design and Methods Since 2010, the Department of Health and Human Services in Victoria, Australia, in collaboration with The University of Melbourne’s School of Population and Global Health, has delivered seven population health short courses aimed to catalyse participants’ transformation into population health change agents. This paper presents key learnings from a combination of evaluation data from six population health short courses using a transformative learning framework from a 2010 independent international commission for health professionals that was designed to support the goals of transformative and interdependent health professionals. Participatory realist evaluation approaches and qualitative methods were used. Results Evaluation findings reveal that there were mixed outcomes in facilitating participants’ implementation of population health approaches, and their transformation into population health agents upon their return to their workplaces. Core enablers, barriers and requirements, at individual, organisational and system levels influence the capability of participants to implement population health approaches. The iterative and systemic evolution of the population health short courses, from a one off event to a program of inter-dependent modules, demonstrates sustained commitment by the short course developers and organisers to the promotion of transformative population health learning outcomes. Conclusions To leverage this commitment, recognising that professional development is not an event but part of an ongoing transformative process, suggestions to further align recognition of population health professional development programs are presented. Significance for public health With decreasing health and wellbeing of whole populations, increasing inequities among specific population groups, health professional educators are increasingly turning their attention to population health. This has implications for implementing evidence into practice. Professional development short courses are being conducted to equip participants (health service managers, health promotion managers and coordinators, health planners, population health planners and senior executives) with knowledge, skills and tools to implement population health approaches and transform them into population health change agents. The findings of this study indicate there were mixed outcomes in facilitating participants’ implementation of population health approaches and their transformation into population health agents upon their return to their workplaces. The study findings informed the evolution of the short courses, from a one off event to a program of interdependent modules, and further reveal that professional development is not an event but part of an on-going transformative process,suggestions to further align recognition of population health professional development programs are presented. PMID:27190973

Principles for the development of Aboriginal health interventions: culturally appropriate methods through systemic empathy.

PubMed

Kendall, Elizabeth; Barnett, Leda

2015-01-01

To increase Aboriginal participation in mainstream health services, it is necessary to understand the factors that influence health service usage. This knowledge can contribute to the development of culturally appropriate health services that respect Aboriginal ways of being. We used a community-based participatory approach to examine the reasons for underutilization of health services by Aboriginal Australians. Based on three focus groups and 18 interviews with Aboriginal health professionals, leaders, and community members in rural, regional, and urban settings, we identified five factors that influenced usage, including (1) negative historical experiences, (2) cultural incompetence, (3) inappropriate communication, (4) a collective approach to health, and (5) a more holistic approach to health. Given that these factors have shaped negative Aboriginal responses to health interventions, they are likely to be principles by which more appropriate solutions are generated. Although intuitively sensible and well known, these principles remain poorly understood by non-Aboriginal health systems and even less well implemented. We have conceptualized these principles as the foundation of an empathic health system. Without empathy, health systems in Australia, and internationally, will continue to face the challenge of building effective services to improve the state of health for all minority populations.

Acceptance and Usage of Electronic Health Record Systems in Small Medical Practices

ERIC Educational Resources Information Center

Tannan, Ritu

2012-01-01

One of the objectives of the U.S. government has been the development of a nationwide health information infrastructure, including adoption and use of an electronic health records (EHR) system. However, a 2008 survey conducted by the National Center for Health Statistics indicated a 41.5% usage of the EHR system by physicians in office-based…

Knowledge management systems for oral health in developing and developed countries.

PubMed

Nattestad, Anders

2012-10-01

Knowledge management systems utilize information technology to manage knowledge in organizations with the purpose of creating, supporting, storing and disseminating information. These systems have been around for decades, but have significantly changed over time in complexity and features with the evolution of information technology and the Internet. With the development of these new technologies, the concept of knowledge management has thrived and has had significant impact on the way in which knowledge is accumulated, stored and accessed. This article will describe the historical development of knowledge management systems in oral health, illustrate the technology using examples and explore the future use of these systems with emerging technologies such as Google Wave®. One example of how knowledge management systems may affect the quality of dental education is the DentEd project, where a collaborative website was developed to coordinate dental school visitations and collection of reports from working groups, leading to several important publications. MEDLINE is another example of an effective knowledge management system in health care, providing access to health care-related scientific literature, which is highly organized under the auspices of the United States National Library of Medicine. Another and very differently organized example of an effective knowledge management system is Wikipedia, which is a free, web-based, collaborative, multilingual encyclopedia project supported by a nonprofit foundation. The final example of an effective knowledge management system is all of the social media, including Facebook and Twitter. These tools have proven very powerful in organizing and collaborating. In conclusion, the development of new technologies and the Internet have changed the way in which information is developed and accessed. This development is still ongoing and only the future will reveal how this will continue to change. © 2012 John Wiley & Sons A/S.

An Informatics Approach to Establishing a Sustainable Public Health Community

ERIC Educational Resources Information Center

Kriseman, Jeffrey Michael

2012-01-01

This work involved the analysis of a public health system, and the design, development and deployment of enterprise informatics architecture, and sustainable community methods to address problems with the current public health system. Specifically, assessment of the Nationally Notifiable Disease Surveillance System (NNDSS) was instrumental in…

Ecological Issues Related to Children's Health and Safety

ERIC Educational Resources Information Center

Aldridge, Jerry; Kohler, Maxie

2009-01-01

Issues concerning the health and safety of children and youth occur at multiple levels. Bronfenbrenner (1995) proposed an ecological systems approach in which multiple systems interact to enhance or diminish children's development. The same systems are at work in health promotion. The authors present and review articles that reflect the multiple…

Tracking changes in the public health system: what researchers need to know to monitor and evaluate these changes.

PubMed

1996-09-01

Just as the medical care system is changing in communities across the country, so too is the public health system. Reduced resources, fragmentation of traditional public health functions, the spread of managed care, and developing new partnerships are key among these changes. Two dozen public health officials and health policy researchers met in April at the Center for Studying Health System Change to discuss the changes in the financing and delivery of public health services and the research needed to monitor and evaluate the impact of these changes.

[Strategy for monitoring and implementing methods for correcting child growth and development in rural areas of Sonora. Mexico].

PubMed

Noriega, J A; Domínguez, S E; Moreno, J M; Sandoval, R; Laborín, J

1992-12-01

An appropriate health technology to facilitate child growth and development in a rural area is presented and documented. Because mother's adequate behavior related to child's care does not produce immediate behavioral or physical changes it is necessary to create a long term social system of consequences. This was achieved joining a longitudinal measurement system with a program to train mothers to identify and deal with health and development issues. During four years, data were collected on weight-length development and morbidity twice a year and simultaneously skills were taught to diagnose treatment and prevent growth and development problems. After the third session child development and anthropometry data became the base of a system to assess maternal behavior, providing consequences for links in the behavior chains associated with child care. This system made organization and participation of the community in primary health care programs more likely, which implied a better score in each child growth and development chart.

Improving the use of health data for health system strengthening.

PubMed

Nutley, Tara; Reynolds, Heidi W

2013-02-13

Good quality and timely data from health information systems are the foundation of all health systems. However, too often data sit in reports, on shelves or in databases and are not sufficiently utilised in policy and program development, improvement, strategic planning and advocacy. Without specific interventions aimed at improving the use of data produced by information systems, health systems will never fully be able to meet the needs of the populations they serve. To employ a logic model to describe a pathway of how specific activities and interventions can strengthen the use of health data in decision making to ultimately strengthen the health system. A logic model was developed to provide a practical strategy for developing, monitoring and evaluating interventions to strengthen the use of data in decision making. The model draws on the collective strengths and similarities of previous work and adds to those previous works by making specific recommendations about interventions and activities that are most proximate to affect the use of data in decision making. The model provides an organizing framework for how interventions and activities work to strengthen the systematic demand, synthesis, review, and use of data. The logic model and guidance are presented to facilitate its widespread use and to enable improved data-informed decision making in program review and planning, advocacy, policy development. Real world examples from the literature support the feasible application of the activities outlined in the model. The logic model provides specific and comprehensive guidance to improve data demand and use. It can be used to design, monitor and evaluate interventions, and to improve demand for, and use of, data in decision making. As more interventions are implemented to improve use of health data, those efforts need to be evaluated.

Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy: A Framework for Understanding Users' Needs.

PubMed

Kayser, Lars; Kushniruk, Andre; Osborne, Richard H; Norgaard, Ole; Turner, Paul

2015-05-20

eHealth systems and applications are increasingly focused on supporting consumers to directly engage with and use health care services. Involving end users in the design of these systems is critical to ensure a generation of usable and effective eHealth products and systems. Often the end users engaged for these participatory design processes are not actual representatives of the general population, and developers may have limited understanding about how well they might represent the full range of intended users of the eHealth products. As a consequence, resulting information technology (IT) designs may not accommodate the needs, skills, cognitive capacities, and/or contexts of use of the intended broader population of health consumers. This may result in challenges for consumers who use the health IT systems, and could lead to limitations in adoption if the diversity of user attributes has not been adequately considered by health IT designers. The objective of this paper is to propose how users' needs and competences can be taken into account when designing new information and communications technology solutions in health care by expanding the user-task-context matrix model with the domains of a new concept of eHealth literacy. This approach expands an existing method for supporting health IT system development, which advocates use of a three-dimensional user-task-context matrix to comprehensively identify the users of health IT systems, and what their needs and requirements are under differing contexts of use. The extension of this model involved including knowledge about users' competences within the seven domains of eHealth literacy, which had been identified based on systematic engagement with computer scientists, academics, health professionals, and patients recruited from various patient organizations and primary care. A concept map was constructed based on a structured brainstorm procedure, card sorting, and computational analysis. The new eHealth literacy concept (based on 7 domains) was incorporated as a key factor in expanding the user-task-context matrix to describe and qualify user requirements and understanding related to eHealth literacy. This resulted in an expanded framework and a five-step process, which can support health IT designers in understanding and more accurately addressing end-users' needs, capabilities, and contexts to improve effectiveness and broader applicability of consumer-focused health IT systems. It is anticipated that the framework will also be useful for policy makers involved in the planning, procuring, and funding of eHealth infrastructure, applications, and services. Developing effective eHealth products requires complete understanding of the end-users' needs from multiple perspectives. In this paper, we have proposed and detailed a framework for modeling users' needs for designing eHealth systems that merges prior work in development of a user-task-context matrix with the emerging area of eHealth literacy. This framework is intended to be used to guide design of eHealth technologies and to make requirements explicitly related to eHealth literacy, enabling a generation of well-targeted, fit-for-purpose, equitable, and effective products and systems.

Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy: A Framework for Understanding Users' Needs

PubMed Central

2015-01-01

Background eHealth systems and applications are increasingly focused on supporting consumers to directly engage with and use health care services. Involving end users in the design of these systems is critical to ensure a generation of usable and effective eHealth products and systems. Often the end users engaged for these participatory design processes are not actual representatives of the general population, and developers may have limited understanding about how well they might represent the full range of intended users of the eHealth products. As a consequence, resulting information technology (IT) designs may not accommodate the needs, skills, cognitive capacities, and/or contexts of use of the intended broader population of health consumers. This may result in challenges for consumers who use the health IT systems, and could lead to limitations in adoption if the diversity of user attributes has not been adequately considered by health IT designers. Objective The objective of this paper is to propose how users’ needs and competences can be taken into account when designing new information and communications technology solutions in health care by expanding the user-task-context matrix model with the domains of a new concept of eHealth literacy. Methods This approach expands an existing method for supporting health IT system development, which advocates use of a three-dimensional user-task-context matrix to comprehensively identify the users of health IT systems, and what their needs and requirements are under differing contexts of use. The extension of this model involved including knowledge about users’ competences within the seven domains of eHealth literacy, which had been identified based on systematic engagement with computer scientists, academics, health professionals, and patients recruited from various patient organizations and primary care. A concept map was constructed based on a structured brainstorm procedure, card sorting, and computational analysis. Results The new eHealth literacy concept (based on 7 domains) was incorporated as a key factor in expanding the user-task-context matrix to describe and qualify user requirements and understanding related to eHealth literacy. This resulted in an expanded framework and a five-step process, which can support health IT designers in understanding and more accurately addressing end-users’ needs, capabilities, and contexts to improve effectiveness and broader applicability of consumer-focused health IT systems. It is anticipated that the framework will also be useful for policy makers involved in the planning, procuring, and funding of eHealth infrastructure, applications, and services. Conclusions Developing effective eHealth products requires complete understanding of the end-users’ needs from multiple perspectives. In this paper, we have proposed and detailed a framework for modeling users’ needs for designing eHealth systems that merges prior work in development of a user-task-context matrix with the emerging area of eHealth literacy. This framework is intended to be used to guide design of eHealth technologies and to make requirements explicitly related to eHealth literacy, enabling a generation of well-targeted, fit-for-purpose, equitable, and effective products and systems. PMID:27025228

From service provision to function based performance - perspectives on public health systems from the USA and Israel

PubMed Central

2012-01-01

If public health agencies are to fulfill their overall mission, they need to have defined measurable targets and should structure services to reach these targets, rather than offer a combination of ill-targeted programs. In order to do this, it is essential that there be a clear definition of what public health should do- a definition that does not ebb and flow based upon the prevailing political winds, but rather is based upon professional standards and measurements. The establishment of the Essential Public Health Services framework in the U.S.A. was a major move in that direction, and the model, or revisions of the model, have been adopted beyond the borders of the U.S. This article reviews the U.S. public health system, the needs and processes which brought about the development of the 10 Essential Public Health Services (EPHS), and historical and contemporary applications of the model. It highlights the value of establishing a common delineation of public health activities such as those contained in the EPHS, and explores the validity of using the same process in other countries through a discussion of the development in Israel of a similar model, the 10 Public Health Essential Functions (PHEF), that describes the activities of Israel’s public health system. The use of the same process and framework to develop similar yet distinct frameworks suggests that the process has wide applicability, and may be beneficial to any public health system. Once a model is developed, it can be used to measure public health performance and improve the quality of services delivered through the development of standards and measures based upon the model, which could, ultimately, improve the health of the communities that depend upon public health agencies to protect their well-being. PMID:23181452

Home health nursing care agenda based on health policy in Korea.

PubMed

Ryu, Hosihn; An, Jiyoung; Koabyashi, Mia

2005-06-01

Home health nursing care (HHNC) in Korea has taken on an important role under the mandate of the national health care system since 2000. This program was developed to verify the possibility of early discharge of hospitalized patients and cost containment through a research and development project that was conducted with the government from 1994 to 1999. The process of development of HHNC provided an opportunity to realize the advancement and changes in the system into a consumer-focused structure. This is an important turning point for the Korean health care system that suggests certain possibilities for building a foundation for further changes in the service delivery structure. The structure, which had been limited to a supplier-oriented model, is moving to a consumer-oriented structure. Accordingly, the major function and role of nursing policy makers in Korea is to develop an agenda and alternatives for policy-making in a systematic manner and to present implementation strategies clearly.

A Community Health Education System to meet the health needs of Indo-Chinese women.

PubMed

Ratnaike, R N; Chinner, T L

1992-04-01

This paper presents a Community Health Education System which is cost-effective, sustainable, strongly community-based, and directed at improving the health status of rural women in Indo-china (Kampuchea, Laos and Vietnam). The system is developed through a series of steps which are concerned with the education of Community Health Education Units (in national ministries of health) and, at the village level, among community health workers, women's groups, and other women. The ultimate aim is the establishment of a community health education program in Indochinese villages.

Integrated Crew Health Care System for Space Flight

NASA Technical Reports Server (NTRS)

Davis, Jeffrey R.

2007-01-01

Dr. Davis' presentation includes a brief overview of space flight and the lessons learned for health care in microgravity. He will describe the development of policy for health care for international crews. He will conclude his remarks with a discussion of an integrated health care system.

Health Sector Reform in the Kurdistan Region - Iraq: Financing Reform, Primary Care, and Patient Safety.

PubMed

Anthony, C Ross; Moore, Melinda; Hilborne, Lee H; Mulcahy, Andrew W

2014-12-30

In 2010, the Kurdistan Regional Government asked the RAND Corporation to help guide reform of the health care system in the Kurdistan Region of Iraq. The overarching goal of reform was to help establish a health system that would provide high-quality services efficiently to everyone to prevent, treat, and manage physical and mental illnesses and injuries. This article summarizes the second phase of RAND's work, when researchers analyzed three distinct but intertwined health policy issue areas: development of financing policy, implementation of early primary care recommendations, and evaluation of quality and patient safety. For health financing, the researchers reviewed the relevant literature, explored the issue in discussions with key stakeholders, developed and assessed various policy options, and developed plans or approaches to overcome barriers and achieve stated policy objectives. In the area of primary care, they developed and helped to implement a new management information system. In the area of quality and patient safety, they reviewed relevant literature, discussed issues and options with health leaders, and recommended an approach toward incremental implementation.

Information systems for mental health in six low and middle income countries: cross country situation analysis.

PubMed

Upadhaya, Nawaraj; Jordans, Mark J D; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Hanlon, Charlotte; Kigozi, Fred; Kizza, Dorothy; Lund, Crick; Semrau, Maya; Shidhaye, Rahul; Thornicroft, Graham; Komproe, Ivan H; Gureje, Oye

2016-01-01

Research on information systems for mental health in low and middle income countries (LMICs) is scarce. As a result, there is a lack of reliable information on mental health service needs, treatment coverage and the quality of services provided. With the aim of informing the development and implementation of a mental health information sub-system that includes reliable and measurable indicators on mental health within the Health Management Information Systems (HMIS), a cross-country situation analysis of HMIS was conducted in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda), participating in the 'Emerging mental health systems in low and middle income countries' (Emerald) research programme. A situation analysis tool was developed to obtain and chart information from documents in the public domain. In circumstances when information was inadequate, key government officials were contacted to verify the data collected. In this paper we compare the baseline policy context, human resources situation as well as the processes and mechanisms of collecting, verifying, reporting and disseminating mental health related HMIS data. The findings suggest that countries face substantial policy, human resource and health governance challenges for mental health HMIS, many of which are common across sites. In particular, the specific policies and plans for the governance and implementation of mental health data collection, reporting and dissemination are absent. Across sites there is inadequate infrastructure, few HMIS experts, and inadequate technical support and supervision to junior staff, particularly in the area of mental health. Nonetheless there are also strengths in existing HMIS where a few mental health morbidity, mortality, and system level indicators are collected and reported. Our study indicates the need for greater technical and resources input to strengthen routine HMIS and develop standardized HMIS indicators for mental health, focusing in particular on indicators of coverage and quality to facilitate the implementation of the WHO mental health action plan 2013-2020.

Development of the PHAST model: generating standard public health services data and evidence for decision-making.

PubMed

Bekemeier, Betty; Park, Seungeun

2018-04-01

Standardized data regarding the distribution, quality, reach, and variation in public health services provided at the community level and in wide use across states and communities do not exist. This leaves a major gap in our nation's understanding of the value of prevention activities and, in particular, the contributions of our government public health agencies charged with assuring community health promotion and protection. Public health and community leaders, therefore, are eager for accessible and comparable data regarding preventive services that can inform policy decisions about where to invest resources. We used literature review and a practice-based approach, employing an iterative process to identify factors that facilitate data provision among public health practitioners. This paper describes the model, systematically developed by our research team and with input from practice partners, that guides our process toward maximizing the uptake and integration of these standardized measures into state and local data collection systems. The model we developed, using a dissemination and implementation science framework, is intended to foster greater interest in and accountability for data collection around local health department services and to facilitate spatial exploration and statistical analysis of local health department service distribution, change, and performance. Our model is the first of its kind to thoroughly develop a means to guide research and practice in realizing the National Academy of Medicine's recommendation for developing systems to measure and track state and local public health system contributions to population health.

China-Africa Health Development Initiatives: Benefits and Implications for Shaping Innovative and Evidence-informed National Health Policies and Programs in Sub-saharan African Countries

PubMed Central

Tambo, Ernest; Ugwu, Chidiebere E.; Guan, Yayi; Wei, Ding; Xiao-Ning; Xiao-Nong, Zhou

2016-01-01

Background and Introduction: This review paper examines the growing implications of China’s engagement in shaping innovative national initiatives against infectious diseases and poverty control and elimination in African countries. It seeks to understand the factors and enhancers that can promote mutual and innovative health development initiatives, and those that are necessary in generating reliable and quality data for evidence-based contextual policy, priorities and programs. Methods: We examined the China-Africa health cooperation in supporting global health agenda on infectious diseases such as malaria, schistosomiasis, Ebola, TB, HIV/AIDS, neglected tropical diseases (NTDs) prevention, control and elimination spanning a period of 10 years. We reviewed referenced publications, global support data, and extensive sources related to and other emerging epidemics and infectious diseases of poverty, programs and interventions, health systems development issues, challenges, opportunities and investments. Published literature in PubMed, Scopus, Google Scholar, Books and web-based peer-reviewed journal articles, government annual reports were assessed from the first Forum on China-Africa Cooperation (FOCAC) in November 2006 to December 2015 Third Ministerial conferences. Results: Our findings highlight current shared public health challenges and emphasize the need to nurture, develop and establish effective, functional and sustainable health systems capacity to detect and respond to all public health threats and epidemic burdens, evidence-based programs and quality care outcomes. China’s significant health diplomacy emphasizes the importance of health financing in establishing health development commitment and investment in improving the gains and opportunities, importantly efficiency and value health priorities and planning. Conclusions and Global Health Implications: Strengthening China-Africa health development agenda towards collective commitment and investment in quality care delivery, effective programs coverage and efficiency, preparedness and emergency response is needed in transforming African health information systems, and local health governance structures and management in emerging epidemics. Furthermore, innovative evidence of operational joint solutions and strategies are critical in advancing healthcare delivery, and further enhancing Universal Health Care, and Sustainable Development Goals to attain global health improvements and economic prosperity. PMID:28058199

Challenges for health care development in Croatia.

PubMed

Ostojić, Rajko; Bilas, Vlatka; Franc, Sanja

2012-09-01

The main aim of the research done in this paper was to establish key challenges and perspectives for health care development in the Republic of Croatia in the next two decades. Empirical research was conducted in the form of semi-structured interviews involving 49 subjects, representatives of health care professionals from both, public and private sectors, health insurance companies, pharmaceutical companies, drug wholesalers, and non-governmental organisations (patient associations). The results have shown that key challenges and problems of Croatian health care can be divided into three groups: functioning of health care systems, health care personnel, and external factors. Research has shown that key challenges related to the functioning of health care are inefficiency, financial unviability, inadequate infrastructure, and the lack of system transparency. Poor governance is another limiting factor. With regard to health care personnel, they face the problems of low salaries, which then lead to migration challenges and a potential shortage of health care personnel. The following external factors are deemed to be among the most significant challenges: ageing population, bad living habits, and an increase in the number of chronic diseases. However, problems caused by the global financial crisis and consequential macroeconomic situation must not be neglected. Guidelines for responding to challenges identified in this research are the backbone for developing a strategy for health care development in the Republic of Croatia. Long-term vision, strategy, policies, and a regulatory framework are all necessary preconditions for an efficient health care system and more quality health services.

Reusable Rocket Engine Turbopump Health Management System

NASA Technical Reports Server (NTRS)

Surko, Pamela

1994-01-01

A health monitoring expert system software architecture has been developed to support condition-based health monitoring of rocket engines. Its first application is in the diagnosis decisions relating to the health of the high pressure oxidizer turbopump (HPOTP) of Space Shuttle Main Engine (SSME). The post test diagnostic system runs off-line, using as input the data recorded from hundreds of sensors, each running typically at rates of 25, 50, or .1 Hz. The system is invoked after a test has been completed, and produces an analysis and an organized graphical presentation of the data with important effects highlighted. The overall expert system architecture has been developed and documented so that expert modules analyzing other line replaceable units may easily be added. The architecture emphasizes modularity, reusability, and open system interfaces so that it may be used to analyze other engines as well.

[Equity issues in health care reform in Argentina].

PubMed

Belmartino, Susana

2002-01-01

This article analyzes the historical and contemporary development of the Argentine health care system from the viewpoint of equity, a principle which is not explicitly mentioned in the system's founding documents. However, other values can be identified such as universal care, accessibility, and solidarity, which are closely related to equity. Nevertheless, the political dynamics characterizing the development of the country's health care system led to the suppression of more universalistic approaches, with group solidarity the only remaining principle providing structure to the system. The 1980s financial crisis highlighted the relative value of this principle as the basis for an equitable system. The authors illustrate the current situation with data on coverage under the medical social security system.

NASA Space Flight Human-System Standard Human Factors, Habitability, and Environmental Health

NASA Technical Reports Server (NTRS)

Holubec, Keith; Connolly, Janis

2010-01-01

This slide presentation reviews the history, and development of NASA-STD-3001, NASA Space Flight Human-System Standard Human Factors, Habitability, and Environmental Health, and the related Human Integration Design Handbook. Currently being developed from NASA-STD-3000, this project standard currently in review will be available in two volumes, (i.e., Volume 1 -- VCrew Health and Volume 2 -- Human Factors, Habitability, and Environmental Health) and the handbook will be both available as a pdf file and as a interactive website.

Sensor Technology for Integrated Vehicle Health Management of Aerospace Vehicles

NASA Technical Reports Server (NTRS)

Prosser, W. H.; Brown, T. L.; Woodard, S. E.; Fleming, G. A.; Cooper, E. G.

2002-01-01

NASA is focusing considerable efforts on technology development for Integrated Vehicle Health Management systems. The research in this area is targeted toward increasing aerospace vehicle safety and reliability, while reducing vehicle operating and maintenance costs. Onboard, real-time sensing technologies that can provide detailed information on structural integrity are central to such a health management system. This paper describes a number of sensor technologies currently under development for integrated vehicle health management. The capabilities, current limitations, and future research needs of these technologies are addressed.

A qualitative appraisal of stakeholder reactions to a tool for burden of disease-based health system budgeting in Ghana.

PubMed

Awoonor-Williams, John Koku; Schmitt, Margaret L; Tiah, Janet; Ndago, Joyce; Asuru, Rofina; Bawah, Ayaga A; Phillips, James F

2016-01-01

In 2010, the Ghana Health Service launched a program of cooperation with the Tanzania Ministry of Health and Social Welfare that was designed to adapt Tanzania's PLANREP budgeting and reporting tool to Ghana's primary health care program. The product of this collaboration is a system of budgeting, data visualization, and reporting that is known as the District Health Planning and Reporting Tool (DiHPART). This study was conducted to evaluate the design and implementation processes (technical, procedures, feedback, maintenance, and monitoring) of the DiHPART tool in northern Ghana. This paper reports on a qualitative appraisal of user reactions to the DiHPART system and implications of pilot experience for national scale-up. A total of 20 health officials responsible for financial planning operations were drawn from the national, regional, and district levels of the health system and interviewed in open-ended discussions about their reactions to DiHPART and suggestions for systems development. The findings show that technical shortcomings merit correction before scale-up can proceed. The review makes note of features of the software system that could be developed, based on experience gained from the pilot. Changes in the national system of financial reporting and budgeting complicate DiHPART utilization. This attests to the importance of pursuing a software application framework that anticipates the need for automated software generation. Despite challenges encountered in the pilot, the results lend support to the notion that evidence-based budgeting merits development and implementation in Ghana.

Environmental assessment for the satellite power system concept development and evaluation program: nonmicrowave health and ecological effects

DOE Office of Scientific and Technical Information (OSTI.GOV)

White, M R

1980-11-01

A Concept Development and Evaluation Program is being carried out for a proposed Satellite Power System (SPS). For purposes of this evaluation, a preliminary reference system has been developed. SPS, as described in the reference system, would collect solar energy on satellites in geosychronous orbit in space. The energy would be converted to microwaves and beamed to an earth-receiving antenna (rectenna). One task in the environmental part of the program is the assessment of the nonmicrowave effects on health and the environment. These effects would result from all phases of SPS development and operation. This report covers the current knowledgemore » regarding these effects, and is based on the reference system. The assessment is summarized as to scope, methodology, impacts of terrestrial development, launch and recovery of spacecraft, space activities (including health effects of the space environment, ionizing radiation, electromagnetic exposure, spacecraft charging and environmental interactions, occupational hazards, etc.) and construction and operation of rectenna (ground receiving station).« less

Critical role of developing national strategic plans as a guide to strengthen laboratory health systems in resource-poor settings.

PubMed

Nkengasong, John N; Mesele, Tsehaynesh; Orloff, Sherry; Kebede, Yenew; Fonjungo, Peter N; Timperi, Ralph; Birx, Deborah

2009-06-01

Medical laboratory services are an essential, yet often neglected, component of health systems in developing countries. Their central role in public health, disease control and surveillance, and patient management is often poorly recognized by governments and donors. However, medical laboratory services in developing countries can be strengthened by leveraging funding from other sources of HIV/AIDS prevention, care, surveillance, and treatment programs. Strengthening these services will require coordinated efforts by national governments and partners and can be achieved by establishing and implementing national laboratory strategic plans and policies that integrate laboratory systems to combat major infectious diseases. These plans should take into account policy, legal, and regulatory frameworks; the administrative and technical management structure of the laboratories; human resources and retention strategies; laboratory quality management systems; monitoring and evaluation systems; procurement and maintenance of equipment; and laboratory infrastructure enhancement. Several countries have developed or are in the process of developing their laboratory plans, and others, such as Ethiopia, have implemented and evaluated their plan.

Impact of Thailand universal coverage scheme on the country's health information systems and health information technology.

PubMed

Kijsanayotin, Boonchai

2013-01-01

Thailand achieved universal healthcare coverage with the implementation of the Universal Coverage Scheme (UCS) in 2001. This study employed qualitative method to explore the impact of the UCS on the country's health information systems (HIS) and health information technology (HIT) development. The results show that health insurance beneficiary registration system helps improve providers' service workflow and country vital statistics. Implementation of casemix financing tool, Thai Diagnosis-Related Groups, has stimulated health providers' HIS and HIT capacity building, data and medical record quality and the adoption of national administrative data standards. The system called "Disease Management Information Systems" aiming at reimbursement for select diseases increased the fragmentation of HIS and increase burden on data management to providers. The financial incentive of outpatient data quality improvement project enhance providers' HIS and HIT investment and also induce data fraudulence tendency. Implementation of UCS has largely brought favorable impact on the country HIS and HIT development. However, the unfavorable effects are also evident.

Going tobacco-free on 24 New York City university campuses: A public health agency's partnership with a large urban public university system.

PubMed

Bresnahan, Marie P; Sacks, Rachel; Farley, Shannon M; Mandel-Ricci, Jenna; Patterson, Ty; Lamberson, Patti

2016-01-01

The New York City Department of Health and Mental Hygiene partnered with the nation's largest university system, the City University of New York (CUNY), to provide technical assistance and resources to support the development and implementation of a system-wide tobacco-free policy. This effort formed one component of Healthy CUNY-a larger initiative to support health promotion and disease prevention across the university system and resulted in the successful introduction of a system-wide tobacco-free policy on all CUNY campuses. Glassman et al (J Am Coll Health. 2011;59:764-768) published a blueprint for action related to tobacco policies that informed our work. This paper describes the policy development and implementation process and presents lessons learned from the perspective of the Health Department, as a practical case study to inform and support other health departments who may be supporting colleges and universities to become tobacco-free.

Study of Global Health Strategy Based on International Trends

PubMed Central

HATANAKA, Takashi; EGUCHI, Narumi; DEGUCHI, Mayumi; YAZAWA, Manami; ISHII, Masami

2015-01-01

The Japanese government at present is implementing international health and medical growth strategies mainly from the viewpoint of business. However, the United Nations is set to resolve the Post-2015 Development Agenda in the fall of 2015; the agenda will likely include the achievement of universal health coverage (UHC) as a specific development goal. Japan’s healthcare system, the foundation of which is its public, nationwide universal health insurance program, has been evaluated highly by the Lancet. The World Bank also praised it as a global model. This paper presents suggestions and problems for Japan regarding global health strategies, including in regard to several prerequisite domestic preparations that must be made. They are summarized as follows. (1) The UHC development should be promoted in coordination with the United Nations, World Bank, and Asian Development Bank. (2) The universal health insurance system of Japan can be a global model for UHC and ensuring its sustainability should be considered a national policy. (3) Trade agreements such as the Trans-Pacific Partnership (TPP) should not disrupt or interfere with UHC, the form of which is unique to each nation, including Japan. (4) Japan should disseminate information overseas, including to national governments, people, and physicians, regarding the course of events that led to the establishment of the Japan’s universal health insurance system and should make efforts to develop international human resources to participate in UHC policymaking. (5) The development of separate healthcare programs and UHC preparation should be promoted by streamlining and centralizing maternity care, school health, infectious disease management such as for tuberculosis, and emergency medicine such as for traffic accidents. (6) Japan should disseminate information overseas about its primary care physicians (kakaritsuke physicians) and develop international human resources. (7) Global health should be developed in integration with global environment problem management. (8) Support systems, such as for managing large-scale disasters of international scale or preventing the spread of infectious diseases, should be developed and maintained. (9) International healthcare policy, which the Japanese government is trying to promote in accordance with international trends, and international development of Japanese healthcare industry should be reconsidered. PMID:26870622

A Platform for Innovation and Standards Evaluation: a Case Study from the OpenMRS Open-Source Radiology Information System.

PubMed

Gichoya, Judy W; Kohli, Marc; Ivange, Larry; Schmidt, Teri S; Purkayastha, Saptarshi

2018-05-10

Open-source development can provide a platform for innovation by seeking feedback from community members as well as providing tools and infrastructure to test new standards. Vendors of proprietary systems may delay adoption of new standards until there are sufficient incentives such as legal mandates or financial incentives to encourage/mandate adoption. Moreover, open-source systems in healthcare have been widely adopted in low- and middle-income countries and can be used to bridge gaps that exist in global health radiology. Since 2011, the authors, along with a community of open-source contributors, have worked on developing an open-source radiology information system (RIS) across two communities-OpenMRS and LibreHealth. The main purpose of the RIS is to implement core radiology workflows, on which others can build and test new radiology standards. This work has resulted in three major releases of the system, with current architectural changes driven by changing technology, development of new standards in health and imaging informatics, and changing user needs. At their core, both these communities are focused on building general-purpose EHR systems, but based on user contributions from the fringes, we have been able to create an innovative system that has been used by hospitals and clinics in four different countries. We provide an overview of the history of the LibreHealth RIS, the architecture of the system, overview of standards integration, describe challenges of developing an open-source product, and future directions. Our goal is to attract more participation and involvement to further develop the LibreHealth RIS into an Enterprise Imaging System that can be used in other clinical imaging including pathology and dermatology.

[Using the concept of universal health coverage to promote the health system reform in China].

PubMed

Hu, S L

2016-11-06

The paper is systematically explained the definition, contents of universal health coverage (UHC). Universal health coverage calls for all people to have access to quality health services they need without facing undue financial burden. The relationship between five main attributes, i.e., quality, efficiency, equity, accountability and resilience, and their 15 action plans has been explained. The nature of UHC is belonged to the State and government. The core function is commitment with equality. The whole-of-system method is used to promoting the health system reform. In China, the universal health coverage has been reached to the preliminary achievements, which include universal coverage of social medical insurance, basic medical services, basic public health services, and the provision of essential medicines. China has completed millennium development goals (MDG) and is being stepped to the sustainable development goals (SDG).

Beyond Watches and Chocolate-Global Mental Health Elective in Switzerland.

PubMed

Schneeberger, Andres R; Weiss, Andrea; von Blumenthal, Suzanne; Lang, Undine E; Huber, Christian G; Schwartz, Bruce J

2016-08-01

Despite increasing interest in global mental health training opportunities, only a few psychiatry residency programs offer global mental health training experiences in developing countries and even fewer programs offer it in other first-world countries. The authors developed a global mental health elective giving US psychiatry residents the opportunity to visit Switzerland to study and experience the mental health care system in this European country. This elective focuses on four major learning objectives: (1) the system of training and curriculum of postgraduate psychiatry education in Switzerland, (2) clinical and organizational aspects of Swiss mental health, (3) administrative aspects of Swiss mental health care delivery, and (4) scholarly activity. This program was uniquely tailored for psychiatry residents. The preliminary experiences with US psychiatry residents show that they value this learning experience, the opportunity to access a different mental health care system, as well as the potential to build international connections with peers.

Systems thinking in practice: the current status of the six WHO building blocks for health system strengthening in three BHOMA intervention districts of Zambia: a baseline qualitative study.

PubMed

Mutale, Wilbroad; Bond, Virginia; Mwanamwenge, Margaret Tembo; Mlewa, Susan; Balabanova, Dina; Spicer, Neil; Ayles, Helen

2013-08-01

The primary bottleneck to achieving the MDGs in low-income countries is health systems that are too fragile to deliver the volume and quality of services to those in need. Strong and effective health systems are increasingly considered a prerequisite to reducing the disease burden and to achieving the health MDGs. Zambia is one of the countries that are lagging behind in achieving millennium development targets. Several barriers have been identified as hindering the progress towards health related millennium development goals. Designing an intervention that addresses these barriers was crucial and so the Better Health Outcomes through Mentorship (BHOMA) project was designed to address the challenges in the Zambia's MOH using a system wide approach. We applied systems thinking approach to describe the baseline status of the Six WHO building blocks for health system strengthening. A qualitative study was conducted looking at the status of the Six WHO building blocks for health systems strengthening in three BHOMA districts. We conducted Focus group discussions with community members and In-depth Interviews with key informants. Data was analyzed using Nvivo version 9. The study showed that building block specific weaknesses had cross cutting effect in other health system building blocks which is an essential element of systems thinking. Challenges noted in service delivery were linked to human resources, medical supplies, information flow, governance and finance building blocks either directly or indirectly. Several barriers were identified as hindering access to health services by the local communities. These included supply side barriers: Shortage of qualified health workers, bad staff attitude, poor relationships between community and health staff, long waiting time, confidentiality and the gender of health workers. Demand side barriers: Long distance to health facility, cost of transport and cultural practices. Participating communities seemed to lack the capacity to hold health workers accountable for the drugs and services. The study has shown that building block specific weaknesses had cross cutting effect in other health system building blocks. These linkages emphasised the need to use system wide approaches in assessing the performance of health system strengthening interventions.

Functioning information in the learning health system.

PubMed

Stucki, Gerold; Bickenbach, Jerome

2017-02-01

In this methodological note on applying the ICF in rehabilitation, we introduce functioning information as fundamental for the "learning health system" and the continuous improvement of the health system's response to people's functioning needs by means of the provision of rehabilitation. A learning health system for rehabilitation operates at the micro-level of the individual patient, meso-level of operational management, and the macro-level of policy that guides rehabilitation programming. All three levels rely on the capacity of the informational system of the health system for standardized documentation and coding of functioning information, and the development of national rehabilitation quality management systems. This methodological note describes how functioning information is used for the continuous improvement of functioning outcomes in a learning health system across these three levels.

Redefining public health leadership in the sustainable development goal era.

PubMed

Reddy, K Srinath; Mathur, Manu Raj; Negi, Sagri; Krishna, Bhargav

2017-06-01

Adoption of the Sustainable Development Goals (SDGs) by member states of the United Nations (UN) has set a new agenda for public health action at national and global levels. The changed context calls for a reframing of what constitutes effective leadership in public health, through a construct that reflects the interdependence of leadership at multiple levels across the health system and its partners in other sectors. This is especially important in the context of Low and Middle Income Countries (LMICs) that are facing complex demographic and epidemiological transitions. The health system needs to exercise leadership that effectively mobilises all its resources for maximising health impact, and channels trans-disciplinary learning into well-coordinated multi-sectoral action on the wider determinants of health. Leadership is essential not only at the level of inspirational individuals who can create collective vision and commitment but also at the level of supportive institutions situated in or aligned to the health system. In turn, the health system as a whole has to exercise leadership that advances public health in the framework of sustainable development. This commentary examines the desirable attributes of effective leadership at each of these levels and explores the nature of their inter-dependence. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Maximizing potential: innovative collaborative strategies between one-stops and mental health systems of care.

PubMed

Boeltzig, Heike; Timmons, Jaimie Ciulla; Marrone, Joe

2008-01-01

Barriers to seamless service delivery between workforce development and mental health systems of care have kept both entities from maximizing their potential in regards to employment for job seekers with mental illness who are capable of work and seeking employment. Using a multiple case study design, this study examined the nature of collaboration between workforce development and mental health systems to understand the policies and practices in place to assist individuals with mental illness to find and keep work. The paper presents innovative strategies that involved staff from both workforce development and mental health agencies. Findings from this research identified the following collaborative strategies: (a) the creation of liaison positions and collaborative teams; (b) staff training on mental health and workforce issues; and (c) multi-level involvement of individuals with mental illness. Implications for workforce professionals are offered as a way to stimulate implementation of such strategies.

Examining construct and predictive validity of the Health-IT Usability Evaluation Scale: confirmatory factor analysis and structural equation modeling results.

PubMed

Yen, Po-Yin; Sousa, Karen H; Bakken, Suzanne

2014-10-01

In a previous study, we developed the Health Information Technology Usability Evaluation Scale (Health-ITUES), which is designed to support customization at the item level. Such customization matches the specific tasks/expectations of a health IT system while retaining comparability at the construct level, and provides evidence of its factorial validity and internal consistency reliability through exploratory factor analysis. In this study, we advanced the development of Health-ITUES to examine its construct validity and predictive validity. The health IT system studied was a web-based communication system that supported nurse staffing and scheduling. Using Health-ITUES, we conducted a cross-sectional study to evaluate users' perception toward the web-based communication system after system implementation. We examined Health-ITUES's construct validity through first and second order confirmatory factor analysis (CFA), and its predictive validity via structural equation modeling (SEM). The sample comprised 541 staff nurses in two healthcare organizations. The CFA (n=165) showed that a general usability factor accounted for 78.1%, 93.4%, 51.0%, and 39.9% of the explained variance in 'Quality of Work Life', 'Perceived Usefulness', 'Perceived Ease of Use', and 'User Control', respectively. The SEM (n=541) supported the predictive validity of Health-ITUES, explaining 64% of the variance in intention for system use. The results of CFA and SEM provide additional evidence for the construct and predictive validity of Health-ITUES. The customizability of Health-ITUES has the potential to support comparisons at the construct level, while allowing variation at the item level. We also illustrate application of Health-ITUES across stages of system development. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

How the Maori community sees the dental-care system.

PubMed

Edward, S J

1992-10-01

This report has addressed the question of how the Maori community sees the system of oral health care by indicating the complex factors influencing the Maori community's attitude toward health issues. These factors preclude the Maori community from many of the perceived benefits of the present oral health-care system. There is a need in this current climate of debate over health policies to re-focus on primary prevention policies that will be relevant to the Maori community of today. No one is seen in the Maori community to be articulating concern for oral health issues. The challenge for the Dental Council of New Zealand is how then to create a focus on oral health issues within the Maori community, and to actively promote oral health care and encourage usage of a system that is affordable, available, accessible, and appropriate. Practical and relevant recommendations arising from Rapuora: Health and Maori Women 1984 and the Hui Hauora Mokopuna, 1990(10) should be considered when planning future health-care systems. Health was one of the four key areas highlighted in the Ka Awatea report, and it will be an important feature of the work of the new Ministry of Maori Development. It is timely that the Dental Council of New Zealand and the Ministry of Maori Development should facilitate oral health-care systems for the future in partnership with the Maori community.

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies.

PubMed

Petersen, Inge; Marais, Debbie; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Chisholm, Dan; Egbe, Catherine; Gureje, Oye; Hanlon, Charlotte; Lund, Crick; Shidhaye, Rahul; Jordans, Mark; Kigozi, Fred; Mugisha, James; Upadhaya, Nawaraj; Thornicroft, Graham

2017-06-01

Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Preparing for the data revolution: identifying minimum health information competencies among the health workforce.

PubMed

Whittaker, Maxine; Hodge, Nicola; Mares, Renata E; Rodney, Anna

2015-04-01

Health information is required for a variety of purposes at all levels of a health system, and a workforce skilled in collecting, analysing, presenting, and disseminating such information is essential to fulfil these demands. While it is established that low- and middle-income countries (LMICs) are facing shortages in human resources for health (HRH), there has been little systematic attention focussed on non-clinical competencies. In response, we developed a framework that defines the minimum health information competencies required by health workers at various levels of a health system. Using the Delphi method, we consulted with leading global health information system (HIS) experts. An initial list of competencies and draft framework were developed based on results of a systematic literature review. During the second half of 2012, we sampled 38 experts with broad-based HIS knowledge and extensive development experience. Two rounds of consultation were carried out with the same group to establish validity of the framework and gain feedback on the draft competencies. Responses from consultations were analysed using Qualtrics® software and content analysis. In round one, 17 experts agreed to participate in the consultation and 11 (65%) completed the survey. In the second round, 11 experts agreed to participate and eight (73%) completed the survey. Overall, respondents agreed that there is a need for all health workers to have basic HIS competencies and that the concept of a minimum HIS competency framework is valid. Consensus was reached around the inclusion of 68 competencies across four levels of a health system. This consultation is one of the first to identify the HIS competencies required among general health workers, as opposed to specialist HIS roles. It is also one of the first attempts to develop a framework on minimum HIS competencies needed in LMICs, highlighting the skills needed at each level of the system, and identifying potential gaps in current training to allow a more systematic approach to HIS capacity-building.

A resource management tool for public health continuity of operations during disasters.

PubMed

Turner, Anne M; Reeder, Blaine; Wallace, James C

2013-04-01

We developed and validated a user-centered information system to support the local planning of public health continuity of operations for the Community Health Services Division, Public Health - Seattle & King County, Washington. The Continuity of Operations Data Analysis (CODA) system was designed as a prototype developed using requirements identified through participatory design. CODA uses open-source software that links personnel contact and licensing information with needed skills and clinic locations for 821 employees at 14 public health clinics in Seattle and King County. Using a web-based interface, CODA can visualize locations of personnel in relationship to clinics to assist clinic managers in allocating public health personnel and resources under dynamic conditions. Based on user input, the CODA prototype was designed as a low-cost, user-friendly system to inventory and manage public health resources. In emergency conditions, the system can run on a stand-alone battery-powered laptop computer. A formative evaluation by managers of multiple public health centers confirmed the prototype design's usefulness. Emergency management administrators also provided positive feedback about the system during a separate demonstration. Validation of the CODA information design prototype by public health managers and emergency management administrators demonstrates the potential usefulness of building a resource management system using open-source technologies and participatory design principles.

A Resource Management Tool for Public Health Continuity of Operations During Disasters

PubMed Central

Turner, Anne M.; Reeder, Blaine; Wallace, James C.

2014-01-01

Objective We developed and validated a user-centered information system to support the local planning of public health continuity of operations for the Community Health Services Division, Public Health - Seattle & King County, Washington. Methods The Continuity of Operations Data Analysis (CODA) system was designed as a prototype developed using requirements identified through participatory design. CODA uses open-source software that links personnel contact and licensing information with needed skills and clinic locations for 821 employees at 14 public health clinics in Seattle and King County. Using a web-based interface, CODA can visualize locations of personnel in relationship to clinics to assist clinic managers in allocating public health personnel and resources under dynamic conditions. Results Based on user input, the CODA prototype was designed as a low-cost, user-friendly system to inventory and manage public health resources. In emergency conditions, the system can run on a stand-alone battery-powered laptop computer. A formative evaluation by managers of multiple public health centers confirmed the prototype design’s usefulness. Emergency management administrators also provided positive feedback about the system during a separate demonstration. Conclusions Validation of the CODA information design prototype by public health managers and emergency management administrators demonstrates the potential usefulness of building a resource management system using open-source technologies and participatory design principles. PMID:24618165

From home, to market, to headquarters, to home. Relocating health services planning and purchasing in New Zealand.

PubMed

Gauld, Robin

2002-01-01

Health sector restructuring has been in vogue, but no country has engaged in as much health sector restructuring as New Zealand where, in a decade, there have been four different public health sector structures. This article discusses New Zealand's four structures with an emphasis on relocating the critical functions of health care planning and purchasing, and on the development of the present district health board system. The four structures include: an area health board system (1989-1991) with planning and purchasing located at "home" in local areas and closely aligned with service provision; a competitive internal market system (1993-1996) which separated planning and purchasing from service provision; a centralised system with a "headquarters" controlling planning and purchasing (1997-1999) while maintaining the distance from provision; and the district health board system currently under development (1999-) which sees purchasing and planning sent home again to regions and linked closely with service provision. The present system entails the devolution of considerable responsibility to the local level, within a framework of strong central government control. Based on New Zealand's experience, the article notes that all but the market structure appear to have provided an adequate environment for effective health care planning and purchasing.

Developing a Health Information Technology Systems Matrix: A Qualitative Participatory Approach

PubMed Central

Chavez, Margeaux; Nazi, Kim M; Antinori, Nicole

2016-01-01

Background The US Department of Veterans Affairs (VA) has developed various health information technology (HIT) resources to provide accessible veteran-centered health care. Currently, the VA is undergoing a major reorganization of VA HIT to develop a fully integrated system to meet consumer needs. Although extensive system documentation exists for various VA HIT systems, a more centralized and integrated perspective with clear documentation is needed in order to support effective analysis, strategy, planning, and use. Such a tool would enable a novel view of what is currently available and support identifying and effectively capturing the consumer’s vision for the future. Objective The objective of this study was to develop the VA HIT Systems Matrix, a novel tool designed to describe the existing VA HIT system and identify consumers’ vision for the future of an integrated VA HIT system. Methods This study utilized an expert panel and veteran informant focus groups with self-administered surveys. The study employed participatory research methods to define the current system and understand how stakeholders and veterans envision the future of VA HIT and interface design (eg, look, feel, and function). Directed content analysis was used to analyze focus group data. Results The HIT Systems Matrix was developed with input from 47 veterans, an informal caregiver, and an expert panel to provide a descriptive inventory of existing and emerging VA HIT in four worksheets: (1) access and function, (2) benefits and barriers, (3) system preferences, and (4) tasks. Within each worksheet is a two-axis inventory. The VA’s existing and emerging HIT platforms (eg, My HealtheVet, Mobile Health, VetLink Kiosks, Telehealth), My HealtheVet features (eg, Blue Button, secure messaging, appointment reminders, prescription refill, vet library, spotlight, vitals tracker), and non-VA platforms (eg, phone/mobile phone, texting, non-VA mobile apps, non-VA mobile electronic devices, non-VA websites) are organized by row. Columns are titled with thematic and functional domains (eg, access, function, benefits, barriers, authentication, delegation, user tasks). Cells for each sheet include descriptions and details that reflect factors relevant to domains and the topic of each worksheet. Conclusions This study provides documentation of the current VA HIT system and efforts for consumers’ vision of an integrated system redesign. The HIT Systems Matrix provides a consumer preference blueprint to inform the current VA HIT system and the vision for future development to integrate electronic resources within VA and beyond with non-VA resources. The data presented in the HIT Systems Matrix are relevant for VA administrators and developers as well as other large health care organizations seeking to document and organize their consumer-facing HIT resources. PMID:27713112

Developing a Health Information Technology Systems Matrix: A Qualitative Participatory Approach.

PubMed

Haun, Jolie N; Chavez, Margeaux; Nazi, Kim M; Antinori, Nicole

2016-10-06

The US Department of Veterans Affairs (VA) has developed various health information technology (HIT) resources to provide accessible veteran-centered health care. Currently, the VA is undergoing a major reorganization of VA HIT to develop a fully integrated system to meet consumer needs. Although extensive system documentation exists for various VA HIT systems, a more centralized and integrated perspective with clear documentation is needed in order to support effective analysis, strategy, planning, and use. Such a tool would enable a novel view of what is currently available and support identifying and effectively capturing the consumer's vision for the future. The objective of this study was to develop the VA HIT Systems Matrix, a novel tool designed to describe the existing VA HIT system and identify consumers' vision for the future of an integrated VA HIT system. This study utilized an expert panel and veteran informant focus groups with self-administered surveys. The study employed participatory research methods to define the current system and understand how stakeholders and veterans envision the future of VA HIT and interface design (eg, look, feel, and function). Directed content analysis was used to analyze focus group data. The HIT Systems Matrix was developed with input from 47 veterans, an informal caregiver, and an expert panel to provide a descriptive inventory of existing and emerging VA HIT in four worksheets: (1) access and function, (2) benefits and barriers, (3) system preferences, and (4) tasks. Within each worksheet is a two-axis inventory. The VA's existing and emerging HIT platforms (eg, My HealtheVet, Mobile Health, VetLink Kiosks, Telehealth), My HealtheVet features (eg, Blue Button, secure messaging, appointment reminders, prescription refill, vet library, spotlight, vitals tracker), and non-VA platforms (eg, phone/mobile phone, texting, non-VA mobile apps, non-VA mobile electronic devices, non-VA websites) are organized by row. Columns are titled with thematic and functional domains (eg, access, function, benefits, barriers, authentication, delegation, user tasks). Cells for each sheet include descriptions and details that reflect factors relevant to domains and the topic of each worksheet. This study provides documentation of the current VA HIT system and efforts for consumers' vision of an integrated system redesign. The HIT Systems Matrix provides a consumer preference blueprint to inform the current VA HIT system and the vision for future development to integrate electronic resources within VA and beyond with non-VA resources. The data presented in the HIT Systems Matrix are relevant for VA administrators and developers as well as other large health care organizations seeking to document and organize their consumer-facing HIT resources.

Guidelines for developing effective health education service in a national health agency.

PubMed

Ochor, J O

1983-01-01

The constraints facing health education include: the fragmentation and dispersal of health-educational services among different agencies and personnel; lack of policy guidelines; ineffectively organized and inefficiently managed health education systems; poor hierarchical status and inadequacy of resources. To resolve these constraints, national health education systems in health agencies should be developed on the basis of stipulated guidelines that could ensure their viability, efficiency and effectiveness. A study at the African Regional Health Education Centre, Ibadan, Nigeria, has yielded thirty synthesized guidelines. The "guidelines" were empirically tested as an evaluation tool by assessing the operational and organizational status of Oyo State Health Education Unit, Ibadan, Nigeria. These guidelines are adaptable to local conditions to enhance the re-organization, re-orientation and consolidation of health education in national health agencies.

Scaling-up health information systems to improve HIV treatment: An assessment of initial patient monitoring systems in Mozambique.

PubMed

Hochgesang, Mindy; Zamudio-Haas, Sophia; Moran, Lissa; Nhampossa, Leopoldo; Packel, Laura; Leslie, Hannah; Richards, Janise; Shade, Starley B

2017-01-01

The rapid scale-up of HIV care and treatment in resource-limited countries requires concurrent, rapid development of health information systems to support quality service delivery. Mozambique, a country with an 11.5% prevalence of HIV, has developed nation-wide patient monitoring systems (PMS) with standardized reporting tools, utilized by all HIV treatment providers in paper or electronic form. Evaluation of the initial implementation of PMS can inform and strengthen future development as the country moves towards a harmonized, sustainable health information system. This assessment was conducted in order to 1) characterize data collection and reporting processes and PMS resources available and 2) provide evidence-based recommendations for harmonization and sustainability of PMS. This baseline assessment of PMS was conducted with eight non-governmental organizations that supported the Ministry of Health to provide 90% of HIV care and treatment in Mozambique. The study team conducted structured and semi-structured surveys at 18 health facilities located in all 11 provinces. Seventy-nine staff were interviewed. Deductive a priori analytic categories guided analysis. Health facilities have implemented paper and electronic monitoring systems with varying success. Where in use, robust electronic PMS facilitate facility-level reporting of required indicators; improve ability to identify patients lost to follow-up; and support facility and patient management. Challenges to implementation of monitoring systems include a lack of national guidelines and norms for patient level HIS, variable system implementation and functionality, and limited human and infrastructure resources to maximize system functionality and information use. This initial assessment supports the need for national guidelines to harmonize, expand, and strengthen HIV-related health information systems. Recommendations may benefit other countries with similar epidemiologic and resource-constrained environments seeking to improve PMS implementation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Human Health and Support Systems Capability Roadmap Progress Review

NASA Technical Reports Server (NTRS)

Grounds, Dennis; Boehm, Al

2005-01-01

The Human Health and Support Systems Capability Roadmap focuses on research and technology development and demonstration required to ensure the health, habitation, safety, and effectiveness of crews in and beyond low Earth orbit. It contains three distinct sub-capabilities: Human Health and Performance. Life Support and Habitats. Extra-Vehicular Activity.

Developing Interdisciplinary Education in Allied Health Programs. Issues and Decisions.

ERIC Educational Resources Information Center

Connelly, Tom, Jr.; Clark, Dan

By definition allied health education operates in a dynamic environment influenced by the diciplines it represents, the educational system in which it resides, and the complexities of the health care delivery system which it serves. Well-designed and implemented interdisciplinary programs would assist allied health administrators in answering the…

Performance-based financing as a health system reform: mapping the key dimensions for monitoring and evaluation.

PubMed

Witter, Sophie; Toonen, Jurrien; Meessen, Bruno; Kagubare, Jean; Fritsche, György; Vaughan, Kelsey

2013-09-29

Performance-based financing is increasingly being applied in a variety of contexts, with the expectation that it can improve the performance of health systems. However, while there is a growing literature on implementation issues and effects on outputs, there has been relatively little focus on interactions between PBF and health systems and how these should be studied. This paper aims to contribute to filling that gap by developing a framework for assessing the interactions between PBF and health systems, focusing on low and middle income countries. In doing so, it elaborates a general framework for monitoring and evaluating health system reforms in general. This paper is based on an exploratory literature review and on the work of a group of academics and PBF practitioners. The group developed ideas for the monitoring and evaluation framework through exchange of emails and working documents. Ideas were further refined through discussion at the Health Systems Research symposium in Beijing in October 2012, through comments from members of the online PBF Community of Practice and Beijing participants, and through discussion with PBF experts in Bergen in June 2013. The paper starts with a discussion of definitions, to clarify the core concept of PBF and how the different terms are used. It then develops a framework for monitoring its interactions with the health system, structured around five domains of context, the development process, design, implementation and effects. Some of the key questions for monitoring and evaluation are highlighted, and a systematic approach to monitoring effects proposed, structured according to the health system pillars, but also according to inputs, processes and outputs. The paper lays out a broad framework within which indicators can be prioritised for monitoring and evaluation of PBF or other health system reforms. It highlights the dynamic linkages between the domains and the different pillars. All of these are also framed within inter-sectoral and wider societal contexts. It highlights the importance of differentiating short term and long term effects, and also effects (intended and unintended) at different levels of the health system, and for different sectors and areas of the country. Outstanding work will include using and refining the framework and agreeing on the most important hypotheses to test using it, in relation to PBF but also other purchasing and provider payment reforms, as well as appropriate research methods to use for this task.

Aligning Education With Health Care Transformation: Identifying a Shared Mental Model of "New" Faculty Competencies for Academic Faculty.

PubMed

Gonzalo, Jed D; Ahluwalia, Amarpreet; Hamilton, Maria; Wolf, Heidi; Wolpaw, Daniel R; Thompson, Britta M

2018-02-01

To develop a potential competency framework for faculty development programs aligned with the needs of faculty in academic health centers (AHCs). In 2014 and 2015, the authors interviewed 23 health system leaders and analyzed transcripts using constant comparative analysis and thematic analysis. They coded competencies and curricular concepts into subcategories. Lead investigators reviewed drafts of the categorization themes and subthemes related to gaps in faculty knowledge and skills, collapsed and combined competency domains, and resolved disagreements via discussion. Through analysis, the authors identified four themes. The first was core functional competencies and curricular domains for conceptual learning, including patient-centered care, health care processes, clinical informatics, population and public health, policy and payment, value-based care, and health system improvement. The second was the need for foundational competency domains, including systems thinking, change agency/management, teaming, and leadership. The third theme was paradigm shifts in how academic faculty should approach health care, categorized into four areas: delivery, transformation, provider characteristics and skills, and education. The fourth theme was the need for faculty to be aware of challenges in the culture of AHCs as an influential context for change. This broad competency framework for faculty development programs expands existing curricula by including a comprehensive scope of health systems science content and skills. AHC leaders can use these results to better align faculty education with the real-time needs of their health systems. Future work should focus on optimal prioritization and methods for teaching.

[Health promotion effectiveness: developing and testing a system for routine evaluation in health education, workplace health promotion and setting approach supplied by the German statutory health insurance agencies].

PubMed

Kliche, T; Riemann, K; Bockermann, C; Niederbühl, K; Wanek, V; Koch, U

2011-04-01

The aim of the study was to develop and test a routine evaluation system for all health promotion and education activities funded by the German statutory health insurance companies. The system aims at measuring both individual health effects and the complex organisational effects of setting projects. Measurement instruments were developed synoptically and tested in three field tests (2003-2008). In order to assess the impact of individual health training, 212 courses of the health insurance companies were evaluated. To assess the setting approach, 56 schools participating in a health-promotion project were included, and for workplace health-promotion 6 projects of different health insurance companies were included. The research design was an observational study. Instead of control groups, individual data were compared to reference values for gender- and age-matched groups from national health surveys. The studies consisted of baseline and final assessment (T1/T2), complemented by a follow-up (T3), all adapted to the time of intervention (i. e., 3-24 months for T1/T2 and 3-18 months for T2/T3). The evaluation system provides multilevel-measurement based upon validated questionnaires for health-related structures and processes in institutions, and for the participating individual's subjective health, health problems, health-related quality of life, workplace and institutional satisfaction. Controlling for central confounders is also possible (input and dosage, age, gender, educational background). Thus, short but valid measurement instruments of high usability are available to evaluate the effectiveness of prevention, health promotion and education. © Georg Thieme Verlag KG Stuttgart · New York.

[THE CRISIS PHENOMENA AND HEALTH].

PubMed

Tishuk, E A

2015-01-01

The analysis was carried out concerning impact of cyclicity of social economic development on population health of the Russian Federation. The conclusions are made related to necessity of determining priorities of development of national system of population health care.

KNOW ESSENTIALS: a tool for informed decisions in the absence of formal HTA systems.

PubMed

Mathew, Joseph L

2011-04-01

Most developing countries and resource-limited settings lack robust health technology assessment (HTA) systems. Because the development of locally relevant HTA is not immediately viable, and the extrapolation of external HTA is inappropriate, a new model for evaluating health technologies is required. The aim of this study was to describe the development and application of KNOW ESSENTIALS, a tool facilitating evidence-based decisions on health technologies by stakeholders in settings lacking formal HTA systems. Current HTA methodology was examined through literature search. Additional issues relevant to resource-limited settings, but not adequately addressed in current methodology, were identified through further literature search, appraisal of contextually relevant issues, discussion with healthcare professionals familiar with the local context, and personal experience. A set of thirteen elements important for evidence-based decisions was identified, selected and combined into a tool with the mnemonic KNOW ESSENTIALS. Detailed definitions for each element, coding for the elements, and a system to evaluate a given health technology using the tool were developed. Developing countries and resource-limited settings face several challenges to informed decision making. Models that are relevant and applicable in high-income countries are unlikely in such settings. KNOW ESSENTIALS is an alternative that facilitates evidence-based decision making by stakeholders without formal expertise in HTA. The tool could be particularly useful, as an interim measure, in healthcare systems that are developing HTA capacity. It could also be useful anywhere when rapid evidence-based decisions on health technologies are required.

Implementing National System of Health Research Ethics Regulations: The Nigerian Experience

PubMed Central

Adebamowo, Clement A.

2013-01-01

Efforts by Nigerian authorities to institutionalize health research dates back to the early 70's with the establishment of the Medical Research Council. Subsequently efforts to strengthen a national health research system in line with the concept of Essential National Health Research (ENHR) were made but albeit un-successfully. This may have been as a result of poor political support, and lack of regulations to promote health research in the country. However little is known about health research regulations and their implementation in Nigeria. Health and health research in Nigeria is not regulated via a set of clearly defined legislation. While the country has developed a regulation document for health research ethics, compliance to this document is likely to be affected by the lack of legislation in for the health system as an entity. In this paper we narrate the developments in health, health research, and health regulations; we describe process for, and extent of implementation of the National Code of Health Research Ethics. We conclude that several factors affect the extent of implementation of the ethics code amongst which legislation is an important one. PMID:24324978

Implementing National System of Health Research Ethics Regulations: The Nigerian Experience.

PubMed

Yakubu, Aminu; Adebamowo, Clement A

2012-01-01

Efforts by Nigerian authorities to institutionalize health research dates back to the early 70's with the establishment of the Medical Research Council. Subsequently efforts to strengthen a national health research system in line with the concept of Essential National Health Research (ENHR) were made but albeit un-successfully. This may have been as a result of poor political support, and lack of regulations to promote health research in the country. However little is known about health research regulations and their implementation in Nigeria. Health and health research in Nigeria is not regulated via a set of clearly defined legislation. While the country has developed a regulation document for health research ethics, compliance to this document is likely to be affected by the lack of legislation in for the health system as an entity. In this paper we narrate the developments in health, health research, and health regulations; we describe process for, and extent of implementation of the National Code of Health Research Ethics. We conclude that several factors affect the extent of implementation of the ethics code amongst which legislation is an important one.

[The health system of Nicaragua].

PubMed

Muiser, Jorine; Sáenz, María del Rocío; Bermúdez, Juan Luis

2011-01-01

This paper describes the health conditions in Nicaragua and discusses the characteristics of its national health system including its structure and coverage, its financial sources its physical, material and human resources the stewardship functions developed by the Ministry of Health the participation of citizens in the operation and evaluation of the system and the level of satisfaction of health care users. It also discusses the most recent policy innovations, including the new General Health Law, the decentralization of the regulation of health facilities and the design and implementation of a new health care model known as Family and Community Health Model.

Leveraging design thinking to build sustainable mobile health systems.

PubMed

Eckman, Molly; Gorski, Irena; Mehta, Khanjan

Mobile health, or mHealth, technology has the potential to improve health care access in the developing world. However, the majority of mHealth projects do not expand beyond the pilot stage. A core reason why is because they do not account for the individual needs and wants of those involved. A collaborative approach is needed to integrate the perspectives of all stakeholders into the design and operation of mHealth endeavours. Design thinking is a methodology used to develop and evaluate novel concepts for systems. With roots in participatory processes and self-determined pathways, design thinking provides a compelling framework to understand and apply the needs of diverse stakeholders to mHealth project development through a highly iterative process. The methodology presented in this article provides a structured approach to apply design thinking principles to assess the feasibility of novel mHealth endeavours during early conceptualisation.

Civil society: the catalyst for ensuring health in the age of sustainable development.

PubMed

Smith, Julia; Buse, Kent; Gordon, Case

2016-07-16

Sustainable Development Goal Three is rightly ambitious, but achieving it will require doing global health differently. Among other things, progressive civil society organisations will need to be recognised and supported as vital partners in achieving the necessary transformations. We argue, using illustrative examples, that a robust civil society can fulfill eight essential global health functions. These include producing compelling moral arguments for action, building coalitions beyond the health sector, introducing novel policy alternatives, enhancing the legitimacy of global health initiatives and institutions, strengthening systems for health, enhancing accountability systems, mitigating the commercial determinants of health and ensuring rights-based approaches. Given that civil society activism has catalyzed tremendous progress in global health, there is a need to invest in and support it as a global public good to ensure that the 2030 Agenda for Sustainable Development can be realised.

Indicators and measurement tools for health system integration: a knowledge synthesis protocol.

PubMed

Oelke, Nelly D; Suter, Esther; da Silva Lima, Maria Alice Dias; Van Vliet-Brown, Cheryl

2015-07-29

Health system integration is a key component of health system reform with the goal of improving outcomes for patients, providers, and the health system. Although health systems continue to strive for better integration, current delivery of health services continues to be fragmented. A key gap in the literature is the lack of information on what successful integration looks like and how to measure achievement towards an integrated system. This multi-site study protocol builds on a prior knowledge synthesis completed by two of the primary investigators which identified 10 key principles that collectively support health system integration. The aim is to answer two research questions: What are appropriate indicators for each of the 10 key integration principles developed in our previous knowledge synthesis and what measurement tools are used to measure these indicators? To enhance generalizability of the findings, a partnership between Canada and Brazil was created as health system integration is a priority in both countries and they share similar contexts. This knowledge synthesis will follow an iterative scoping review process with emerging information from knowledge-user engagement leading to the refinement of research questions and study selection. This paper describes the methods for each phase of the study. Research questions were developed with stakeholder input. Indicator identification and prioritization will utilize a modified Delphi method and patient/user focus groups. Based on priority indicators, a search of the literature will be completed and studies screened for inclusion. Quality appraisal of relevant studies will be completed prior to data extraction. Results will be used to develop recommendations and key messages to be presented through integrated and end-of-grant knowledge translation strategies with researchers and knowledge-users from the three jurisdictions. This project will directly benefit policy and decision-makers by providing an easy accessible set of indicators and tools to measure health system integration across different contexts and cultures. Being able to evaluate the success of integration strategies and initiatives will lead to better health system design and improved health outcomes for patients.

Understanding global health governance as a complex adaptive system.

PubMed

Hill, Peter S

2011-01-01

The transition from international to global health reflects the rapid growth in the numbers and nature of stakeholders in health, as well as the constant change embodied in the process of globalisation itself. This paper argues that global health governance shares the characteristics of complex adaptive systems, with its multiple and diverse players, and their polyvalent and constantly evolving relationships, and rich and dynamic interactions. The sheer quantum of initiatives, the multiple networks through which stakeholders (re)configure their influence, the range of contexts in which development for health is played out - all compound the complexity of this system. This paper maps out the characteristics of complex adaptive systems as they apply to global health governance, linking them to developments in the past two decades, and the multiple responses to these changes. Examining global health governance through the frame of complexity theory offers insight into the current dynamics of governance, and while providing a framework for making meaning of the whole, opens up ways of accessing this complexity through local points of engagement.

Reusable Rocket Engine Advanced Health Management System. Architecture and Technology Evaluation: Summary

NASA Technical Reports Server (NTRS)

Pettit, C. D.; Barkhoudarian, S.; Daumann, A. G., Jr.; Provan, G. M.; ElFattah, Y. M.; Glover, D. E.

1999-01-01

In this study, we proposed an Advanced Health Management System (AHMS) functional architecture and conducted a technology assessment for liquid propellant rocket engine lifecycle health management. The purpose of the AHMS is to improve reusable rocket engine safety and to reduce between-flight maintenance. During the study, past and current reusable rocket engine health management-related projects were reviewed, data structures and health management processes of current rocket engine programs were assessed, and in-depth interviews with rocket engine lifecycle and system experts were conducted. A generic AHMS functional architecture, with primary focus on real-time health monitoring, was developed. Fourteen categories of technology tasks and development needs for implementation of the AHMS were identified, based on the functional architecture and our assessment of current rocket engine programs. Five key technology areas were recommended for immediate development, which (1) would provide immediate benefits to current engine programs, and (2) could be implemented with minimal impact on the current Space Shuttle Main Engine (SSME) and Reusable Launch Vehicle (RLV) engine controllers.

Consensus statement understanding health and malnutrition through a systems approach: the ENOUGH program for early life.

PubMed

Kaput, Jim; van Ommen, Ben; Kremer, Bas; Priami, Corrado; Monteiro, Jacqueline Pontes; Morine, Melissa; Pepping, Fre; Diaz, Zoey; Fenech, Michael; He, Yiwu; Albers, Ruud; Drevon, Christian A; Evelo, Chris T; Hancock, Robert E W; Ijsselmuiden, Carel; Lumey, L H; Minihane, Anne-Marie; Muller, Michael; Murgia, Chiara; Radonjic, Marijana; Sobral, Bruno; West, Keith P

2014-01-01

Nutrition research, like most biomedical disciplines, adopted and often uses experimental approaches based on Beadle and Tatum's one gene-one polypeptide hypothesis, thereby reducing biological processes to single reactions or pathways. Systems thinking is needed to understand the complexity of health and disease processes requiring measurements of physiological processes, as well as environmental and social factors, which may alter the expression of genetic information. Analysis of physiological processes with omics technologies to assess systems' responses has only become available over the past decade and remains costly. Studies of environmental and social conditions known to alter health are often not connected to biomedical research. While these facts are widely accepted, developing and conducting comprehensive research programs for health are often beyond financial and human resources of single research groups. We propose a new research program on essential nutrients for optimal underpinning of growth and health (ENOUGH) that will use systems approaches with more comprehensive measurements and biostatistical analysis of the many biological and environmental factors that influence undernutrition. Creating a knowledge base for nutrition and health is a necessary first step toward developing solutions targeted to different populations in diverse social and physical environments for the two billion undernourished people in developed and developing economies.

Development of a Video Coding Scheme for Analyzing the Usability and Usefulness of Health Information Systems.

PubMed

Kushniruk, Andre W; Borycki, Elizabeth M

2015-01-01

Usability has been identified as a key issue in health informatics. Worldwide numerous projects have been carried out in an attempt to increase and optimize health system usability. Usability testing, involving observing end users interacting with systems, has been widely applied and numerous publications have appeared describing such studies. However, to date, fewer works have been published describing methodological approaches to analyzing the rich data stream that results from usability testing. This includes analysis of video, audio and screen recordings. In this paper we describe our work in the development and application of a coding scheme for analyzing the usability of health information systems. The phases involved in such analyses are described.

Using Systems Thinking to Advance Global Health Engagement in Education and Practice.

PubMed

Phillips, Janet M; Stalter, Ann M

2018-04-01

The integration of global health into nursing practice within complex systems requires a strategic approach. The System-Level Awareness Model (SAM) can be used to guide the process of enhancing systems thinking for global health. The purpose of this article is to explain the SAM and how to use it for integrating systems thinking into nursing education in academic, professional development, and continuing education settings to promote global health across the nursing continuum. Tips are provided on how to teach systems thinking for global health in nursing education and practice, consistent with continuing education national learning competencies for health care professionals. J Contin Educ Nurs. 2018;49(4):154-156. Copyright 2018, SLACK Incorporated.

[Organizational capacity for continuous improvement of health services].

PubMed

Saturno-Hernández, Pedro J; Hernández-Avila, Mauricio; Magaña-Valladares, Laura; Garcia-Saisó, Sebastián; Vertiz-Ramírez, José de Jesús

2015-01-01

While the Mexican health system has achieved significant progress, as reflected in the growing improvement in population health, heterogeneity in the quality of services and its impact on health in different population groups is still a challenge. The costs or poor quality represent about 20 to 40% of the health system's expenditure. We need to develop organizational capacity to implement quality management systems in order to identify, evaluate, prevent and eventually overcome the health system's challenges. A competency-based comprehensive strategy for training human resources is proposed including undergraduate and graduate education as well as continuing education, which will contribute to improve the quality function at the various levels of responsibility in the health system. The proposed strategy responds to the context of the Mexican health system, but it could be adapted to other systems and contexts.

Science-based health innovation in Ghana: health entrepreneurs point the way to a new development path.

PubMed

Al-Bader, Sara; Daar, Abdallah S; Singer, Peter A

2010-12-13

Science, technology and innovation have long played a role in Ghana's vision for development, including in improving its health outcomes. However, so far little research has been conducted on Ghana's capacity for health innovation to address local diseases. This research aims to fill that gap, mapping out the key actors involved, highlighting examples of indigenous innovation, setting out the challenges ahead and outlining recommendations for strengthening Ghana's health innovation system. Case study research methodology was used. Data were collected through reviews of academic literature and policy documents and through open-ended, face-to-face interviews with 48 people from across the science-based health innovation system. Data was collected over three visits to Ghana from February 2007 to August 2008, and stakeholders engaged subsequently. Ghana has strengths which could underpin science-based health innovation in the future, including health and biosciences research institutions with strong foreign linkages and donor support; a relatively strong regulatory system which is building capacity in other West African countries; the beginnings of new funding forms such as venture capital; and the return of professionals from the diaspora, bringing expertise and contacts. Some health products and services are already being developed in Ghana by individual entrepreneurs, which are innovative in the sense of being new to the country and, in some cases, the continent. They include essential medicines, raw pharmaceutical materials, new formulations for pediatric use and plant medicines at various stages of development. While Ghana has many institutions concerned with health research and its commercialization, their ability to work together to address clear health goals is low. If Ghana is to capitalize on its assets, including political and macroeconomic stability which underpin investment in health enterprises, it needs to improve the health innovation environment through increasing support for its small firms; coordinating policies; and beginning a dialogue with donors on how health research can create locally-owned knowledge and be more demand-driven. Mobilizing stakeholders around health product development areas, such as traditional medicines and diagnostics, would help to create trust between groups and build a stronger health innovation system.

Science-based health innovation in Ghana: health entrepreneurs point the way to a new development path

PubMed Central

2010-01-01

Background Science, technology and innovation have long played a role in Ghana’s vision for development, including in improving its health outcomes. However, so far little research has been conducted on Ghana’s capacity for health innovation to address local diseases. This research aims to fill that gap, mapping out the key actors involved, highlighting examples of indigenous innovation, setting out the challenges ahead and outlining recommendations for strengthening Ghana’s health innovation system. Methods Case study research methodology was used. Data were collected through reviews of academic literature and policy documents and through open-ended, face-to-face interviews with 48 people from across the science-based health innovation system. Data was collected over three visits to Ghana from February 2007 to August 2008, and stakeholders engaged subsequently. Results Ghana has strengths which could underpin science-based health innovation in the future, including health and biosciences research institutions with strong foreign linkages and donor support; a relatively strong regulatory system which is building capacity in other West African countries; the beginnings of new funding forms such as venture capital; and the return of professionals from the diaspora, bringing expertise and contacts. Some health products and services are already being developed in Ghana by individual entrepreneurs, which are innovative in the sense of being new to the country and, in some cases, the continent. They include essential medicines, raw pharmaceutical materials, new formulations for pediatric use and plant medicines at various stages of development. Conclusions While Ghana has many institutions concerned with health research and its commercialization, their ability to work together to address clear health goals is low. If Ghana is to capitalize on its assets, including political and macroeconomic stability which underpin investment in health enterprises, it needs to improve the health innovation environment through increasing support for its small firms; coordinating policies; and beginning a dialogue with donors on how health research can create locally-owned knowledge and be more demand-driven. Mobilizing stakeholders around health product development areas, such as traditional medicines and diagnostics, would help to create trust between groups and build a stronger health innovation system. PMID:21144073

SANDS: A Service-Oriented Architecture for Clinical Decision Support in a National Health Information Network

PubMed Central

Wright, Adam; Sittig, Dean F.

2008-01-01

In this paper we describe and evaluate a new distributed architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support), which leverages current health information exchange efforts and is based on the principles of a service-oriented architecture. The architecture allows disparate clinical information systems and clinical decision support systems to be seamlessly integrated over a network according to a set of interfaces and protocols described in this paper. The architecture described is fully defined and developed, and six use cases have been developed and tested using a prototype electronic health record which links to one of the existing prototype National Health Information Networks (NHIN): drug interaction checking, syndromic surveillance, diagnostic decision support, inappropriate prescribing in older adults, information at the point of care and a simple personal health record. Some of these use cases utilize existing decision support systems, which are either commercially or freely available at present, and developed outside of the SANDS project, while other use cases are based on decision support systems developed specifically for the project. Open source code for many of these components is available, and an open source reference parser is also available for comparison and testing of other clinical information systems and clinical decision support systems that wish to implement the SANDS architecture. PMID:18434256

Contemporary specificities of labour in the health care sector: introductory notes for discussion

PubMed Central

Campos, Francisco Eduardo; Albuquerque, Eduardo da Motta e

2005-01-01

Background This paper combines the literature on public health, on economics of health and on economics of technological innovation to discuss the peculiarities of labour in the health care sector. Method and framework The starting point is the investigation of the economic peculiarities of medical care. Results and discussions This investigation leads to the identification of the prevalence of non-market forms of medical care in the countries of the Organisation for Economic Co-operation and Development (OECD). Furthermore, the health care system has a distinctive characteristic from other economic sectors: it is the intersection between social welfare and innovation systems. The relationship between technological innovation and cost in the health care sector is surveyed. Finally, the Brazilian case is discussed as an example of a developing country. Conclusion The peculiarities of labour in the health care sector suggest the need to recognize the worth of sectoral labour and to cease to treat it separately. This process should take into account the rapid development of the health innovation system and one important consequence: the obsolescence of the acquired knowledge. One way to dignify labour is to implement continued education and training of health professions personnel. PMID:16109174

Contemporary specificities of labour in the health care sector: introductory notes for discussion.

PubMed

Campos, Francisco Eduardo; Albuquerque, Eduardo da Motta e

2005-08-18

This paper combines the literature on public health, on economics of health and on economics of technological innovation to discuss the peculiarities of labour in the health care sector. METHOD AND FRAMEWORK: The starting point is the investigation of the economic peculiarities of medical care. This investigation leads to the identification of the prevalence of non-market forms of medical care in the countries of the Organisation for Economic Co-operation and Development (OECD). Furthermore, the health care system has a distinctive characteristic from other economic sectors: it is the intersection between social welfare and innovation systems. The relationship between technological innovation and cost in the health care sector is surveyed. Finally, the Brazilian case is discussed as an example of a developing country. The peculiarities of labour in the health care sector suggest the need to recognize the worth of sectoral labour and to cease to treat it separately. This process should take into account the rapid development of the health innovation system and one important consequence: the obsolescence of the acquired knowledge. One way to dignify labour is to implement continued education and training of health professions personnel.

Development of grid-like applications for public health using Web 2.0 mashup techniques.

PubMed

Scotch, Matthew; Yip, Kevin Y; Cheung, Kei-Hoi

2008-01-01

Development of public health informatics applications often requires the integration of multiple data sources. This process can be challenging due to issues such as different file formats, schemas, naming systems, and having to scrape the content of web pages. A potential solution to these system development challenges is the use of Web 2.0 technologies. In general, Web 2.0 technologies are new internet services that encourage and value information sharing and collaboration among individuals. In this case report, we describe the development and use of Web 2.0 technologies including Yahoo! Pipes within a public health application that integrates animal, human, and temperature data to assess the risk of West Nile Virus (WNV) outbreaks. The results of development and testing suggest that while Web 2.0 applications are reasonable environments for rapid prototyping, they are not mature enough for large-scale public health data applications. The application, in fact a "systems of systems," often failed due to varied timeouts for application response across web sites and services, internal caching errors, and software added to web sites by administrators to manage the load on their servers. In spite of these concerns, the results of this study demonstrate the potential value of grid computing and Web 2.0 approaches in public health informatics.

An integrated approach to preventing cardiovascular disease: community-based approaches, health system initiatives, and public health policy.

PubMed

Karwalajtys, Tina; Kaczorowski, Janusz

2010-01-01

Cardiovascular disease (CVD) is largely the product of interactions among modifiable risk factors that are common in developed nations and increasingly of concern in developing countries. Hypertension is an important precursor to the development of CVD, and although detection and treatment rates have improved in recent years in some jurisdictions, effective strategies and policies supporting a shift in distribution of risk factors at the population level remain paramount. Challenges in managing cardiovascular health more effectively include factors at the patient, provider, and system level. Strategies to reduce hypertension and CVD should be population based, incorporate multilevel, multicomponent, and socioenvironmental approaches, and integrate community resources with public health and clinical care. There is an urgent need to improve monitoring and management of risk factors through community-wide, primary care-linked initiatives, increase the evidence base for community-based prevention strategies, further develop and evaluate promising program components, and develop new approaches to support healthy lifestyle behaviors in diverse age, socioeconomic, and ethnocultural groups. Policy and system changes are critical to reduce risk in populations, including legislation and public education to reduce dietary sodium and trans-fatty acids, food pricing policies, and changes to health care delivery systems to explicitly support prevention and management of CVD.

Early colonial health developments in Mauritius.

PubMed

Parahoo, K A

1986-01-01

The historical development of Mauritius and in particular the early developments in health care are crucial to an understanding of the contemporary health system. The introduction of major epidemic diseases through the movements of French soldiers to and from India and the immigration of indentured laborers from India account for the high mortality and morbidity rates in the 18th and 19th centuries and later. The colonial economy created and fortified the dependence on a single cash crop and on imported food. It also contributed toward the impoverization of large sections of the Mauritian population. The colonial era is also responsible for initiating a three tier system of health care.

General Purpose Data-Driven Online System Health Monitoring with Applications to Space Operations

NASA Technical Reports Server (NTRS)

Iverson, David L.; Spirkovska, Lilly; Schwabacher, Mark

2010-01-01

Modern space transportation and ground support system designs are becoming increasingly sophisticated and complex. Determining the health state of these systems using traditional parameter limit checking, or model-based or rule-based methods is becoming more difficult as the number of sensors and component interactions grows. Data-driven monitoring techniques have been developed to address these issues by analyzing system operations data to automatically characterize normal system behavior. System health can be monitored by comparing real-time operating data with these nominal characterizations, providing detection of anomalous data signatures indicative of system faults, failures, or precursors of significant failures. The Inductive Monitoring System (IMS) is a general purpose, data-driven system health monitoring software tool that has been successfully applied to several aerospace applications and is under evaluation for anomaly detection in vehicle and ground equipment for next generation launch systems. After an introduction to IMS application development, we discuss these NASA online monitoring applications, including the integration of IMS with complementary model-based and rule-based methods. Although the examples presented in this paper are from space operations applications, IMS is a general-purpose health-monitoring tool that is also applicable to power generation and transmission system monitoring.

Web-Based Cancer Communication and Decision Making Systems: Connecting Patients, Caregivers, and Clinicians for Improved Health Outcomes

PubMed Central

DuBenske, Lori L.; Gustafson, David H.; Shaw, Bret R.; Cleary, James F.

2011-01-01

Over the cancer disease trajectory, from diagnosis and treatment to remission or end of life, patients and their families face difficult decisions. The provision of information and support when most relevant can optimize cancer decision making and coping. An interactive health communication system (IHCS) offers the potential to bridge the communication gaps that occur among patients, family, and clinicians and to empower each to actively engage in cancer care and shared decision making. This is a report of the authors' experience (with a discussion of relevant literature) in developing and testing a Web-based IHCS—the Comprehensive Health Enhancement Support System (CHESS)—for patients with advanced lung cancer and their family caregivers. CHESS provides information, communication, and coaching resources as well as a symptom tracking system that reports health status to the clinical team. Development of an IHCS includes a needs assessment of the target audience and applied theory informed by continued stakeholder involvement in early testing. Critical issues of IHCS implementation include 1) need for interventions that accommodate a variety of format preferences and technology comfort ranges; 2) IHCS user training, 3) clinician investment in IHCS promotion, and 4) IHCS integration with existing medical systems. In creating such comprehensive systems, development strategies need to be grounded in population needs with appropriate use of technology that serves the target users, including the patient/family, clinical team, and health care organization. Implementation strategies should address timing, personnel, and environmental factors to facilitate continued use and benefit from IHCS. An interactive health communication system (IHCS) offers one platform for providing the information, communication, and coaching resources that cancer patients and their families need to understand the disease, find support, and develop decision-making and coping skills. One such IHCS—the Comprehensive Health Enhancement Support System (CHESS)—has evolved over the past 20 years. Based on our recent experience creating and testing a new version of CHESS—“Coping with Lung Cancer: A Network of Support”—this article outlines the issues faced in developing and implementing such a system within the cancer context. PMID:21041539

The role of strategic health planning processes in the development of health care reform policies: a comparative study of Eritrea, Mozambique and Zimbabwe.

PubMed

Green, Andrew; Collins, Charles; Stefanini, Angelo; Ferrinho, Paulo; Chapman, Glyn; Hagos, Besrat; Adams, Yussuf; Omar, Mayeh

2007-01-01

This paper reports on comparative analysis of health planning and its relationship with health care reform in three countries, Eritrea, Mozambique and Zimbabwe. The research examined strategic planning in each country focusing in particular on its role in developing health sector reforms. The paper analyses the processes for strategic planning, the values that underpin the planning systems, and issues related to resources for planning processes. The resultant content of strategic plans is assessed and not seen to have driven the development of reforms; whilst each country had adopted strategic planning systems, in all three countries a more complex interplay of forces, including influences outside both the health sector and the country, had been critical forces behind the sectoral changes experienced over the previous decade. The key roles of different actors in developing the plans and reforms are also assessed. The paper concludes that a number of different conceptions of strategic planning exist and will depend on the particular context within which the health system is placed. Whilst similarities were discovered between strategic planning systems in the three countries, there are also key differences in terms of formality, timeframes, structures and degrees of inclusiveness. No clear leadership role for strategic planning in terms of health sector reforms was discovered. Planning appears in the three countries to be more operational than strategic. Copyright (c) 2006 John Wiley & Sons, Ltd.

Implementation of a Socio-Ecological System Navigation Approach to Human Development in Sub-Saharan African Communities

PubMed Central

Gilioli, Gianni; Caroli, Anna Maria; Tikubet, Getachew; Herren, Hans R.; Baumgärtner, Johann

2014-01-01

This paper presents a framework for the development of socio-ecological systems towards enhanced sustainability. Emphasis is given to the dynamic properties of complex, adaptive social-ecological systems, their structure and to the fundamental role of agriculture. The tangible components that meet the needs of specific projects executed in Kenya and Ethiopia encompass project objectives, innovation, facilitation, continuous recording and analyses of monitoring data, that allow adaptive management and system navigation. Two case studies deal with system navigation through the mitigation of key constraints; they aim to improve human health thanks to anopheline malaria vectors control in Nyabondo (Kenya), and to improve cattle health through tsetse control and antitrypanosomal drug administration to cattle in Luke (Ethiopia). The second case deals with a socio-ecological navigation system to enhance sustainability, establishing a periurban diversified enterprise in Addis Ababa (Ethiopia) and developing a rural sustainable social-ecological system in Luke (Ethiopia). The project procedures are briefly described here and their outcomes are analysed in relation to the stated objectives. The methodology for human and cattle disease vector control were easier to implement than the navigation of social-ecological systems towards sustainability enhancement. The achievements considerably differed between key constraints removal and sustainability enhancement projects. Some recommendations are made to rationalise human and cattle health improvement efforts and to smoothen the road towards enhanced sustainability: i) technology system implementation should be carried out through an innovation system; ii) transparent monitoring information should be continuously acquired and evaluated for assessing the state of the system in relation to stated objectives for (a) improving the insight into the systems behaviour and (b) rationalizing decision support; iii) the different views of all stakeholders should be reconciled in a pragmatic approach to social-ecological system management. Significance for public health Recently, there is a growing interest in studying the link between human, animal and environmental health. The connection between these different dimensions is particularly important for developing countries in which people face the challenge of escaping vicious cycle of high diseases prevalence, food insecurity driven by absolute poverty and population growth, and natural capital as a poverty trap. The design and implementation of such efforts, aiming at human health improvement and poverty alleviation, should be framed into adaptive social-ecological system management perspectives. In this paper, we present few case studies dealing with human health improvement through anopheline malaria vectors control in Kenya, cattle health improvement through tsetse vectored nagana control, antitrypanosomal drug administration to cattle in Ethiopia and with the development of rural sustainable communities in Ethiopia. Some recommendations are given to rationalise human and cattle health improvement efforts and to smoothen the road towards enhanced sustainability. PMID:25170511

Implementation of a socio-ecological system navigation approach to human development in sub-saharan african communities.

PubMed

Gilioli, Gianni; Caroli, Anna Maria; Tikubet, Getachew; Herren, Hans R; Baumgärtner, Johann

2014-03-26

This paper presents a framework for the development of socio-ecological systems towards enhanced sustainability. Emphasis is given to the dynamic properties of complex, adaptive social-ecological systems, their structure and to the fundamental role of agriculture. The tangible components that meet the needs of specific projects executed in Kenya and Ethiopia encompass project objectives, innovation, facilitation, continuous recording and analyses of monitoring data, that allow adaptive management and system navigation. Two case studies deal with system navigation through the mitigation of key constraints; they aim to improve human health thanks to anopheline malaria vectors control in Nyabondo (Kenya), and to improve cattle health through tsetse control and antitrypanosomal drug administration to cattle in Luke (Ethiopia). The second case deals with a socio-ecological navigation system to enhance sustainability, establishing a periurban diversified enterprise in Addis Ababa (Ethiopia) and developing a rural sustainable social-ecological system in Luke (Ethiopia). The project procedures are briefly described here and their outcomes are analysed in relation to the stated objectives. The methodology for human and cattle disease vector control were easier to implement than the navigation of social-ecological systems towards sustainability enhancement. The achievements considerably differed between key constraints removal and sustainability enhancement projects. Some recommendations are made to rationalise human and cattle health improvement efforts and to smoothen the road towards enhanced sustainability: i) technology system implementation should be carried out through an innovation system; ii) transparent monitoring information should be continuously acquired and evaluated for assessing the state of the system in relation to stated objectives for (a) improving the insight into the systems behaviour and (b) rationalizing decision support; iii) the different views of all stakeholders should be reconciled in a pragmatic approach to social-ecological system management. Significance for public healthRecently, there is a growing interest in studying the link between human, animal and environmental health. The connection between these different dimensions is particularly important for developing countries in which people face the challenge of escaping vicious cycle of high diseases prevalence, food insecurity driven by absolute poverty and population growth, and natural capital as a poverty trap. The design and implementation of such efforts, aiming at human health improvement and poverty alleviation, should be framed into adaptive social-ecological system management perspectives. In this paper, we present few case studies dealing with human health improvement through anopheline malaria vectors control in Kenya, cattle health improvement through tsetse vectored nagana control, antitrypanosomal drug administration to cattle in Ethiopia and with the development of rural sustainable communities in Ethiopia. Some recommendations are given to rationalise human and cattle health improvement efforts and to smoothen the road towards enhanced sustainability.

Towards a sustainable livestock production in developing countries and the importance of animal health strategy therein.

PubMed

Kaasschieter, G A; de Jong, R; Schiere, J B; Zwart, D

1992-04-01

Livestock and animal health development projects have not always led to substantial increases in animal productivity or in farmers' welfare. Some have even resulted in unsustainable systems, when they were not based on an understanding of (livestock) production systems. The multipurpose functions of livestock and complex relationships between the biological, technical and social components require a systems approach, whereby nutrition, animal health, breeding, biotechnology knowhow, inputs and technologies are used to optimise resource use. The challenge for developed and developing countries is to reverse the current degradation of the environment, and arrive at sustainable increases in crop and livestock production to secure present and future food supplies. For rural development, governments should show long term commitment and political will to support the rural population in development programmes, because smallholders (including women and landless livestock keepers) represent a large labour force in developing countries. Different systems need different approaches. Pastoral systems must focus on effective management of grazing pressure of the rangelands. Communal rangelands management involves not only the development and application of technologies (e.g. feedlots, vaccination campaigns), but also land tenure policies, institutional development, economic return and a reduction in the number of people depending upon livestock. Smallholder mixed farms must aim at intensification of the total production system, in which external inputs are indispensable, but with the emphasis on optimum input-output relationships by reducing resource losses due to poor management. Resource-poor farming systems must aim at the improved management of the various livestock species in backyards and very small farms, and proper packages for cattle, buffaloes, sheep, goats, rabbits and poultry should be developed. Specialised commercial livestock farming systems (poultry, pigs, dairy or meat) can only be sustainable with adequate marketing, supply of quality feed, veterinary services, labour, management and control of pollution. Animal health programmes play a keyrole in the proposed system approach.

Becoming customer-driven: one health system's story.

PubMed

Bagnell, A

1998-01-01

Market research was done by Crozer-Keystone Health System to better understand the new health care consumer. The information will assist in developing, promoting, and delivering products and services of maximum value to current and prospective consumers. The system is responding by bundling and delivering products and services around consumer-based dimensions, developing new and better ways to improve customer convenience, access, and service. Operationalizing these initiatives for change involves building an information infrastructure of extensive content and customer databases, using new technologies to customize communications and ultimately service components.

[Primary health care: challenges for implementation in Latin America].

PubMed

Giraldo Osorio, Alexandra; Vélez Álvarez, Consuelo

2013-01-01

A development process, marked by the re-appearance of the primary health care as the core of health systems, has emerged in Latin America. Governments have made a commitment to renew this strategy as the basis of their health systems. However, these health systems are mainly faced with re-introducing equity values, and there are common challenges such as providing the health systems with trained human resources in sufficient numbers, overcoming the fragmentation/segmentation of the systems, ensuring financial sustainability, improving governance, quality of care and information systems, expanding coverage, preparing to face the consequences of an aging population, the changing epidemiological profile, and increase in the response capacity of the public health system. This article is intended to provide a comprehensive view of the progress and challenges of the inclusion of primary care health systems in Latin American countries. Copyright © 2012 Elsevier España, S.L. All rights reserved.

[The health system of Guatemala].

PubMed

Becerril-Montekio, Víctor; López-Dávila, Luis

2011-01-01

This paper describes the health conditions in Guatemala and, in more detail, the characteristics of the Guatemalan health system, including its structure en coverage, its financial sources, the stewardship functions developed by the Ministry of Health, as well as the generation of health information and the development of research activities. It also discusses the recent efforts to extend coverage of essential health services, mostly to poor rural areas.The most recent innovations also discussed in this paper include the Program for the Expansion of Coverage of Essential Services, the Program to Expand Access to Essential Drugs and the agreements between the Ministry of Health and several non-governmental organizations to provide essential services in rural settings.

Informing evidence-based policies for ageing and health in Ghana

PubMed Central

Byles, Julie; Aquah, Charles; Amofah, George; Biritwum, Richard; Panisset, Ulysses; Goodwin, James; Beard, John

2015-01-01

Abstract Problem Ghana’s population is ageing. In 2011, the Government of Ghana requested technical support from the World Health Organization (WHO) to help revise national policies on ageing and health. Approach We applied WHO’s knowledge translation framework on ageing and health to assist evidence based policy-making in Ghana. First, we defined priority problems and health system responses by performing a country assessment of epidemiologic data, policy review, site visits and interviews of key informants. Second, we gathered evidence on effective health systems interventions in low- middle- and high-income countries. Third, key stakeholders were engaged in a policy dialogue. Fourth, policy briefs were developed and presented to the Ghana Health Services. Local setting Ghana has a well-structured health system that can adapt to meet the health care needs of older people. Relevant changes Six problems were selected as priorities, however after the policy dialogue, only five were agreed as priorities by the stakeholders. The key stakeholders drafted evidence-based policy recommendations that were used to develop policy briefs. The briefs were presented to the Ghana Health Service in 2014. Lessons learnt The framework can be used to build local capacity on evidence-informed policy-making. However, knowledge translation tools need further development to be used in low-income countries and in the field of ageing. The terms and language of the tools need to be adapted to local contexts. Evidence for health system interventions on ageing populations is very limited, particularly for low- and middle-income settings. PMID:25558107

Purchasing population health: aligning financial incentives to improve health outcomes.

PubMed

Kindig, D A

1999-01-01

To review the concept of population health, including its definition, measurement, and determinants, and to suggest an approach for aligning financial incentives toward this goal. DATA SOURCE, STUDY DESIGN, DATA EXTRACTION: Literature review, policy analysis The article presents the argument that a major reason for our slow progress toward health outcome improvement is that there is no operational definition of population health and that financial incentives are not aligned to this goal. Current attempts at process measures as indicators of quality or outcome are not adequate for the task. It is suggested that some measure of health-adjusted life expectancy be adopted for this purpose, and that integrated delivery systems and other agents responsible for nonmedical determinants be rewarded for improvement in this measure. This will require the development of an investment portfolio across the determinants of health based on relative marginal return to health, with horizontal integration strategies across sectoral boundaries. A 20-year three-phase development strategy is proposed, including components of research and acceptance, integrated health system implementation, and cross-sectoral integration. The U.S. health care system is a $1 trillion industry without a definition of its product. Until population outcome measures are developed and rewarded for, we will not solve the twenty-first century challenge of maximizing health outcome improvement for the resources available.

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.

Creating a new investment pool for innovative health systems research.

PubMed

Laba, Tracey-Lea; Patel, Anushka; Jan, Stephen

2017-05-01

Recent trends in health research funding towards 'safe bets' is discouraging investment into the development of health systems interventions and choking off a vital area of policy-relevant research. This paper argues that to encourage investment into innovative and perceivably riskier health systems research, researchers need to create more attractive business cases by exploring alternative approaches to the design and evaluation of health system interventions. At the same time, the creation of dedicated funding opportunities to support this work, as well as for relevant early career researchers, is needed.

Leadership Development among a Cohort of Undergraduate Interdisciplinary Students in the Health Professions

ERIC Educational Resources Information Center

McKinney, Nicole S.; Waite, Roberta

2016-01-01

Leadership content and pedagogical strategies are fundamental to health professionals' education. All health professionals must be able to lead effectively and thrive in today's complex health systems. Students must be involved in meaningful didactic and experiential leadership development early in their academic progression, and educators are…

'Including health in systems responsible for urban planning': a realist policy analysis research programme.

PubMed

Harris, Patrick; Friel, Sharon; Wilson, Andrew

2015-07-23

Realist methods are increasingly being used to investigate complex public health problems. Despite the extensive evidence base clarifying the built environment as a determinant of health, there is limited knowledge about how and why land-use planning systems take on health concerns. Further, the body of research related to the wider determinants of health suffers from not using political science knowledge to understand how to influence health policy development and systems. This 4-year funded programme of research investigates how the land-use planning system in New South Wales, Australia, incorporates health and health equity at multiple levels. The programme uses multiple qualitative methods to develop up to 15 case studies of different activities of the New South Wales land-use planning system. Comparison cases from other jurisdictions will be included where possible and useful. Data collection includes publicly available documentation and purposively sampled stakeholder interviews and focus groups of up to 100 participants across the cases. The units of analysis in each case are institutional structures (rules and mandates constraining and enabling actors), actors (the stakeholders, organisations and networks involved, including health-focused agencies), and ideas (policy content, information, and framing). Data analysis will focus on and develop propositions concerning the mechanisms and conditions within and across each case leading to inclusion or non-inclusion of health. Data will be refined using additional political science and sociological theory. Qualitative comparative analysis will compare cases to develop policy-relevant propositions about the necessary and sufficient conditions needed to include health issues. Ethics has been approved by Sydney University Human Research Ethics Committee (2014/802 and 2015/178). Given the nature of this research we will incorporate stakeholders, often as collaborators, throughout. We outline our research translation strategies following best practice approaches. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Ubiquitous Health in Korea: Progress, Barriers, and Prospects

PubMed Central

Lee, Yountae

2012-01-01

Objectives Korea has one of the most advanced information technology (IT) infrastructures in the world, and the application of IT in health systems is rapidly progressing from computerization to information systems, ubiquitous systems, and smart systems. This study aims to analyze Korean environments in regards to the development of their u-Health industry and propose directions for u-Healthcare services based on this analysis. Methods This paper reviews the background, progress history, and current status of u-Health in Korea, and suggests strategies for the u-Health industry based on an analysis of its barriers and obstacles. Results When u-Health was introduced to Koreans, their policies and approaches focused mainly on environmental factors, yet these efforts have not progressed further to impact the u-Healthcare service industry itself. To develop the u-Healthcare industry, four points need to be considered: the development and support of the practical service model, institutional support, support of core technology and industry, and the institutionalization of health management service. Conclusions Korea is at a strategic point to start building u-Healthcare service delivery models. u-Healthcare is a healthcare service that provides added value through u-Health environments. By identifying critical success factors in u-Healthcare, we can strengthen the u-Health industry and implement policies to coordinate our efforts in the process of value chains to which we belong. PMID:23346474

Globalization of psychiatry - a barrier to mental health development.

PubMed

Fernando, Suman

2014-10-01

The concept of globalization has been applied recently to ways in which mental health may be developed in low- and middle-income countries (LMICs), sometimes referred to as the 'Third World' or developing countries. This paper (1) describes the roots of psychiatry in western culture and its current domination by pharmacological therapies; (2) considers the history of mental health in LMICs, focusing on many being essentially non-western in cultural background with a tradition of using a plurality of systems of care and help for mental health problems, including religious and indigenous systems of medicine; and (3) concludes that in a post-colonial world, mental health development in LMICs should not be left to market forces, which are inevitably manipulated by the interests of multinational corporations mostly located in ex-colonizing countries, especially the pharmaceutical companies.

Developing effective policy and practice for health promotion in Scotland.

PubMed

Wimbush, Erica; Young, Ian; Robertson, Graham

2007-01-01

Scotland has recently embarked on a new phase of policy and infrastructure development for improving population health and reducing health inequalities that broadly conforms to the Ottawa Charter and WHO's strategic framework for the prevention and control of non-communicable diseases. The new phase is characterised by an integrated, cross-government approach to improving health with strengthened political and Scottish Executive leadership and investment since devolution. A comprehensive policy framework for improving young people's health and reducing inequalities has been developed across education, health, environment and social justice. It builds on an earlier phase of relative stability and continuity in the health promotion infrastructure with policy focused on CVD and cancer prevention and tackling the behavioural risk factors (smoking, alcohol, diet, physical activity) as well as sexual health and mental health and wellbeing. These national strategies are currently being implemented across Scotland. They combine promotion, prevention, treatment and protection goals and target both population-level and high-risk groups. Crosscutting government objectives and headline targets for addressing poverty, disadvantage and health inequalities now supplement the NHS health improvement targets on smoking, alcohol, physical activity, teenage pregnancy and child immunization. Within the health service, prevention efforts are largely concerned with primary care development (anticipatory care) and health system reform to maximize their impact on reducing health inequalities. Efforts to tackle the social determinants of health and reduce inequalities in health outcomes are beginning to be connected and mainstreamed across local government with Community Planning Partnerships as the main vehicle. National level mechanisms for integrated funding, planning and performance reporting to deliver shared priority outcomes have yet to be developed. The development of health improvement strategies has been founded upon a rich source of population health data to monitor changes and improvements, epidemiological studies and evaluation work. The key issues have been to find ways of intervening to accelerate the rate of improvement and to stem the growing health inequalities. A further challenge is to ensure that the lessons from reviews and evaluations of past programmes and strategies are not lost, but help to guide improvements in the complex delivery system and to inform future policy direction. Within the health service, prevention efforts are largely concerned with primary care development and health system reform. Efforts to reduce inequalities in health outcomes are beginning to be connected and mainstreamed across local government.

Towards Requirements in Systems Engineering for Aerospace IVHM Design

NASA Technical Reports Server (NTRS)

Saxena, Abhinav; Roychoudhury, Indranil; Lin, Wei; Goebel, Kai

2013-01-01

Health management (HM) technologies have been employed for safety critical system for decades, but a coherent systematic process to integrate HM into the system design is not yet clear. Consequently, in most cases, health management resorts to be an after-thought or 'band-aid' solution. Moreover, limited guidance exists for carrying out systems engineering (SE) on the subject of writing requirements for designs with integrated vehicle health management (IVHM). It is well accepted that requirements are key to developing a successful IVHM system right from the concept stage to development, verification, utilization, and support. However, writing requirements for systems with IVHM capability have unique challenges that require the designers to look beyond their own domains and consider the constraints and specifications of other interlinked systems. In this paper we look at various stages in the SE process and identify activities specific to IVHM design and development. More importantly, several relevant questions are posed that system engineers must address at various design and development stages. Addressing these questions should provide some guidance to systems engineers towards writing IVHM related requirements to ensure that appropriate IVHM functions are built into the system design.

What is clinical leadership…and why is it important?

PubMed

Swanwick, Tim; McKimm, Judy

2011-03-01

The 'invitation' for clinicians to participate in leadership practices, previously considered the province of the professional health service manager, is driven by a number of international policy and professional agendas. This article, the first in a short series, considers definitions and theories of clinical leadership and management, and explores leadership roles and responsibilities of the clinician in terms of levels of engagement. Recent developments in the UK's National Health Service (NHS), the largest health care organisation in the world, are used as illustrations of how theory has informed clinical leadership development. Narrative review and discussion. The tensions arising from the situation of health care professionals within managed health care are described. Leadership is defined alongside its relationship to management. Key theories of leadership are considered and applications of theory to practice explored. The role and usefulness of the 'competency framework' in leadership development is debated. Health care is delivered by complex systems often involving large numbers of individuals and organisations. The effective clinician needs to understand these pathways and systems of care if they are to be able to function effectively, and must be comfortable working both within, and with, these systems for the benefit of their patients. Engaging in leading and managing systems of health care, on whatever scale - team, department, unit, hospital or health authority - is therefore a professional obligation of all clinicians. Just as leadership is argued to be necessary 'at all levels', so 'leadership development', assessment and feedback must be provided throughout the education and training of health professionals. © Blackwell Publishing Ltd 2011.

Delivery of health services in Arab countries: a review.

PubMed

Kronfol, N M

2012-12-01

This paper reviews the essential components of health care delivery systems in Arab countries and their development over the past 3 decades. The changes and challenges which evolved during the last half of the 20th century have had a significant impact on health systems and on health outcomes. An adequate network of hospitals and primary health care facilities has been established in most Arab countries of the Region. The increased participation of civil society has impacted positively on health systems. However, the main challenge is represented by the move towards market economies. In many developing economies, macroeconomic reforms have often necessitated cuts in public spending on social sectors. Cost-sharing policies have been implemented in order to compensate for diminishing government budgets allocated to health. However, this is not to minimize the enormous strides that have been made in all countries nor the important challenges that need to be addressed.

Description of a research-based health activism curriculum for medical students.

PubMed

Cha, Stephen S; Ross, Joseph S; Lurie, Peter; Sacajiu, Galit

2006-12-01

Few curricula train medical students to engage in health system reform. To develop physician activists by teaching medical students the skills necessary to advocate for socially equitable health policies in the U.S. health system. Montefiore Medical Center, the University Hospital of the Albert Einstein College of Medicine, Bronx, NY. We designed a 1-month curriculum in research-based health activism to develop physician activists. The annual curriculum includes a student project and 4 course sections;health policy, research methods, advocacy, and physician activists as role models; taught by core faculty and volunteers from academic institutions, government, and nongovernmental organizations. From 2002 to 2005, 47 students from across the country have participated. Students reported improved capabilities to generate a research question, design a research proposal,and create an advocacy plan. Our curriculum demonstrates a model for training physician activists to engage in health systems reform.

Building Responsive Health Systems to Help Communities Affected by Migration: An International Delphi Consensus

PubMed Central

Pottie, Kevin; Hui, Charles; Rahman, Prinon; Ingleby, David; Akl, Elie A.; Russell, Grant; Ling, Li; Wickramage, Kolitha; Mosca, Davide; Brindis, Claire D.

2017-01-01

Persons affected by migration require health systems that are responsive and adaptable to the needs of both disadvantaged migrants and non-migrant populations. The objective of this study is to support health systems for populations affected by migration. Materials and Methods: An international Delphi consensus process was used to identify policy approaches to improve health systems for populations affected by migration. Participants were leading migrant health experts from Americas, Europe, Middle East, Asia, and Australasia. We calculated average ranking scores and qualitatively analyzed open-ended questions. Results: Participants identified the following key areas as priorities for policy development: health inequities, system discrimination, migrant related health data, disadvantaged migrant sub-groups, and considerations for disadvantaged non-migrant populations. Highly ranked items to improve health systems were: Health Equity Impact Assessment, evidence based guidelines, and the International Organization for Migration annual reports. Discussion: Policy makers need tools, data and resources to address health systems challenges. Policies need to avoid preventable deaths of migrants and barriers to basic health services. PMID:28165380

The educational needs of health information managers in an electronic environment: what information technology and health informatics skills and knowledge are required?

PubMed

Robertson, Merryn; Callen, Joanne

The profile of health information managers (HIMs) employed within one metropolitan area health service in New South Wales (NSW) was identified, together with which information technology and health informatics knowledge and skills they possess, and which ones they require in their workplace. The subjects worked in a variety of roles: 26% were employed in the area's Information Systems Division developing and implementing point-of-care clinical systems. Health information managers perceived they needed further continuing and formal education in point-of-care clinical systems, decision support systems, the electronic health record, privacy and security, health data collections, and database applications.

Quality improvement and emerging global health priorities

PubMed Central

Mensah Abrampah, Nana; Syed, Shamsuzzoha Babar; Hirschhorn, Lisa R; Nambiar, Bejoy; Iqbal, Usman; Garcia-Elorrio, Ezequiel; Chattu, Vijay Kumar; Devnani, Mahesh; Kelley, Edward

2018-01-01

Abstract Quality improvement approaches can strengthen action on a range of global health priorities. Quality improvement efforts are uniquely placed to reorient care delivery systems towards integrated people-centred health services and strengthen health systems to achieve Universal Health Coverage (UHC). This article makes the case for addressing shortfalls of previous agendas by articulating the critical role of quality improvement in the Sustainable Development Goal era. Quality improvement can stimulate convergence between health security and health systems; address global health security priorities through participatory quality improvement approaches; and improve health outcomes at all levels of the health system. Entry points for action include the linkage with antimicrobial resistance and the contentious issue of the health of migrants. The work required includes focussed attention on the continuum of national quality policy formulation, implementation and learning; alongside strengthening the measurement-improvement linkage. Quality improvement plays a key role in strengthening health systems to achieve UHC. PMID:29873793

M-HELP: a miniaturized total health examination system launched on a mobile phone platform.

PubMed

Yu, Yang; Li, Jingjing; Liu, Jing

2013-11-01

A timely health examination is of great significance for incipient disease detection and prevention. However, conventional examinations generally rely heavily on bulky and expensive instrumentation, which is not easily available. To address technical barriers, an innovative, highly miniaturized, and integrated health examination system-Mobile Health Examination Launched on the Phone (M-HELP)-was developed. Based on the design of a multifunctional Android® (Google, Mountain View, CA) application and the development of different wireless biomedical sensor modules, a mobile phone was incorporated into a central terminal for personal health examination. More than 12 parameters, including electrocardiogram, heart sound, and eye test, as well as others, covered the majority of the crucial parameters in a total health examination and have been successfully established and incorporated into the system. Unlike the conventional examination, the M-HELP system could generate electronic health records and send them to physicians via e-mails or multimedia messages. This significantly simplifies the general health examination with much lower cost and fewer temporal and spatial restrictions. For proof of concept, a bench-scale test recruiting 11 volunteer subjects showed that the average time spent on a total health examination with M-HELP system was about 28 min. This article clarifies the basic concept of a total health examination on the platform of a mobile phone, demonstrates the basic features of the M-HELP system with group tests, and suggests the practical future application of the new system and the scientific issues thus raised.

Health System Development and Performance in Korea and Japan: A Comparative Study of 2000–2013

PubMed Central

Dronina, Yuliya; Yoon, Young Min; Sakamaki, Hiroyuki; Nam, Eun Woo

2016-01-01

Background The Japanese and Korean healthcare systems are very similar and thus, they have the same problems and weaknesses. This study discusses the problems and proposes complementary solutions based on the results of a comparative analysis of conditions in the healthcare systems of the two countries. Methods This article presents a comparative analysis of the healthcare status of the two countries based on certain health criteria used worldwide, a literature review, and data from the Korean Ministry of Health and Welfare, Japanese Ministry of Health, Labour and Welfare, World Health Organization (WHO), World Bank, and Organization for Economic Cooperation and Development (OECD). Results The scores of the healthcare systems were calculated for quantitative comparison. The performance of the Japanese health system was the best, followed by the Korean health system. Both countries observed an increased life expectancy and decreased infant and under-five mortality rates during the last 14 years. However, lower fertility rates were found, which could lead to a decreased working population and a subsequent increase in the economic burden of governments and households. A higher alcohol consumption rate was found in Korea, which was related to the establishment of interpersonal relationships. Conclusion The reform of the healthcare systems in Korea and Japan led to an increased life expectancy; concurrently, reduced fertility rates led to an increasing aging population. As a result, increasing health costs require additional measures to improve health equity and strengthen health promotion. PMID:27358836

Importance of public participation in decision-making process in healthcare system illustarted with an example of the development of American and Polish scope of health benefit basket.

PubMed

Kolasa, Katarzyna; Hermanowski, Tomasz; Borek, Ewa

2013-01-01

The process of the development of health benefit basket may serve as a good example of decision-making process in the healthcare system which is based on public participation. Comparative analysis of development and implementation of health benefit basket in Poland and the USA. On a basis of the literature review, following questions were studied, i.e.: What is the origin of health benefit basket development in the USA and Poland? What was the role of pubic opinion in determining the range of health benefit basket in both countries? What criteria were employed to determine the range of health benefit basket in both countries? What conclusions can be drawn for Poland from the USA experience of determining the range of health benefit basket? Irrespective of the similarities in the origin of health benefit basket development, both countries approached this issue differently. In the USA, the approach based on social dialogue and patient's perspective was selected while in Poland the perspective of public payer predominated. The transparency of principles and social dialogue constitute the fundamental elements of effective process of health benefit basket development and implementation which is both required and generally unpopular modification.

Foreign aid or foreign investments: call for a paradigm shift in mentality and nomenclature

PubMed Central

Oleribe, Obinna Ositadimma; Nwanwanyu, Okey

2015-01-01

Funding for health care programs has over the years been an important challenge for health and health care services. However with the advent of financing, part of this problem was resolved. Through these investments, lives were saved, many destinies recovered and some obsolete systems reengineered. Major proofs of these expenditures are number of people reached and sometimes number of sites opened/supported, which in several cases, are not entirely verifiable. Sustainable development from these funds is limited, and far and in between. This is despite the fact that supports for health care and health care services have been ongoing for more than 60 years. As long as these funds are seen as aids to developing countries, they will continue to fail to achieve their primary objectives. But looking at these as investments in supported countries will significantly improve the outcome, health system impacts, as well as engineer sustainable health system strengthening and improvement. Such a re-branding will reduce the politics of support, improve effectiveness and efficiency in the use of the resources, and empower receiving nations towards better health systems. PMID:26113945

Foreign aid or foreign investments: call for a paradigm shift in mentality and nomenclature.

PubMed

Oleribe, Obinna Ositadimma; Nwanwanyu, Okey

2015-01-01

Funding for health care programs has over the years been an important challenge for health and health care services. However with the advent of financing, part of this problem was resolved. Through these investments, lives were saved, many destinies recovered and some obsolete systems reengineered. Major proofs of these expenditures are number of people reached and sometimes number of sites opened/supported, which in several cases, are not entirely verifiable. Sustainable development from these funds is limited, and far and in between. This is despite the fact that supports for health care and health care services have been ongoing for more than 60 years. As long as these funds are seen as aids to developing countries, they will continue to fail to achieve their primary objectives. But looking at these as investments in supported countries will significantly improve the outcome, health system impacts, as well as engineer sustainable health system strengthening and improvement. Such a re-branding will reduce the politics of support, improve effectiveness and efficiency in the use of the resources, and empower receiving nations towards better health systems.

Towards public health decision support: a systematic review of bidirectional communication approaches.

PubMed

Dixon, Brian E; Gamache, Roland E; Grannis, Shaun J

2013-05-01

To summarize the literature describing computer-based interventions aimed at improving bidirectional communication between clinical and public health. A systematic review of English articles using MEDLINE and Google Scholar. Search terms included public health, epidemiology, electronic health records, decision support, expert systems, and decision-making. Only articles that described the communication of information regarding emerging health threats from public health agencies to clinicians or provider organizations were included. Each article was independently reviewed by two authors. Ten peer-reviewed articles highlight a nascent but promising area of research and practice related to alerting clinicians about emerging threats. Current literature suggests that additional research and development in bidirectional communication infrastructure should focus on defining a coherent architecture, improving interoperability, establishing clear governance, and creating usable systems that will effectively deliver targeted, specific information to clinicians in support of patient and population decision-making. Increasingly available clinical information systems make it possible to deliver timely, relevant knowledge to frontline clinicians in support of population health. Future work should focus on developing a flexible, interoperable infrastructure for bidirectional communications capable of integrating public health knowledge into clinical systems and workflows.

Building Sustainable Capacity for Cardiovascular Care at a Public Hospital in Western Kenya.

PubMed

Binanay, Cynthia A; Akwanalo, Constantine O; Aruasa, Wilson; Barasa, Felix A; Corey, G Ralph; Crowe, Susie; Esamai, Fabian; Einterz, Robert; Foster, Michael C; Gardner, Adrian; Kibosia, John; Kimaiyo, Sylvester; Koech, Myra; Korir, Belinda; Lawrence, John E; Lukas, Stephanie; Manji, Imran; Maritim, Peris; Ogaro, Francis; Park, Peter; Pastakia, Sonak D; Sugut, Wilson; Vedanthan, Rajesh; Yanoh, Reuben; Velazquez, Eric J; Bloomfield, Gerald S

2015-12-08

Cardiovascular disease deaths are increasing in low- and middle-income countries and are exacerbated by health care systems that are ill-equipped to manage chronic diseases. Global health partnerships, which have stemmed the tide of infectious diseases in low- and middle-income countries, can be similarly applied to address cardiovascular diseases. In this review, we present the experiences of an academic partnership between North American and Kenyan medical centers to improve cardiovascular health in a national public referral hospital. We highlight our stepwise approach to developing sustainable cardiovascular services using the health system strengthening World Health Organization Framework for Action. The building blocks of this framework (leadership and governance, health workforce, health service delivery, health financing, access to essential medicines, and health information system) guided our comprehensive and sustainable approach to delivering subspecialty care in a resource-limited setting. Our experiences may guide the development of similar collaborations in other settings. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Telehealth: Telecommunications Technology in Health Care and Health Education in Canada. New Technologies in Canadian Education Series. Paper 15.

ERIC Educational Resources Information Center

Cervinskas, Jenny

This examination of the use of telecommunications systems in the health care field in Canada notes that the use of such systems to assist in the delivery of health care at a distance is critical to the remote and isolated regions of the country. The report begins by reviewing the development of 'telemedicine' or 'telehealth' systems using various…

The Panamanian health research system: a baseline analysis for the construction of a new phase

PubMed Central

2013-01-01

Background In Panama, the health research system has been strengthened during recent years by the development of new financing opportunities, promotion of scientific and technological activities, and initiation of human capital training to ultimately improve competitiveness. However, aligning this system with the population’s health needs is a significant challenge. This study was designed to characterize the National Health Research System in Panama, aiming to understand it within a local context to facilitate policymaking. Methods The study was based on the analysis of operative and functional components of the National Health Research System, characterized by four specific components: stewardship, financing, creation and maintenance of resources, and production and use of research results. The analysis was based on official documents from key local institutions in the areas of science, technology and innovation management, and health and health research, as well as bibliographic databases. Results Panama’s National Health Research System is characterized by the presence of only two biomedical research institutes and reduced research activity in hospitals and universities, ambivalent governance, a low critical mass of researchers, reduced capacity to recruit new researchers, poor scientific production, and insufficient investment in science and technology. Conclusions The present study illustrates an approach to the context of the Panamanian Health Research System which characterizes the system as insufficient to accomplish its operative role of generating knowledge for new health interventions and input for innovations. In turn, this analysis emphasizes the need to develop a National Health Research Policy, which should include longer-term plans and a strategy to overcome the asymmetries and gaps between the different actors and components of the current system. PMID:24007409

New frontiers for health information systems using Epi Info in developing countries: structured application framework for Epi Info (SAFE).

PubMed

Ma, J; Otten, M; Kamadjeu, R; Mir, R; Rosencrans, L; McLaughlin, S; Yoon, S

2008-04-01

For more than two decades, Epi Info software has been used to meet the data management, analysis, and mapping needs of public health professionals in more than 181 countries and 13 languages. Until now, most Epi Info systems have been relatively simple, mainly because of a lack of detailed and structured guidance for developing complex systems. We created the structured application framework for Epi Info (SAFE), which is a set of guidelines that allows developers to create both simple and complex information systems using accepted good programming practices. This has resulted in application code blocks that are re-useable and easy to maintain, modify, and enhance. The flexibility of SAFE allows various aggregate and case-based application modules to be rapidly created, combined, and updated to create health information systems or sub-systems enabling continuous, incremental enhancement as national and local capacity increases. SAFE and Epi Info are both cost-free and have low system requirements--characteristics that render this framework and software beneficial for developing countries.

[Intelligent watch system for health monitoring based on Bluetooth low energy technology].

PubMed

Wang, Ji; Guo, Hailiang; Ren, Xiaoli

2017-08-01

According to the development status of wearable technology and the demand of intelligent health monitoring, we studied the multi-function integrated smart watches solution and its key technology. First of all, the sensor technology with high integration density, Bluetooth low energy (BLE) and mobile communication technology were integrated and used in develop practice. Secondly, for the hardware design of the system in this paper, we chose the scheme with high integration density and cost-effective computer modules and chips. Thirdly, we used real-time operating system FreeRTOS to develop the friendly graphical interface interacting with touch screen. At last, the high-performance application software which connected with BLE hardware wirelessly and synchronized data was developed based on android system. The function of this system included real-time calendar clock, telephone message, address book management, step-counting, heart rate and sleep quality monitoring and so on. Experiments showed that the collecting data accuracy of various sensors, system data transmission capacity, the overall power consumption satisfy the production standard. Moreover, the system run stably with low power consumption, which could realize intelligent health monitoring effectively.

Lessons from a local government unit - health academic partnership.

PubMed

Paterno, Elizabeth R

2007-08-01

The devolution of health services from the Department of Health to the Local Government Unit in the Philippines in 1992 led to the deterioration of the management of local health services. The UP College of Medicine (UPCM) has forged a partnership with a Local Government Unit of a rural municipality to implement a community based health program geared towards the development of local health systems. Program objectives were: (1) to provide learning opportunities for UPCM faculty, medical residents and students in community medicine; and (2) to assist communities develop their health systems. In July, 2004, the UPCM jointly drafted a municipal health plan with its partner municipality. Before the actual planning session, the rural health midwives were assisted by the UPCM students in determining the health needs of their communities and in drafting community health plans. The plans were then presented by the midwives in a 2-day planning workshop, and became the basis of the municipal health plan. The outcome of the workshop was the first municipal health plan that this health office had drafted. Main outcomes from the implementation of the plan included the organization of the Local Health Board, improved health service provision by the municipal health office, active health committees in selected villages and better learning opportunities for medical residents and interns. Colleges of Medicine in the Philippines can and should play a role in the development of local health systems within the overall framework of Alma Ata Primary Health Care. National health planners should seriously consider this role of the health academe.

Air Pollution and Children's Health in Chinese.

PubMed

Lin, Wei-Wei; Chen, Zan-Xiong; Kong, Min-Li; Xie, Yan-Qi; Zeng, Xiao-Wen

2017-01-01

Children can be considered as a high-risk population to environmental stress since some of the organ systems including the immune system and respiratory system are still in development during childhood. During childhood, the impact of environmental pollutants exposure may program child growth and development that have long-term consequences on later health and disease risk. Considering the rapid economic growth in recent decades in China, the impact of ambient air pollution on children health causes concerns. Therefore, we aimed to review the current epidemiological evidence on the effects of air pollution exposure on adverse health outcome, including respiratory diseases, lung function, high blood pressure, cognitive disorder, and obesity in childhood in China. We believe that the findings summarized in our review demonstrate an unequivocal relationship between air pollutants exposure and Chinese children health and these results have large public health influences.

Vertical leadership in highly complex and unpredictable health systems.

PubMed

Till, Alex; Dutta, Nina; McKimm, Judy

2016-08-02

This article explores how the concept of vertical leadership development might help health organizations cope with and thrive within highly complex and unpredictable health systems, looking at concepts of VUCA (volatility, uncertainty, complexity and ambiguity) and RUPT (rapid, unpredictable, paradoxical and tangled).

Enhanced semantic interoperability by profiling health informatics standards.

PubMed

López, Diego M; Blobel, Bernd

2009-01-01

Several standards applied to the healthcare domain support semantic interoperability. These standards are far from being completely adopted in health information system development, however. The objective of this paper is to provide a method and suggest the necessary tooling for reusing standard health information models, by that way supporting the development of semantically interoperable systems and components. The approach is based on the definition of UML Profiles. UML profiling is a formal modeling mechanism to specialize reference meta-models in such a way that it is possible to adapt those meta-models to specific platforms or domains. A health information model can be considered as such a meta-model. The first step of the introduced method identifies the standard health information models and tasks in the software development process in which healthcare information models can be reused. Then, the selected information model is formalized as a UML Profile. That Profile is finally applied to system models, annotating them with the semantics of the information model. The approach is supported on Eclipse-based UML modeling tools. The method is integrated into a comprehensive framework for health information systems development, and the feasibility of the approach is demonstrated in the analysis, design, and implementation of a public health surveillance system, reusing HL7 RIM and DIMs specifications. The paper describes a method and the necessary tooling for reusing standard healthcare information models. UML offers several advantages such as tooling support, graphical notation, exchangeability, extensibility, semi-automatic code generation, etc. The approach presented is also applicable for harmonizing different standard specifications.

Mental health in Aceh--Indonesia: A decade after the devastating tsunami 2004.

PubMed

Marthoenis, Marthoenis; Yessi, Sarifah; Aichberger, Marion C; Schouler-Ocak, Meryam

2016-02-01

The province of Aceh has suffered enormously from the perennial armed conflict and the devastating Tsunami in 2004. Despite the waves of external aid and national concern geared toward improving healthcare services as part of the reconstruction and rehabilitation efforts after the Tsunami, mental health services still require much attention. This paper aims to understand the mental healthcare system in Aceh Province, Indonesia; its main focus is on the burden, on the healthcare system, its development, service delivery and cultural issues from the devastating Tsunami in 2004 until the present. We reviewed those published and unpublished reports from the local and national government, from international instances (UN bodies, NGOs) and from the academic literature pertaining to mental health related programs conducted in Aceh. To some extent, mental health services in Aceh have been improved compared to their condition before the Tsunami. The development programs have focused on procurement of policy, improvement of human resources, and enhancing service delivery. Culture and religious beliefs shape the pathways by which people seek mental health treatment. The political system also determines the development of the mental health service in the province. The case of Aceh is a unique example where conflict and disaster serve as the catalysts toward the development of a mental healthcare system. Several factors contribute to the improvement of the mental health system, but security is a must. Whilst the Acehnese enjoy the improvements, some issues such as stigma, access to care and political fluctuations remain challenging. Copyright © 2016 Elsevier B.V. All rights reserved.

The process of development of a prioritization tool for a clinical decision support build within a computerized provider order entry system: Experiences from St Luke's Health System.

PubMed

Wolf, Matthew; Miller, Suzanne; DeJong, Doug; House, John A; Dirks, Carl; Beasley, Brent

2016-09-01

To establish a process for the development of a prioritization tool for a clinical decision support build within a computerized provider order entry system and concurrently to prioritize alerts for Saint Luke's Health System. The process of prioritizing clinical decision support alerts included (a) consensus sessions to establish a prioritization process and identify clinical decision support alerts through a modified Delphi process and (b) a clinical decision support survey to validate the results. All members of our health system's physician quality organization, Saint Luke's Care as well as clinicians, administrators, and pharmacy staff throughout Saint Luke's Health System, were invited to participate in this confidential survey. The consensus sessions yielded a prioritization process through alert contextualization and associated Likert-type scales. Utilizing this process, the clinical decision support survey polled the opinions of 850 clinicians with a 64.7 percent response rate. Three of the top rated alerts were approved for the pre-implementation build at Saint Luke's Health System: Acute Myocardial Infarction Core Measure Sets, Deep Vein Thrombosis Prophylaxis within 4 h, and Criteria for Sepsis. This study establishes a process for developing a prioritization tool for a clinical decision support build within a computerized provider order entry system that may be applicable to similar institutions. © The Author(s) 2015.

Developing and theoretically justifying innovative organizational practices in health information assurance

NASA Astrophysics Data System (ADS)

Collmann, Jeff R.

2003-05-01

This paper justifies and explains current efforts in the Military Health System (MHS) to enhance information assurance in light of the sociological debate between "Normal Accident" (NAT) and "High Reliability" (HRT) theorists. NAT argues that complex systems such as enterprise health information systems display multiple, interdependent interactions among diverse parts that potentially manifest unfamiliar, unplanned, or unexpected sequences that operators may not perceive or immediately understand, especially during emergencies. If the system functions rapidly with few breaks in time, space or process development, the effects of single failures ramify before operators understand or gain control of the incident thus producing catastrophic accidents. HRT counters that organizations with strong leadership support, continuous training, redundant safety features and "cultures of high reliability" contain the effects of component failures even in complex, tightly coupled systems. Building highly integrated, enterprise-wide computerized health information management systems risks creating the conditions for catastrophic breaches of data security as argued by NAT. The data security regulations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) implicitly depend on the premises of High Reliability Theorists. Limitations in HRT thus have implications for both safe program design and compliance efforts. MHS and other health care organizations should consider both NAT and HRT when designing and deploying enterprise-wide computerized health information systems.

Sustainable development and public health: a national perspective.

PubMed

Adshead, Fiona; Thorpe, Allison; Rutter, Jill

2006-12-01

The increasing policy focus on sustainable development offers new opportunities to align the public health narrative with that of sustainable development to promote both sustainable health for the population, and a sustainable health care system for England. This paper provides some insights into ways in which potential linkages between the two areas can be made meaningful across a wide range of policies at a national level.

Professional competencies in health promotion and public health: what is common and what is specific? Review of the European debate and perspectives for professional development.

PubMed

Mereu, Alessandra; Sotgiu, Alessandra; Buja, Alessandra; Casuccio, Alessandra; Cecconi, Rosaria; Fabiani, Leila; Guberti, Emilia; Lorini, Chiara; Minelli, Liliana; Pocetta, Giancarlo; Contu, Paolo

2015-01-01

According to the Nairobi Call to Action, the growth of practitioners' skills can be favoured by setting accreditation standards and by reorienting professional competencies of current and future health workers. This will make it possible to develop a critical mass of competent practitioners, foster training, and increase visibility of the professional field. Through a review of the literature, the authors offer an overview of competency-based strategies for professional development in health promotion. The main research questions discussed were as follows: Is there a shared definition of public health?; Is there a shared definition of health promotion?; Who are the main stakeholders for public health and health promotion in Europe?; What is the meaning of professional competencies in education and practice for public health and health promotion?; Is there a shared system of professional core competencies in public health and health promotion?;What is common and what is specific between the two systems of professional competencies?; Is it useful and feasible to create specific strategies of professional development for public health and health promotion? A transformative use of competencies makes it possible to inform students, professionals, employers, and political decision-makers about what is expected from a specific profession and its values.

Feasibility of health systems strengthening in South Sudan: a qualitative study of international practitioner perspectives

PubMed Central

Jones, Abigail; Legido-Quigley, Helena

2015-01-01

Objective To explore the feasibility of health systems strengthening from the perspective of international healthcare implementers and donors in South Sudan. Design A qualitative interview study, with thematic analysis using the WHO health system building blocks framework. Setting South Sudan. Participants 17 health system practitioners, working for international agencies in South Sudan, were purposively sampled for their knowledge and experiences of health systems strengthening, services delivery, health policy and politics in South Sudan. Results Participants universally reported the health workforce as insufficient and of low capacity and service delivery as poor, while access to medicines was restricted by governmental lack of commitment in undertaking procurement and supply. However, progress was clear in improved county health department governance, health management information system functionality, increased health worker salary harmonisation and strengthened financial management. Conclusions Resurgent conflict and political tensions have negatively impacted all health system components and maintaining or continuing health system strengthening has become extremely challenging. A coordinated approach to balancing humanitarian need particularly in conflict-affected areas, with longer term development is required so as not to lose improvements gained. PMID:26700280

Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

PubMed

Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

2017-01-01

Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

A qualitative appraisal of stakeholder reactions to a tool for burden of disease–based health system budgeting in Ghana

PubMed Central

Awoonor-Williams, John Koku; Schmitt, Margaret L.; Tiah, Janet; Ndago, Joyce; Asuru, Rofina; Bawah, Ayaga A.; Phillips, James F.

2016-01-01

Background In 2010, the Ghana Health Service launched a program of cooperation with the Tanzania Ministry of Health and Social Welfare that was designed to adapt Tanzania's PLANREP budgeting and reporting tool to Ghana's primary health care program. The product of this collaboration is a system of budgeting, data visualization, and reporting that is known as the District Health Planning and Reporting Tool (DiHPART). Objective This study was conducted to evaluate the design and implementation processes (technical, procedures, feedback, maintenance, and monitoring) of the DiHPART tool in northern Ghana. Design This paper reports on a qualitative appraisal of user reactions to the DiHPART system and implications of pilot experience for national scale-up. A total of 20 health officials responsible for financial planning operations were drawn from the national, regional, and district levels of the health system and interviewed in open-ended discussions about their reactions to DiHPART and suggestions for systems development. Results The findings show that technical shortcomings merit correction before scale-up can proceed. The review makes note of features of the software system that could be developed, based on experience gained from the pilot. Changes in the national system of financial reporting and budgeting complicate DiHPART utilization. This attests to the importance of pursuing a software application framework that anticipates the need for automated software generation. Conclusions Despite challenges encountered in the pilot, the results lend support to the notion that evidence-based budgeting merits development and implementation in Ghana. PMID:27246868

A novel performance monitoring framework for health research systems: experiences of the National Institute for Health Research in England

PubMed Central

2011-01-01

Background The National Institute for Health Research (NIHR) was established in 2006 with the aim of creating an applied health research system embedded within the English National Health Service (NHS). NIHR sought to implement an approach for monitoring its performance that effectively linked early indicators of performance with longer-term research impacts. We attempted to develop and apply a conceptual framework for defining appropriate key performance indicators for NIHR. Method Following a review of relevant literature, a conceptual framework for defining performance indicators for NIHR was developed, based on a hybridisation of the logic model and balanced scorecard approaches. This framework was validated through interviews with key NIHR stakeholders and a pilot in one division of NIHR, before being refined and applied more widely. Indicators were then selected and aggregated to create a basket of indicators aligned to NIHR's strategic goals, which could be reported to NIHR's leadership team on a quarterly basis via an oversight dashboard. Results Senior health research system managers and practitioners endorsed the conceptual framework developed and reported satisfaction with the breadth and balance of indicators selected for reporting. Conclusions The use of the hybrid conceptual framework provides a pragmatic approach to defining performance indicators that are aligned to the strategic aims of a health research system. The particular strength of this framework is its capacity to provide an empirical link, over time, between upstream activities of a health research system and its long-term strategic objectives. PMID:21435265

Health level 7 development framework for medication administration.

PubMed

Kim, Hwa Sun; Cho, Hune

2009-01-01

We propose the creation of a standard data model for medication administration activities through the development of a clinical document architecture using the Health Level 7 Development Framework process based on an object-oriented analysis and the development method of Health Level 7 Version 3. Medication administration is the most common activity performed by clinical professionals in healthcare settings. A standardized information model and structured hospital information system are necessary to achieve evidence-based clinical activities. A virtual scenario is used to demonstrate the proposed method of administering medication. We used the Health Level 7 Development Framework and other tools to create the clinical document architecture, which allowed us to illustrate each step of the Health Level 7 Development Framework in the administration of medication. We generated an information model of the medication administration process as one clinical activity. It should become a fundamental conceptual model for understanding international-standard methodology by healthcare professionals and nursing practitioners with the objective of modeling healthcare information systems.

Health financing in Malawi: Evidence from National Health Accounts

PubMed Central

2010-01-01

Background National health accounts provide useful information to understand the functioning of a health financing system. This article attempts to present a profile of the health system financing in Malawi using data from NHA. It specifically attempts to document the health financing situation in the country and proposes recommendations relevant for developing a comprehensive health financing policy and strategic plan. Methods Data from three rounds of national health accounts covering the Financial Years 1998/1999 to 2005/2006 was used to describe the flow of funds and their uses in the health system. Analysis was performed in line with the various NHA entities and health system financing functions. Results The total health expenditure per capita increased from US$ 12 in 1998/1999 to US$25 in 2005/2006. In 2005/2006 public, external and private contributions to the total health expenditure were 21.6%, 60.7% and 18.2% respectively. The country had not met the Abuja of allocating at least 15% of national budget on health. The percentage of total health expenditure from households' direct out-of-pocket payments decreased from 26% in 1998/99 to 12.1% in 2005/2006. Conclusion There is a need to increase government contribution to the total health expenditure to at least the levels of the Abuja Declaration of 15% of the national budget. In addition, the country urgently needs to develop and implement a prepaid health financing system within a comprehensive health financing policy and strategy with a view to assuring universal access to essential health services for all citizens. PMID:21062503

Developing a Competency-Based Pan-European Accreditation Framework for Health Promotion

ERIC Educational Resources Information Center

Battel-Kirk, Barbara; Van der Zanden, Gerard; Schipperen, Marielle; Contu, Paolo; Gallardo, Carmen; Martinez, Ana; Garcia de Sola, Silvia; Sotgiu, Alessandra; Zaagsma, Miriam; Barry, Margaret M.

2012-01-01

Background: The CompHP Pan-European Accreditation Framework for Health Promotion was developed as part of the CompHP Project that aimed to develop competency-based standards and an accreditation system for health promotion practice, education, and training in Europe. Method: A phased, multiple-method approach was employed to facilitate consensus…

[Electronic medical records in Bosnia-Herzegovina. The electronic card--the medical record of the future in Boznia-Herzegovina].

PubMed

Masić, I; Pandza, H; Ridanović, Z; Dover, M

1997-01-01

The biggest problem in organisation of the effective and rational health care of good quality in Bosnia quality and Herzegovina is a functional and updated Health Information System. In this system, important role play Health Statistic System in which documentation and evidence are very important segment. Developed countries proceeded from the manual and semiautomatic method of medical data processing and system management to the new methods of entering, storage, transfer, searching and protection of data using electronic equipment. Recently, the competition between manufacturers of the Smart Card and Laser Card is reality. Also scientific and professional debate exists about the standard card for storage of medical information in Health Care System. First option is supported by West European countries that developing Smart Card called Eurocard and second by USA and Far East countries. Because the Health Care System and other segments of Society of Bosnia and Herzegovina innovate intensively similar systems, the authors of this article intend to open discussion, and to show advantages and failures of each technological medium.

The Overview of the Health Monitoring Management System

NASA Astrophysics Data System (ADS)

Zhong-Ji, Tan; Zhiqiang, Zhang; Yan-Bin, Shi

The health monitoring management system has prominent function to improve the security and dependability of the aircraft, can also shortens the maintain cycle by a large margin, improves the sortie rate at the same time. This paper has explained the concept, the development in domestic and international and the key technology of the health monitoring management system of aircraft; Construct the structure of the aircraft health monitoring management system, and has carried on analysis and research to its implementation method.

Space Station Freedom CHeCS overview. [Crew Health Care System

NASA Technical Reports Server (NTRS)

Boyce, Joey B.

1990-01-01

The current status, progress, and future plans for development of the Crew Health Care System (CHeCS) for the International Space Station Freedom are presented. Essential operational biomedical support requirements for the astronauts, including medical care, environmental habitat monitoring, and countermeasures for the potentially maladaptive physiological effects of space flight will be provided by the CHeCS. Three integral parts will make up the system: a health maintenance facility, an environmental health system, and the exercise countermeasures facility. Details of each of the major systems and their subsystems are presented.

A qualitative study of health information technology in the Canadian public health system.

PubMed

Zinszer, Kate; Tamblyn, Robyn; Bates, David W; Buckeridge, David L

2013-05-25

Although the adoption of health information technology (HIT) has advanced in Canada over the past decade, considerable challenges remain in supporting the development, broad adoption, and effective use of HIT in the public health system. Policy makers and practitioners have long recognized that improvements in HIT infrastructure are necessary to support effective and efficient public health practice. The objective of this study was to identify aspects of health information technology (HIT) policy related to public health in Canada that have succeeded, to identify remaining challenges, and to suggest future directions to improve the adoption and use of HIT in the public health system. A qualitative case study was performed with 24 key stakeholders representing national and provincial organizations responsible for establishing policy and strategic direction for health information technology. Identified benefits of HIT in public health included improved communication among jurisdictions, increased awareness of the need for interoperable systems, and improvement in data standardization. Identified barriers included a lack of national vision and leadership, insufficient investment, and poor conceptualization of the priority areas for implementing HIT in public health. The application of HIT in public health should focus on automating core processes and identifying innovative applications of HIT to advance public health outcomes. The Public Health Agency of Canada should develop the expertise to lead public health HIT policy and should establish a mechanism for coordinating public health stakeholder input on HIT policy.

[Change and revolution: the rise of the National Health System in Cuba, 1959-1970].

PubMed

Chaple, Enrique Beldarraín

2005-01-01

This article studies the impact on the Cuban public health system of the political, economical and social changes that occurred after the 1959 Revolution, and the main transformations that occurred in the Cuban public health system during the 1960s, such as the creation of a new public health ministry, the nationalization of the pharmaceutical industry, the massive emigration of health professionals, a reform of medical studies, the creation of a Medical Rural Service, the incorporation of socialist principles in public health and the development of primary health care. As this article intends to demonstrate, these measures guided Cuban public health reform towards the construction of a state monopolized National Health System in 1970.

Printable thermoelectric devices and conductive patterns for medical applications

NASA Astrophysics Data System (ADS)

Lee, Jungmin; Kim, Hyunjung; Chen, Linfeng; Choi, Sang H.; Varadan, Vijay K.

2012-10-01

Remote point-of-care is expected to revolutionize the modern medical practice, and many efforts have been made for the development of wireless health monitoring systems for continuously detecting the physiological signals of patients. To make the remote point-of-care generally accepted and widely used, it is necessary to develop cost-effective and durable wireless health monitoring systems. Printing technique will be helpful for the fabrication of high-quality and low-cost medical devices and systems because it allows high-resolution and high-speed fabrication, low material consumption and nano-sized patterning on both flexible and rigid substrates. Furthermore, application of thermoelectric generators can replace conventional batteries as the power sources for wireless health monitoring systems because thermoelectric generators can convert the wasted heat or the heat from nature into electricity which is required for the operation of the wireless health monitoring systems. In this research, we propose the concept of printable thermoelectric devices and conductive patterns for the realization of more portable and cost-effective medical devices. To print thermoelectric generators and conductive patterns on substrates, printing inks with special characteristics should be developed. For the development of thermoelectric inks, nano-structured thermoelectric materials are synthesized and characterized; and for the development of conductive inks, two kinds of surface treated carbon nanotubes are used as active materials.

Sources of project financing in health care systems.

PubMed

Smith, D G; Wheeler, J R; Rivenson, H L; Reiter, K L

2000-01-01

Through discussions with chief financial officers of leading health care systems, insights are offered on preferences for project financing and development efforts. Data from these same systems provide at least anecdotal evidence in support of pecking-order theory.

Thoughts on the development of active regional public health systems.

PubMed

Reis, Ademar Arthur Chioro Dos; Sóter, Ana Paula Menezes; Furtado, Lumena Almeida Castro; Pereira, Silvana Souza da Silva

2017-04-01

Decentralization and regionalization are strategic themes for reforms in the health system. This paper analyzes the complex process of health regionalization being developed in Brazil. This paper identifies that the normative framework from the Brazilian National Health System, SUS has made advances with respect to its institutionalization and overcoming the initial centrality involved in municipalization. This has strengthened the development of regionalization and the intergovernmental agreement on health but the evidence points to the need to promote a revision. Based on document analysis, literature review and the views given by the authors involved in management in SUS as well as generating radically different views, the challenges for the construction of a regionalization that is active, is debated. We also discuss: its relations with planning and the dimensioning of service networks, the production of active care networks and shared management spaces, the inter-federative agreements and regional regulations, the capacity to coordinate regional systems and financing and the impact of the political dimension and electoral cycles. Regionalization (and SUS itself) is an open book, therefore ways and possibilities on how to maintain an active form of regionalization can be recommended.

Understanding health system reform - a complex adaptive systems perspective.

PubMed

Sturmberg, Joachim P; O'Halloran, Di M; Martin, Carmel M

2012-02-01

Everyone wants a sustainable well-functioning health system. However, this notion has different meaning to policy makers and funders compared to clinicians and patients. The former perceive public policy and economic constraints, the latter clinical or patient-centred strategies as the means to achieving a desired outcome. Theoretical development and critical analysis of a complex health system model. We introduce the concept of the health care vortex as a metaphor by which to understand the complex adaptive nature of health systems, and the degree to which their behaviour is predetermined by their 'shared values' or attractors. We contrast the likely functions and outcomes of a health system with a people-centred attractor and one with a financial attractor. This analysis suggests a shift in the system's attractor is fundamental to progress health reform thinking. © 2012 Blackwell Publishing Ltd.

Purchasing population health: aligning financial incentives to improve health outcomes.

PubMed

Kindig, D A

1998-06-01

To review the concept of population health, including its definition, measurement, and determinants, and to suggest an approach for aligning financial incentives toward this goal. DATA SOURCE, STUDY DESIGN, DATA EXTRACTION. Literature review, policy analysis The article presents the argument that a major reason for our slow progress toward health outcome improvement is that there is no operational definition of population health and that financial incentives are not aligned to this goal. Current attempts at process measures as indicators of quality or outcome are not adequate for the task. It is suggested that some measure of health-adjusted life expectancy be adopted for this purpose, and that integrated delivery systems and other agents responsible for nonmedical determinants be rewarded for improvement in this measure. This will require the development of an investment portfolio across the determinants of health based on relative marginal return to health, with horizontal integration strategies across sectoral boundaries. A 20-year three-phase development strategy is proposed, including components of research and acceptance, integrated health system implementation, and cross-sectoral integration. The U.S. healthcare system is a $1 trillion industry without a definition of its product. Until population outcome measures are developed and rewarded for, we will not solve the twenty-first century challenge of maximizing health outcome improvement for the resources available.

A review on architectures and communications technologies for wearable health-monitoring systems.

PubMed

Custodio, Víctor; Herrera, Francisco J; López, Gregorio; Moreno, José Ignacio

2012-10-16

Nowadays society is demanding more and more smart healthcare services that allow monitoring patient status in a non-invasive way, anywhere and anytime. Thus, healthcare applications are currently facing important challenges guided by the u-health (ubiquitous health) and p-health (pervasive health) paradigms. New emerging technologies can be combined with other widely deployed ones to develop such next-generation healthcare systems. The main objective of this paper is to review and provide more details on the work presented in "LOBIN: E-Textile and Wireless-Sensor-Network-Based Platform for Healthcare Monitoring in Future Hospital Environments", published in the IEEE Transactions on Information Technology in Biomedicine, as well as to extend and update the comparison with other similar systems. As a result, the paper discusses the main advantages and disadvantages of using different architectures and communications technologies to develop wearable systems for pervasive healthcare applications.

A Review on Architectures and Communications Technologies for Wearable Health-Monitoring Systems

PubMed Central

Custodio, Víctor; Herrera, Francisco J.; López, Gregorio; Moreno, José Ignacio

2012-01-01

Nowadays society is demanding more and more smart healthcare services that allow monitoring patient status in a non-invasive way, anywhere and anytime. Thus, healthcare applications are currently facing important challenges guided by the u-health (ubiquitous health) and p-health (pervasive health) paradigms. New emerging technologies can be combined with other widely deployed ones to develop such next-generation healthcare systems. The main objective of this paper is to review and provide more details on the work presented in “LOBIN: E-Textile and Wireless-Sensor-Network-Based Platform for Healthcare Monitoring in Future Hospital Environments”, published in the IEEE Transactions on Information Technology in Biomedicine, as well as to extend and update the comparison with other similar systems. As a result, the paper discusses the main advantages and disadvantages of using different architectures and communications technologies to develop wearable systems for pervasive healthcare applications. PMID:23202028

Accessing timely rehabilitation services for a global aging society? Exploring the realities within Canada's universal health care system.

PubMed

Landry, Michel D; Raman, Sudha; Al-Hamdan, Elham

2010-07-01

The proportion of older persons is increasing in developed and developing countries: this aging trend can be viewed as a two-edged sword. On the one hand, it represents remarkable successes regarding advances in health care; and on the other hand, it represents a considerable challenge for health systems to meet growing demand. A growing disequilibrium between supply and demand may be particularly challenging within publicly funding health systems that 'guarantee' services to eligible populations. Rehabilitation, including physical therapy, is a service that if provided in a timely manner, can maximize function and mobility for older persons, which may in turn optimize efficiency and effectiveness of overall health care systems. However, physical therapy services are not considered an insured service under the legislative framework of the Canadian health system, and as such, a complex public/private mix of funding and delivery has emerged. In this article, we explore the consequences of a public/private mix of physical therapy on timely access to services, and use the World Health Organization (WHO) health system performance framework to assess the extent to which the emerging system influences the goal of aggregated and equitable health. Overall, we argue that a shift to a public/private mix may not have positive influences at the population level, and that innovative approaches to deliver services would be desirable to strengthening rather than weaken the publicly funded system. We signal that strategies aimed at scaling up rehabilitation interventions are required in order to improve health outcomes in an evolving global aging society.

[The development of the system of medical rehabilitation based at the Russian health resort facilities: investment prospects].

PubMed

Povazhnaya, E L; Gusakova, E V; Moiseenko, S V

2018-05-21

The present work is devoted to the prospects for attracting investments for the maintenance and development of the medical rehabilitation practices based at the Russian health resort facilities. The article describes the prerequisites for the enhancement of the investment attractiveness of the development of the system of medical rehabilitation in the said institutions including the formulation and strengthening of the legal and regulatory framework, the capacity for the organization of the second and third stages of medical rehabilitation in the existing spa and health resort facilities, the attraction of the funds of compulsory medical insurance as an additional source of the financial support. The main legal documents regulating the organization and provision of medical rehabilitation based at the spa and health resort facilities are presented. The results of the implementation of the investment concept of the development of medical rehabilitation in the framework of the system of health resort treatment as exemplified by the experience of JSC «The group of companies «Medsi» are discussed. It is shown that the development of medical rehabilitation based at the spa and health resort facilities greatly contributes to the significant expansion of the potential customer base and promotes the further growth of business scale.

Health information systems - past, present, future.

PubMed

Haux, Reinhold

2006-01-01

In 1984, Peter Reichertz gave a lecture on the past, present and future of hospital information systems. In the meantime, there has been a tremendous progress in medicine as well as in informatics. One important benefit of this progress is that our life expectancy is nowadays significantly higher than it would have been even some few decades ago. This progress, leading to aging societies, is of influence to the organization of health care and to the future development of its information systems. Twenty years later, referring to Peter Reichertz' lecture, but now considering health information systems (HIS), two questions are discussed: which were lines of development in health information systems from the past until today? What are consequences for health information systems in the future? The following lines of development for HIS were considered as important: (1) the shift from paper-based to computer-based processing and storage, as well as the increase of data in health care settings; (2) the shift from institution-centered departmental and, later, hospital information systems towards regional and global HIS; (3) the inclusion of patients and health consumers as HIS users, besides health care professionals and administrators; (4) the use of HIS data not only for patient care and administrative purposes, but also for health care planning as well as clinical and epidemiological research; (5) the shift from focusing mainly on technical HIS problems to those of change management as well as of strategic information management; (6) the shift from mainly alpha-numeric data in HIS to images and now also to data on the molecular level; (7) the steady increase of new technologies to be included, now starting to include ubiquitous computing environments and sensor-based technologies for health monitoring. As consequences for HIS in the future, first the need for institutional and (inter-) national HIS-strategies is seen, second the need to explore new (transinstitutional) HIS architectural styles, third the need for education in health informatics and/or biomedical informatics, including appropriate knowledge and skills on HIS. As these new HIS are urgently needed for reorganizing health care in an aging society, as last consequence the need for research around HIS is seen. Research should include the development and investigation of appropriate transinstitutional information system architectures, of adequate methods for strategic information management, of methods for modeling and evaluating HIS, the development and investigation of comprehensive electronic patient records, providing appropriate access for health care professionals as well as for patients, in the broad sense as described here, e.g. including home care and health monitoring facilities. Comparing the world in 1984 and in 2004, we have to recognize that we imperceptibly, stepwise arrived at a new world. HIS have become one of the most challenging and promising fields of research, education and practice for medical informatics, with significant benefits to medicine and health care in general.

IMPROVING THE EFFECTIVENESS AND EFFICIENCY OF EVIDENCE PRODUCTION FOR HEALTH TECHNOLOGY ASSESSMENT.

PubMed

Facey, Karen; Henshall, Chris; Sampietro-Colom, Laura; Thomas, Sarah

2015-01-01

Health Technology Assessment (HTA) needs to address the challenges posed by high cost, effective technologies, expedited regulatory approaches, and the opportunities provided by collaborative real-world evaluation of technologies. The Health Technology Assessment International (HTAi) Policy Forum met to consider these issues and the implications for evidence production to inform HTA. This paper shares their discussion to stimulate further debate. A background paper, presentations, group discussions, and stakeholder role play at the 2015 HTAi Policy Forum meeting informed this paper. HTA has an important role to play in helping improve evidence production and ensuring that the health service is ready to adopt effective technologies. It needs to move from simply informing health system decisions to also working actively to align stakeholder expectations about realistic evidence requirements. Processes to support dialogue over the health technology life cycle need to be developed that are mindful of limited resources, operate across jurisdictions and learn from past processes. Collaborations between health technology developers and health systems in different countries should be encouraged to develop evidence that will inform decision making. New analytical techniques emerging for real-world data should be harnessed to support modeling for HTA. A paradigm shift (to "Health Innovation System 2.0") is suggested where HTA adopts a more central, proactive role to support alignment within and amongst stakeholders over the whole life cycle of the technology. This could help ensure that evidence production is better aligned with patient and health system needs and so is more effective and efficient.

Post-conflict health reconstruction: search for a policy.

PubMed

Rubenstein, Leonard S

2011-10-01

Despite increasing experience in health reconstruction in societies emerging from conflict, the policy basis for investing in the development of equitable and effective health systems in the wake of war remains unsettled. Consideration of post-conflict health reconstruction is almost entirely absent in donor policies on global health. Practically by default, health programmes are seen increasingly as an element of stabilisation and security interventions in the aftermath of armed conflict. That perspective, however, lacks an evidence base and can skew health programmes towards short-term security and stabilisation goals that have a marginal impact and violate the principles of equity, non-discrimination, and quality, which are central to sound health systems and public acceptance of them. A better approach is to ground policy in legitimacy, viewing health both as a core social institution and one that, if developed according to human rights principles, including equity, non-discrimination, participation and accountability, can advance the effectiveness and the quality of governance in the emerging state. © 2011 The Author(s). Disasters © Overseas Development Institute, 2011.

Development and evaluation of a dual purpose bridge health monitoring and weigh-in-motion system for a steel girder bridge : phase two.

DOT National Transportation Integrated Search

2016-06-30

The primary objective of this second phase is the further development, demonstration : and field evaluation of a permanent dual purpose bridge weigh-in-motion and health monitoring : system over an extended period of time. Calibrated test truck resul...

75 FR 61502 - Cooperative Agreement With the Pan American Health Organization for the Development of an...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-05

... Medical Products and Related Regulatory Processes and Systems in the Americas Region AGENCY: Food and Drug... Health Organization (PAHO) for the development of an information hub in the areas of medical products and related regulatory processes and systems (e.g., including drugs, biologics, vaccines, medical devices, and...

Armenia: health system review.

PubMed

Richardson, Erica

2013-01-01

This analysis of the Armenian health system reviews the developments in organization and governance, health financing, healthcare provision, health reforms and health system performance since 2006. Armenia inherited a Semashko style health system on independence from the Soviet Union in 1991. Initial severe economic and sociopolitical difficulties during the 1990s affected the population health, though strong economic growth from 2000 benefited the populations health. Nevertheless, the Armenian health system remains unduly tilted towards inpatient care concentrated in the capital city despite overall reductions in hospital beds and concerted efforts to reform primary care provision. Changes in health system financing since independence have been more profound, as out-of-pocket (OOP) payments now account for over half of total health expenditure. This reduces access to essential services for the poorest households - particularly for inpatient care and pharmaceuticals - and many households face catastrophic health expenditure. Improving health system performance and financial equity are therefore the key challenges for health system reform. The scaling up of some successful recent programmes for maternal and child health may offer solutions, but require sustained financial resources that will be challenging in the context of financial austerity and the low base of public financing. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).