WorldWideScience

Sample records for regional healthcare system

  1. Implementing standards for the interoperability among healthcare providers in the public regionalized Healthcare Information System of the Lombardy Region.

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    Barbarito, Fulvio; Pinciroli, Francesco; Mason, John; Marceglia, Sara; Mazzola, Luca; Bonacina, Stefano

    2012-08-01

    Information technologies (ITs) have now entered the everyday workflow in a variety of healthcare providers with a certain degree of independence. This independence may be the cause of difficulty in interoperability between information systems and it can be overcome through the implementation and adoption of standards. Here we present the case of the Lombardy Region, in Italy, that has been able, in the last 10 years, to set up the Regional Social and Healthcare Information System, connecting all the healthcare providers within the region, and providing full access to clinical and health-related documents independently from the healthcare organization that generated the document itself. This goal, in a region with almost 10 millions citizens, was achieved through a twofold approach: first, the political and operative push towards the adoption of the Health Level 7 (HL7) standard within single hospitals and, second, providing a technological infrastructure for data sharing based on interoperability specifications recognized at the regional level for messages transmitted from healthcare providers to the central domain. The adoption of such regional interoperability specifications enabled the communication among heterogeneous systems placed in different hospitals in Lombardy. Integrating the Healthcare Enterprise (IHE) integration profiles which refer to HL7 standards are adopted within hospitals for message exchange and for the definition of integration scenarios. The IHE patient administration management (PAM) profile with its different workflows is adopted for patient management, whereas the Scheduled Workflow (SWF), the Laboratory Testing Workflow (LTW), and the Ambulatory Testing Workflow (ATW) are adopted for order management. At present, the system manages 4,700,000 pharmacological e-prescriptions, and 1,700,000 e-prescriptions for laboratory exams per month. It produces, monthly, 490,000 laboratory medical reports, 180,000 radiology medical reports, 180

  2. Regional Healthcare Effectiveness

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    Olga Vladimirovna Kudelina

    2016-03-01

    Full Text Available An evaluation of healthcare systems effectiveness of the regions of the Russian Federation (federal districts was conducted using the Minmax method based on the data available at the United Interdepartmental Statistical Information System. Four groups of components (i.e. availability of resources; use of resources; access to resources and medical effectiveness decomposed into 17 items were analyzed. The resource availability was measured by four indicators, including the provision of doctors, nurses, hospital beds; agencies providing health care to the population. Use of resources was measured by seven indicators: the average hospital stay, days; the average bed occupancy, days; the number of operations per 1 physician surgical; the cost per unit volume of medical care: in outpatient clinics, day hospitals, inpatient and emergency care. Access to the resources was measured by three indicators: the satisfaction of the population by medical care; the capacity of outpatient clinics; the average number of visits to health facility. The medical effectiveness was also measured by three indicators: incidence with the "first-ever diagnosis of malignancy"; life expectancy at birth, years; the number of days of temporary disability. The study of the dynamics of the components and indexes for 2008–2012 allows to indicate a multidirectional influence on the regional healthcare system. In some federal districts (e.g. North Caucasian, the effectiveness decreases due to resource availability, in others (South, North Caucasian — due to the use of resources, in others (Far Eastern, Ural — due to access to resources. It is found that the effectiveness of the healthcare systems of the federal districts differs significantly. In addition, the built matrix proves the variability the of effectiveness (comparison of expenditures and results of healthcare systems of the federal districts of the Russian Federation: the high results can be obtained at high costs

  3. Healthcare regions and their care networks: an organizational-systemic model for SUS.

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    Santos, Lenir

    2017-04-01

    This paper describes a comprehensive effort to develop studies regarding Brazil's Unified Healthcare System (SUS), as a result of the combination of public services in a network that follows a region-based rationale (tripartite organization). The SUS emerges from such an integration and should be organized as such. The intention is to demonstrate that this type of organization is essential, given that Brazil is organized as a Federation, and all three governmental levels are, in a broad sense, equally responsible for healthcare. Healthcare services and actions are a complex set of activities that are interconnected on behalf of citizen health, which is a global concept that cannot be split up. Services must follow this rationale and be organized as such. Thus, healthcare services must be systematically organized to serve everyone equally, regardless of where a citizen lives. This systemic organization requires permanent interaction between federative units to discuss and operationalize reference services, funding and other technical and administrative aspects. These are the essential elements that make the SUS so complex and demand it be organized regionally, as a network of healthcare services.

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

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

    2016-11-21

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

  5. Is variation management included in regional healthcare governance systems? Some proposals from Italy.

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    Nuti, Sabina; Seghieri, Chiara

    2014-01-01

    The Italian National Health System, which follows a Beveridge model, provides universal healthcare coverage through general taxation. Universal coverage provides uniform healthcare access to citizens and is the characteristic usually considered the added value of a welfare system financed by tax revenues. Nonetheless, wide differences in practice patterns, health outcomes and regional usages of resources that cannot be justified by differences in patient needs have been demonstrated to exist. Beginning with the experience of the health care system of the Tuscany region (Italy), this study describes the first steps of a long-term approach to proactively address the issue of geographic variation in healthcare. In particular, the study highlights how the unwarranted variation management has been addressed in a region with a high degree of managerial control over the delivery of health care and a consolidated performance evaluation system, by first, considering it a high priority objective and then by actively integrating it into the regional planning and control mechanism. The implications of this study can be useful to policy makers, professionals and managers, and will contribute to the understanding of how the management of variation can be implemented with performance measurements and financial incentives. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  6. Public-Privat e Partnership in the System of Regional Healthcare Financing

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    Margarita Yur’evna Molchanova

    2016-05-01

    Full Text Available Healthcare financing reform in the Russian Federation, besides its positive consequences, has led to the emergence of several major organizational and economic problems that hinder the expansion of financing sources for this sphere, which also involves public-private partnership (PPP. The paper highlights the regional specifics of such healthcare projects compared to similar projects of other spheres of the national economy. The author describes the problems of PPP projects implementation in healthcare; they include the insufficiency of substantiation of public-private partnership application in healthcare, and the absence of typical models for establishment of relations between PPP participants. The paper presents the healthcare priorities put forward by the author; these priorities are based on the theory of the life cycle of a service. The author presents her own model for organizing a regional concession, which is the most common form of public-private partnership in healthcare so far. The cluster brings together on a voluntary basis the legally independent organizations that are interested in improving the quality and increasing the accessibility of health services. These can include medical institutions of various forms of ownership located in the region, clinics, facilities, institutions that train healthcare workers, authorities, etc. The author shows that a favorable environment for the formation and implementation of PPP projects can be created under the cluster approach to the organization of healthcare. When establishing the medical cluster, the main task is to organize interaction between all its subjects in the interest of the overall development of healthcare in the region and the implementation of one’s own interests

  7. Pittsburgh Regional Healthcare Initiative puts new spin on improving healthcare quality.

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    2002-11-01

    For nearly 4 years, the Pittsburgh Regional Healthcare Initiative (PRHI) has been working to improve the way healthcare is delivered in southwestern Pennsylvania by combining the voices and resources of hospitals, providers, the business community, insurers, health plans, and federal agencies. As one example of borrowing from business, the PRHI has created a new learning and management system, called Perfecting Patient Care, which is based on the Toyota Production System model and is now being used successfully in hospitals.

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

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    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

  9. The Regional Healthcare Ecosystem Analyst (RHEA): a simulation modeling tool to assist infectious disease control in a health system.

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    Lee, Bruce Y; Wong, Kim F; Bartsch, Sarah M; Yilmaz, S Levent; Avery, Taliser R; Brown, Shawn T; Song, Yeohan; Singh, Ashima; Kim, Diane S; Huang, Susan S

    2013-06-01

    As healthcare systems continue to expand and interconnect with each other through patient sharing, administrators, policy makers, infection control specialists, and other decision makers may have to take account of the entire healthcare 'ecosystem' in infection control. We developed a software tool, the Regional Healthcare Ecosystem Analyst (RHEA), that can accept user-inputted data to rapidly create a detailed agent-based simulation model (ABM) of the healthcare ecosystem (ie, all healthcare facilities, their adjoining community, and patient flow among the facilities) of any region to better understand the spread and control of infectious diseases. To demonstrate RHEA's capabilities, we fed extensive data from Orange County, California, USA, into RHEA to create an ABM of a healthcare ecosystem and simulate the spread and control of methicillin-resistant Staphylococcus aureus. Various experiments explored the effects of changing different parameters (eg, degree of transmission, length of stay, and bed capacity). Our model emphasizes how individual healthcare facilities are components of integrated and dynamic networks connected via patient movement and how occurrences in one healthcare facility may affect many other healthcare facilities. A decision maker can utilize RHEA to generate a detailed ABM of any healthcare system of interest, which in turn can serve as a virtual laboratory to test different policies and interventions.

  10. The healthcare system and the provision of oral healthcare in European Union member states. Part 8: Italy.

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    Bindi, M; Paganelli, C; Eaton, K A; Widström, E

    2017-05-26

    In Italy healthcare is provided for all Italian citizens and residents and it is delivered mainly by public providers, with some private or private-public entities. Italy's public healthcare system - the Servizio Sanitario Nazionale (SSN) - is organised by the Ministry of Health and administered on a devolved regional basis. It is financed by general taxation that provides universal coverage, largely free of charge at the point of service. The central government establishes the basic national health benefits package, which must be uniformly provided throughout the country, through services guaranteed under the NHS provision called LEA - (Livelli Essenziali di Assistenza [Essential Level of Assistance]) and allocates national funds to the regions. The regions, through their regional health departments, are responsible for organising, administering and delivering primary, secondary and tertiary healthcare services as well as preventive and health promotion services. Regions are allowed a large degree of autonomy in how they perform this role and regarding decisions about the local structure of the system. Complementary and supplementary private health insurance is also available. However, as in most other Mediterranean European countries, in Italy oral healthcare is mainly provided under private arrangements. The public healthcare system provides only 5-8% of oral healthcare services and this percentage varies from region to region. Oral healthcare is included in the Legislation on Essential levels of care (LEAs) for specific populations such as children, vulnerable people (medically compromised and those on low income) and individuals who need oral healthcare in some urgent/emergency cases. For other people, oral healthcare is generally not covered. Apart from the national benefits package, regions may also carry out their own initiatives autonomously, but must finance these themselves. The number of dentists working in Italy has grown rapidly in the last few years

  11. Creating a Regional Healthcare Network: People First.

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    Michel-Verkerke, Margreet B

    2016-01-01

    Care organizations in the Dutch region Apeldoorn want to collaborate more in order to improve the care provision to elderly and psychiatric patients living independently. In order to support the collaboration they intend to create a regional digital healthcare network. The research was focused on the relevance of a regional healthcare network for care providers. Eleven semi-structured interviews based on the USE IT-model, were conducted with care providers and staff members. Results show that care providers need to tune their activities for this target group and create an agreement on integrated care. The relevance of a digital communication and collaboration platform is high. The regional healthcare network should support the collaboration between care providers by: 1. Offering a communication platform to replace the time consuming communication by telephone; 2. Making patient information available for patient and care provider at patients' homes; 3. Giving insight in who is giving what care to whom; and 4. Giving access to knowledge about the target group: elderly and psychiatric patients living independently.

  12. iMAGE cloud: medical image processing as a service for regional healthcare in a hybrid cloud environment.

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    Liu, Li; Chen, Weiping; Nie, Min; Zhang, Fengjuan; Wang, Yu; He, Ailing; Wang, Xiaonan; Yan, Gen

    2016-11-01

    To handle the emergence of the regional healthcare ecosystem, physicians and surgeons in various departments and healthcare institutions must process medical images securely, conveniently, and efficiently, and must integrate them with electronic medical records (EMRs). In this manuscript, we propose a software as a service (SaaS) cloud called the iMAGE cloud. A three-layer hybrid cloud was created to provide medical image processing services in the smart city of Wuxi, China, in April 2015. In the first step, medical images and EMR data were received and integrated via the hybrid regional healthcare network. Then, traditional and advanced image processing functions were proposed and computed in a unified manner in the high-performance cloud units. Finally, the image processing results were delivered to regional users using the virtual desktop infrastructure (VDI) technology. Security infrastructure was also taken into consideration. Integrated information query and many advanced medical image processing functions-such as coronary extraction, pulmonary reconstruction, vascular extraction, intelligent detection of pulmonary nodules, image fusion, and 3D printing-were available to local physicians and surgeons in various departments and healthcare institutions. Implementation results indicate that the iMAGE cloud can provide convenient, efficient, compatible, and secure medical image processing services in regional healthcare networks. The iMAGE cloud has been proven to be valuable in applications in the regional healthcare system, and it could have a promising future in the healthcare system worldwide.

  13. Web-based integrated public healthcare information system of Korea: development and performance.

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

    2013-12-01

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

  14. HEALTHCARE QUALITY AND ITS EFFECTS ON GROWTH. A REGIONAL ANALYSIS

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    Ana Iolanda VODA

    2015-11-01

    Full Text Available The purpose of our paper is to analyse the relation between the inequalities of the healthcare system and economic growth. With respect to methodology, we focus on the eight development regions of Romania which group counties with different development levels and complementary economies. By using descriptive and comparative analyses, we aim at highlighting the discrepancies of the Romanian system considering the following indicators: life expectancy at birth (years, standardised death rate, all causes of death per 100 000 inhabitants, infant mortality, physicians or doctors (per 100000 inhabitants, dentists (per 100000 inhabitants, number of nurses (per 100000 inhabitants, available beds in hospitals, number of hospitals available in the regions and family care units.

  15. The Cuban National Healthcare System: Characterization of primary healthcare services.

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    Keli Regina DAL PRÁ

    2015-10-01

    Full Text Available This article presents a report on the experience of healthcare professionals in Florianópolis, who took the course La Atención Primaria de Salud y la Medicina Familiar en Cuba [Primary Healthcare and Family Medicine in Cuba], in 2014. The purpose of the study is to characterize the healthcare units and services provided by the Cuban National Healthcare System (SNS and to reflect on this experience/immersion, particularly on Cuba’s Primary Healthcare Service. The results found that in comparison with Brazil’s Single Healthcare System (SUS Cuba’s SNS Family Healthcare (SF service is the central organizing element of the Primary Healthcare Service. The number of SF teams per inhabitant is different than in Brazil; the programs given priority in the APS are similar to those in Brazil and the intersectorial nature and scope of the services prove to be effective in the resolution of healthcare problems.

  16. Romanian healthcare system at a glance

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    Christiana Balan

    2013-04-01

    Full Text Available The Romanian healthcare system is facing constant challenges to produce high quality care with low costs. Objectives The paper aims to analyze the efficiency of the Romanian healthcare system in terms of resources allocation. The evaluation and the dimension of healthcare system efficiency are important for identifying a balance between the resources required and the health outcomes. Prior Work Previous studies describe the Romanian healthcare system as a system in transition. This study focuses on the relationship between the inputs and outputs of the system. Approach In order to assess the efficiency of the Romanian healthcare system we use Data Envelopment Analysis approach. Both input and output healthcare indicators are observed for the period 1999-2010 and the years when healthcare inputs have been used efficiently are identified. Results The results show that human, financial, and technological resources have been used at maximum capacity in 1999, 2003, 2004, 2007 and 2010. Implications Though efficiency is defined differently by diverse stakeholders, healthcare policies should focus on rising the responsibility of communities and individuals for better treatments and services and better access to information on healthcare providers. Value The paper is an empirically based study of the healthcare resources allocation in Romania.

  17. Healthcare Firms and the ERP Systems

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    A. Garefalakis

    2016-04-01

    Full Text Available With the continuous and drastic changes due to the economic crisis, along with the increasing market demands, major reforms are initiated in the healthcare sector in order to improve the quality of healthcare and operational efficiency, while reducing costs and optimizing back-end operations. ERP systems have been the basic technological infrastructure to many sectors as well as healthcare. The main objective of this study is to discuss how the adoption of ERP systems in healthcare organizations improves their functionality, simplifies their business processes, assure the quality of care services and helps their management accounting and controlling. This study presents also the stages required for the implementation of ERP system in healthcare organizations. This study utilizes a literature review in order to reach the research conclusions. Specifically, through related case studies and research, it examines how ERP systems are used to evaluate the better functionality of the healthcare organizations, addressing in parallel important problems, and possible malfunctions. The implementation of ERP systems in healthcare organizations promises to evolve and align strictly to the organizations’ corporate objectives and high-levels of healthcare quality. In order to accomplish this goal, the right decisions should be made by the managers of the healthcare organization regarding the choice of the appropriate ERP system following its installation and its application. Limited research exists on the significance ERP systems implementation in healthcare organizations, while possible dysfunctions and challenges during its installation and implementation are recorded. Therefore, new evidence in the significance of ERP systems in healthcare organization is provided.

  18. Architecture of personal healthcare information system in ubiquitous healthcare

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    Bhardwaj, S.; Sain, M.; Lee, H.-J.; Chung, W.Y.; Slezak, D.; et al., xx

    2009-01-01

    Due to recent development in Ubiquitous Healthcare now it’s time to build such application which can work independently and with less interference of Physician. In this paper we are try to build the whole architecture of personal Healthcare information system for ubiquitous healthcare which also

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

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    Durrani, Hammad

    2016-01-01

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

  20. Information resources assessment of a healthcare integrated delivery system.

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    Gadd, C. S.; Friedman, C. P.; Douglas, G.; Miller, D. J.

    1999-01-01

    While clinical healthcare systems may have lagged behind computer applications in other fields in the shift from mainframes to client-server architectures, the rapid deployment of newer applications is closing that gap. Organizations considering the transition to client-server must identify and position themselves to provide the resources necessary to implement and support the infrastructure requirements of client-server architectures and to manage the accelerated complexity at the desktop, including hardware and software deployment, training, and maintenance needs. This paper describes an information resources assessment of the recently aligned Pennsylvania regional Veterans Administration Stars and Stripes Health Network (VISN4), in anticipation of the shift from a predominantly mainframe to a client-server information systems architecture in its well-established VistA clinical information system. The multimethod assessment study is described here to demonstrate this approach and its value to regional healthcare networks undergoing organizational integration and/or significant information technology transformations. PMID:10566414

  1. Information resources assessment of a healthcare integrated delivery system.

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    Gadd, C S; Friedman, C P; Douglas, G; Miller, D J

    1999-01-01

    While clinical healthcare systems may have lagged behind computer applications in other fields in the shift from mainframes to client-server architectures, the rapid deployment of newer applications is closing that gap. Organizations considering the transition to client-server must identify and position themselves to provide the resources necessary to implement and support the infrastructure requirements of client-server architectures and to manage the accelerated complexity at the desktop, including hardware and software deployment, training, and maintenance needs. This paper describes an information resources assessment of the recently aligned Pennsylvania regional Veterans Administration Stars and Stripes Health Network (VISN4), in anticipation of the shift from a predominantly mainframe to a client-server information systems architecture in its well-established VistA clinical information system. The multimethod assessment study is described here to demonstrate this approach and its value to regional healthcare networks undergoing organizational integration and/or significant information technology transformations.

  2. The Construction of Social Rights and Healthcare Systems: the Challenges of Borders

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    Roser Pérez Jiménez

    2009-01-01

    Full Text Available This article presents the asymmetries between economic and social globalization, revealing the existing territorial inequalities in healthcare, as well as the rise of new demands with repercussion for social rights. The movements of capital and of productive processes take place in an intense manner, contrary to what occurs with the processes of social protection and healthcare, which continue to be limited to nation states. The initiatives in the countries of the European Union and Mercosur have not transcended isolated interventions, marked by the urgency of attention, and have not achieved the construction of rights on a regional level. The different healthcare systems and characteristics of coverage have not been placed in harmony, while there is a great diversity of attention to healthcare in the border regions. This is the case of the situations presented in the two regions in Spain, Estremadura and Catalunha, and in the region of the Brazil, Argentina and Paraguay border – in the cities of Foz de Iguaçu, Porto Iguaçu and Cidade do Leste.

  3. Interorganisational Integration: Healthcare Professionals’ Perspectives on Barriers and Facilitators within the Danish Healthcare System

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    Anne Marie Lyngsø

    2016-03-01

    Full Text Available Introduction: Despite many initiatives to improve coordination of patient pathways and intersectoral cooperation, Danish health care is still fragmented, lacking intra- and interorganisational integration. This study explores barriers to and facilitators of interorganisational integration as perceived by healthcare professionals caring for patients with chronic obstructive pulmonary disease within the Danish healthcare system. Methods: Seven focus groups were conducted in January through July 2014 with 21 informants from general practice, local healthcare centres and a pulmonary department at a university hospital in the Capital Region of Denmark. Results and discussion: Our results can be grouped into five influencing areas for interorganisational integration: communication/information transfer, committed leadership, patient engagement, the role and competencies of the general practitioner and organisational culture. Proposed solutions to barriers in each area hold the potential to improve care integration as experienced by individuals responsible for supporting and facilitating it. Barriers and facilitators to integrating care relate to clinical, professional, functional and normative integration. Especially, clinical, functional and normative integration seems fundamental to developing integrated care in practice from the perspective of healthcare professionals.

  4. Using key performance indicators as knowledge-management tools at a regional health-care authority level.

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    Berler, Alexander; Pavlopoulos, Sotiris; Koutsouris, Dimitris

    2005-06-01

    The advantages of the introduction of information and communication technologies in the complex health-care sector are already well-known and well-stated in the past. It is, nevertheless, paradoxical that although the medical community has embraced with satisfaction most of the technological discoveries allowing the improvement in patient care, this has not happened when talking about health-care informatics. Taking the above issue of concern, our work proposes an information model for knowledge management (KM) based upon the use of key performance indicators (KPIs) in health-care systems. Based upon the use of the balanced scorecard (BSC) framework (Kaplan/Norton) and quality assurance techniques in health care (Donabedian), this paper is proposing a patient journey centered approach that drives information flow at all levels of the day-to-day process of delivering effective and managed care, toward information assessment and knowledge discovery. In order to persuade health-care decision-makers to assess the added value of KM tools, those should be used to propose new performance measurement and performance management techniques at all levels of a health-care system. The proposed KPIs are forming a complete set of metrics that enable the performance management of a regional health-care system. In addition, the performance framework established is technically applied by the use of state-of-the-art KM tools such as data warehouses and business intelligence information systems. In that sense, the proposed infrastructure is, technologically speaking, an important KM tool that enables knowledge sharing amongst various health-care stakeholders and between different health-care groups. The use of BSC is an enabling framework toward a KM strategy in health care.

  5. Healthcare Strategic Planning as Part of National and Regional Development in the Israeli Galilee: A Case Study of the Planning Process.

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    Peled, Ronit; Schenirer, Jerry

    2009-10-01

    This article describes a systematic process of geographic and strategic planning for healthcare services as a part of a regional development plan in the Israeli Galilee. The planning process consisted of three stages: (a) assessment of needs, demand and existing resources; (b) prioritisation of initiatives; and (c) scheduling of theoretical priorities. For many years the region has suffered from inequities and inequalities regarding the availability and accessibility of a regional healthcare system, resulting in high mortality and morbidity rates and low quality of life. The aim of the healthcare strategic plan was to suggest initiatives and actions to be taken in order to improve healthcare provision and the health and wellbeing of local residents.

  6. Pervasive mobile healthcare systems for chronic disease monitoring.

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    Huzooree, Geshwaree; Kumar Khedo, Kavi; Joonas, Noorjehan

    2017-05-01

    Pervasive mobile healthcare system has the potential to improve healthcare and the quality of life of chronic disease patients through continuous monitoring. Recently, many articles related to pervasive mobile healthcare system focusing on health monitoring using wireless technologies have been published. The main aim of this review is to evaluate the state-of-the-art pervasive mobile healthcare systems to identify major technical requirements and design challenges associated with the realization of a pervasive mobile healthcare system. A systematic literature review was conducted over IEEE Xplore Digital Library to evaluate 20 pervasive mobile healthcare systems out of 683 articles from 2011 to 2016. The classification of the pervasive mobile healthcare systems and other important factors are discussed. Potential opportunities and challenges are pointed out for the further deployment of effective pervasive mobile healthcare systems. This article helps researchers in health informatics to have a holistic view toward understanding pervasive mobile healthcare systems and points out new technological trends and design challenges that researchers have to consider when designing such systems for better adoption, usability, and seamless integration.

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

    Science.gov (United States)

    Pedroso, Marcelo Caldeira; Malik, Ana Maria

    2012-10-01

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

  8. The Role of Corruption and Healthcare Expenditure in Healthcare Systems of the Persian Gulf Region

    Directory of Open Access Journals (Sweden)

    Maryam Asghari

    2016-06-01

    Full Text Available Background and Purpose: More than a third of the world’s population lack access to essential medicines, despite the presence of several international agreements that proclaim health as a human right. Corruption, in its many forms, such as bribery and embezzlement, causes several detrimental effects on the health sector and access to medicines including economic, health, and government image and trust issues. Global health corruption remains a serious, ongoing, and under-recognized threat to global health progress. This paper aim is examination how global corruption and health-care expenditure (HE affect health statue in the Persian Gulf countries over 1980-2014 and what can be done to combat corruption in the health sector. Materials and Methods: This study is an experimental and applied research. To verify the consistency of the results of the model, this study used the appropriate panel data analysis methods such as feasible general least square method for the nine Persian Gulf countries over 1980-2014. I employ different panel data procedures to avoid estimation problems, namely, autocorrelation and heteroskedasticity. The used package id Stata version 14. Results: The level of gross domestic product per capita, the level of corruption in the country, per capita HE, the quality of air and water, population density levels have negative effect on region people’s life expectancy, but the index of environmental policy and the education, measured as years of education obtained, have positive effect on region people’s life expectancy over 1980-2014. Conclusion: The results indicate that corruption and HE have negative effect on the Persian Gulf region people‘s life expectancy.

  9. Activity System Theory Approach to Healthcare Information System

    OpenAIRE

    Bai, Guohua

    2004-01-01

    Healthcare information system is a very complex system and has to be approached from systematic perspectives. This paper presents an Activity System Theory (ATS) approach by integrating system thinking and social psychology. First part of the paper, the activity system theory is presented, especially a recursive model of human activity system is introduced. A project ‘Integrated Mobile Information System for Diabetic Healthcare (IMIS)’ is then used to demonstrate a practical application of th...

  10. An assessment of Regional and Gender equity in healthcare ...

    African Journals Online (AJOL)

    The study assesses regional and gender equity in healthcare coverage under two different ... 1Department of Geography and Resource Development ...... government budgets, 3) innovative financing and, 4) development assistance for health; ...

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

    Science.gov (United States)

    Juhnke, Christin; Mühlbacher, Axel C

    2013-01-01

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

  12. Patient-centeredness in Integrated healthcare delivery systems - Needs, expectations and priorities for organized healthcare systems

    Directory of Open Access Journals (Sweden)

    Christin Juhnke

    2013-11-01

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

  13. Patient-centeredness in Integrated healthcare delivery systems - Needs, expectations and priorities for organized healthcare systems

    Directory of Open Access Journals (Sweden)

    Christin Juhnke

    2013-11-01

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

  14. Concepts and trends in healthcare information systems

    CERN Document Server

    Koutsouris, Dionysios-Dimitrios

    2014-01-01

    ​Concepts and Trends in Healthcare Information Systems covers the latest research topics in the field from leading researchers and practitioners. This book offers theory-driven research that explores the role of Information Systems in the delivery of healthcare in its diverse organizational and regulatory settings. In addition to the embedded role of Information Technology (IT) in clinical and diagnostics equipment, Information Systems are uniquely positioned to capture, store, process, and communicate timely information to decision makers for better coordination of healthcare at both the individual and population levels. For example, data mining and decision support capabilities can identify potential adverse events for an individual patient while also contributing to the population's health by providing insights into the causes of disease complications. Information systems have great potential to reduce healthcare costs and improve outcomes. The healthcare delivery systems share similar characteristics w...

  15. Implications of climate change (global warming) for the healthcare system.

    Science.gov (United States)

    Raffa, R B; Eltoukhy, N S; Raffa, K F

    2012-10-01

    Temperature-sensitive pathogenic species and their vectors and hosts are emerging in previously colder regions as a consequence of several factors, including global warming. As a result, an increasing number of people will be exposed to pathogens against which they have not previously needed defences. We illustrate this with a specific example of recent emergence of Cryptococcus gattii infections in more temperate climates. The outbreaks in more temperate climates of the highly virulent--but usually tropically restricted--C. gattii is illustrative of an anticipated growing challenge for the healthcare system. There is a need for preparedness by healthcare professionals in anticipation and for management of such outbreaks, including other infections whose recent increased prevalence in temperate climates can be at least partly associated with global warming. (Re)emergence of temperature-sensitive pathogenic species in more temperate climates will present new challenges for healthcare systems. Preparation for outbreaks should precede their occurrence. © 2012 Blackwell Publishing Ltd.

  16. Systems design for remote healthcare

    CERN Document Server

    Bonfiglio, Silvio

    2014-01-01

    This book provides a multidisciplinary overview of the design and implementation of systems for remote patient monitoring and healthcare. Readers are guided step-by-step through the components of such a system and shown how they could be integrated in a coherent framework for deployment in practice. The authors explain planning from subsystem design to complete integration and deployment, given particular application constraints. Readers will benefit from descriptions of the clinical requirements underpinning the entire application scenario, physiological parameter sensing techniques, information processing approaches and overall, application dependent system integration. Each chapter ends with a discussion of practical design challenges and two case studies are included to provide practical examples and design methods for two remote healthcare systems with different needs. ·         Provides a multi-disciplinary overview of next-generation mobile healthcare system design; ·         Includes...

  17. INVESTMENTS AS A FACTOR OF STABILITY OF THE RUSSIAN HEALTHCARE SYSTEM

    Directory of Open Access Journals (Sweden)

    Lyudmila Valentinovna Tokun

    2016-01-01

    Full Text Available In this article the author examines the structure of public expenditure on health in Russia and analyzes the adequacy of the investments in the health system. Goal / Objectives. The aim of this article is to analyze the expenses of the project “Development strategy of the Russian healthcare system for the long-term period 2015–2030”. The main objectives of this article are the definition of the technical condition of the buildings and improvement of health facilities, evaluation of the value of fixed assets in the healthcare and medical equipment depreciation, evaluation of tariff s in the compulsory health insurance system. Methodology. the method of comparative analysis of 10 past years indicators is used in this article Results. From 2005 to 2014 healthcare expenditures have increased 3 times, which is comparable to GDP growth. In the same period, investments in health have increased by 2 times. The main increase in expenditures occurred in the wages. These trends may indicate a lack of attention in relation to fixed assets. In relation to the renovation and the depreciation factor, rate of growth and the level of investment cast doubt on the adequacy and sustainability of the healthcare’s material basis for the provision of necessary medical assistance. It is required to calculate the standard, which includes continuous updating of fixed assets based on the each region of RF, depending on the regional characteristics and the structure of fixed assets. Conclusions / Significance. The study concluded that at the moment the size of the annual investment in health by the federal and regional budgets do not meet the needs of even simple reproduction, not to mention the modernization and development. Planning budget investment requirements can be carried out based on a special standard ratio, which takes into account the volume, composition and structure of fixed assets. Financial stability of the Russian healthcare depends not only on

  18. Awareness of the healthcare system and rights to healthcare in the Colombian population.

    Science.gov (United States)

    Delgado Gallego, María Eugenia; Vázquez-Navarrete, María Luisa

    2013-01-01

    To analyze changes in users' awareness of the healthcare system and of their rights to healthcare in Colombia in the last 10 years, as well as the factors that influence users' awareness. We carried out a descriptive study to compare the results of two cross-sectional studies based on two surveys of users of the Colombian healthcare system. The first survey was performed in 2000 and the second in 2010. The municipalities of Tuluá (urban area) and Palmira (rural area) were surveyed. In both surveys, a stratified, multistage probability sample was selected. There were 1497 users in the first sample and 1405 in the second. Changes in awareness of the healthcare system and associated factors in each year were assessed through multivariate logistic regressions. Users' awareness of the healthcare system was limited in 2000 and was significantly lower in 2010, except for that relating to health insurers and providers. In contrast, more than 90% of users in both surveys perceived themselves as having healthcare rights. The factors consistently associated with greater awareness were belonging to a high socioeconomic stratum and having higher education. The most underprivileged users were less likely to be aware of the healthcare system, hampering their ability to make informed decisions and to exercise their health rights. To correct this situation, health institutions and the government should act decisively to reduce social inequalities. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

  19. Behavioral Reference Model for Pervasive Healthcare Systems.

    Science.gov (United States)

    Tahmasbi, Arezoo; Adabi, Sahar; Rezaee, Ali

    2016-12-01

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

  20. The Integration of Two Healthcare Systems: A Common Healthcare Problem.

    Science.gov (United States)

    Cassatly, Hannah; Cassatly, Michael

    2015-01-01

    The change in reimbursement mandated by the Affordable Care Act is causing a rapid consolidation of the marketplace as well as the delivery of clinical care in a team-based model. This case report examines the successful joining of two clinical teams concurrent with the merger of two healthcare organizations and discusses some of the difficulties encountered. A subsequent discussion focuses on the resolution: the need for physicians to embrace the team concept of healthcare delivery and for healthcare systems to facilitate this transition with team and leadership coaching.

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

    Science.gov (United States)

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

    2016-07-01

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

  2. An evolving systems-based methodology for healthcare planning.

    Science.gov (United States)

    Warwick, Jon; Bell, Gary

    2007-01-01

    Healthcare planning seems beset with problems at all hierarchical levels. These are caused by the 'soft' nature of many of the issues present in healthcare planning and the high levels of complexity inherent in healthcare services. There has, in recent years, been a move to utilize systems thinking ideas in an effort to gain a better understanding of the forces at work within the healthcare environment and these have had some success. This paper argues that systems-based methodologies can be further enhanced by metrication and modeling which assist in exploring the changed emergent behavior of a system resulting from management intervention. The paper describes the Holon Framework as an evolving systems-based approach that has been used to help clients understand complex systems (in the education domain) that would have application in the analysis of healthcare problems.

  3. Healthcare waste management practice in the West Black Sea Region, Turkey: A comparative analysis with the developed and developing countries.

    Science.gov (United States)

    Ciplak, Nesli; Kaskun, Songul

    2015-12-01

    The need for proper healthcare waste management has been a crucial issue in many developing countries as it is in Turkey. The regulation regarding healthcare wastes in Turkey was updated in 2005 in accordance with the European Union (EU) waste directives, but it still falls behind meeting the requirements of current waste treatment technologies. Therefore, this study aims to reveal deficiencies, inconsistencies, and improper applications of healthcare waste management in the western part of the Turkish Black Sea Region. In this study, it was revealed that nearly 1 million people live in the region, resulting in 5 million hospital admissions annually. All the healthcare waste produced (1000 tons yr(-1)) is treated in an autoclave plant. However, treating some categories of healthcare wastes in autoclave units mismatches with the EU waste regulations, as alternative treatment technologies are not technically able to treat all types of healthcare wastes. A proper waste management system, therefore, requires an internal segregation scheme to divert these wastes from the main healthcare waste stream. The existing malpractice in the region could cause serious health problems if no measure is taken urgently. It is expected that healthcare waste management in the region and then all across Turkey will be improved with the significant deficiencies and inconsistencies pointed out in this research. In developed countries, specific rules and regulations have already been implemented along with the recommendations for handling of healthcare waste. However, in Turkey, these wastes are treated in autoclave units, which mismatches with the European Union waste regulations, as alternative treatment technologies are not technically capable to treat all types of healthcare wastes. The existing malpractice could cause serious health problems if no measure is taken urgently. The authors demonstrated the existing status of Turkish waste management and revealed deficiencies

  4. Some perspectives on affordable healthcare systems in China.

    Science.gov (United States)

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

    2007-01-01

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

  5. Strategic alliances in healthcare: opportunities for the Veterans Affairs healthcare system.

    Science.gov (United States)

    Halverson, P K; Kaluzny, A D; Young, G J

    1997-01-01

    Strategic alliances are proving to be effective strategies for responding and adapting to changing environments, and as such they offer the U.S. Department of Veterans Affairs (VA) healthcare system valuable opportunities for accomplishing the goals of its major reorganization effort. This article begins with an examination of basic strategic-alliance structures that are employed across many different types of industries. Next, consideration is given to the ways in which these basic alliance structures may be adapted to the unique organizations and individuals that serve as providers, purchasers, and consumers of health services. Finally, this article explores how models of strategic alliance in healthcare can be tailored to the specific needs and constraints of the VA healthcare system through an examination of existing and potential alliance opportunities.

  6. Examining quality and efficiency of the U.S. healthcare system.

    Science.gov (United States)

    Kumar, Sameer; Ghildayal, Neha S; Shah, Ronak N

    2011-01-01

    The fundamental concern of this research study is to learn the quality and efficiency of U.S. healthcare services. It seeks to examine the impact of quality and efficiency on various stakeholders to achieve the best value for each dollar spent for healthcare. The study aims to offer insights on quality reformation efforts, contemporary healthcare policy and a forthcoming change shaped by the Federal healthcare fiscal policy and to recommend the improvement objective by comparing the U.S. healthcare system with those of other developed nations. The US healthcare system is examined utilizing various data on recent trends in: spending, budgetary implications, economic indicators, i.e., GDP, inflation, wage and population growth. Process maps, cause and effect diagrams and descriptive data statistics are utilized to understand the various drivers that influence the rising healthcare cost. A proposed cause and effect diagram is presented to offer potential solutions, for significant improvement in U.S. healthcare. At present, the US healthcare system is of vital interest to the nation's economy and government policy (spending). The U.S. healthcare system is characterized as the world's most expensive yet least effective compared with other nations. Growing healthcare costs have made millions of citizens vulnerable. Major drivers of the healthcare costs are institutionalized medical practices and reimbursement policies, technology-induced costs and consumer behavior. Reviewing many articles, congressional reports, internet websites and related material, a simplified process map of the US healthcare system is presented. The financial process map is also created to further understand the overall process that connects the stakeholders in the healthcare system. Factors impacting healthcare are presented by a cause and effect diagram to further simplify the complexities of healthcare. This tool can also be used as a guide to improve efficiency by removing the "waste" from the

  7. Geographic variation in Medicare and the military healthcare system.

    Science.gov (United States)

    Adesoye, Taiwo; Kimsey, Linda G; Lipsitz, Stuart R; Nguyen, Louis L; Goodney, Philip; Olaiya, Samuel; Weissman, Joel S

    2017-08-01

    To compare geographic variation in healthcare spending and utilization between the Military Health System (MHS) and Medicare across hospital referral regions (HRRs). Retrospective analysis. Data on age-, sex-, and race-adjusted Medicare per capita expenditure and utilization measures by HRR were obtained from the Dartmouth Atlas for 2007 to 2010. Similarly, adjusted data from 2007 and 2010 were obtained from the MHS Data Repository and patients assigned to HRRs. We compared high- and low-spending regions, and computed coefficient of variation (CoV) and correlation coefficients for healthcare spending, hospital inpatient days, hip surgery, and back surgery between MHS and Medicare patients. We found significant variation in spending and utilization across HRRs in both the MHS and Medicare. CoV for spending was higher in the MHS compared with Medicare, (0.24 vs 0.15, respectively) and CoV for inpatient days was 0.36 in the MHS versus 0.19 in Medicare. The CoV for back surgery was also greater in the MHS compared with Medicare (0.47 vs 0.29, respectively). Per capita Medicare spending per HRR was significantly correlated to adjusted MHS spending (r = 0.3; P spending markets in both systems were not comparable; lower spending markets were located mostly in the Midwest. In comparing 2 systems with similar pricing schemes, differences in spending likely reflect variation in utilization and the influence of local provider culture.

  8. Toward a Nationwide Mobile-Based Public Healthcare Service System with Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Chien-wen Shen

    2016-01-01

    Full Text Available This paper describes the development of a nationwide public healthcare service system with the integration of cloud technology, wireless sensor networks, and mobile technology to provide citizens with convenient and professional healthcare services. The basic framework of the system includes the architectures for the user end of wireless physiological examinations, for the regional healthcare cloud, and for national public healthcare service system. Citizens with chronic conditions or elderly people who are living alone can use the wireless physiological sensing devices to keep track of their health conditions and get warning if the system detects abnormal signals. Through mobile devices, citizens are able to get real-time health advice, prompt warning, health information, feedback, personalized support, and intervention ubiquitously. With the long-term tracking data for physiological sensing, reliable prediction models for epidemic diseases and chronic diseases can be developed for the government to respond to and control diseases immediately. Besides, such a nationwide approach enables government to have a holistic understanding of the public health information in real time, which is helpful to establish effective policies or strategies to prevent epidemic diseases or chronic diseases.

  9. Performance comparison among the major healthcare financing systems in six cities of the Pearl River Delta region, mainland China.

    Directory of Open Access Journals (Sweden)

    Martin C S Wong

    Full Text Available BACKGROUND: The healthcare system of mainland China is undergoing drastic reform and the optimal models for healthcare financing for provision of primary care will need to be identified. This study compared the performance indicators of the community health centres (CHCs under different healthcare financing systems in the six cities of the Pearl River Delta region. METHODS: Approximately 300 hypertensive patients were randomly recruited from the computerized chronic disease management records provided by one CHC in each of the six cities in 2011 using a multi-stage cluster random sampling method. The major outcome measures included the treatment rate of hypertension, defined as prescription of ≥ one antihypertensive agent; and the control rate of hypertension, defined as systolic blood pressure levels <140 mmHg and diastolic blood pressure levels <90 mmHg in patients without diabetes mellitus, or <130/80 mmHg among patients with concomitant diabetes. Binary logistic regression analyses were conducted with these two measures as outcome variables, respectively, controlling for patients' socio-demographic variables. The financing system (Hospital- vs. Government- vs. private-funded was the independent variable tested for association with the outcomes. RESULTS: From 1,830 patients with an average age of 65.9 years (SD 12.8, the overall treatment and control rates were 75.4% and 20.2%, respectively. When compared with hospital-funded CHCs, patients seen in the Government-funded (adjusted odds ratio [AOR] 0.462, 95% C.I. 0.325-0.656 and private-funded CHCs (AOR 0.031, 95% C.I. 0.019-0.052 were significantly less likely to be prescribed antihypertensive medication. However, the Government-funded CHC was more likely to have optimal BP control (AOR 1.628, 95% C.I. 1.157-2.291 whilst the privately-funded CHC was less likely to achieve BP control (AOR 0.146, 95% C.I. 0.069-0.310, irrespective of whether antihypertensive drugs were prescribed. CONCLUSIONS

  10. Measuring healthcare productivity - from unit to system level.

    Science.gov (United States)

    Kämäräinen, Vesa Johannes; Peltokorpi, Antti; Torkki, Paulus; Tallbacka, Kaj

    2016-04-18

    Purpose - Healthcare productivity is a growing issue in most Western countries where healthcare expenditure is rapidly increasing. Therefore, accurate productivity metrics are essential to avoid sub-optimization within a healthcare system. The purpose of this paper is to focus on healthcare production system productivity measurement. Design/methodology/approach - Traditionally, healthcare productivity has been studied and measured independently at the unit, organization and system level. Suggesting that productivity measurement should be done in different levels, while simultaneously linking productivity measurement to incentives, this study presents the challenges of productivity measurement at the different levels. The study introduces different methods to measure productivity in healthcare. In addition, it provides background information on the methods used to measure productivity and the parameters used in these methods. A pilot investigation of productivity measurement is used to illustrate the challenges of measurement, to test the developed measures and to prove the practical information for managers. Findings - The study introduces different approaches and methods to measure productivity in healthcare. Practical implications - A pilot investigation of productivity measurement is used to illustrate the challenges of measurement, to test the developed measures and to prove the practical benefits for managers. Originality/value - The authors focus on the measurement of the whole healthcare production system and try to avoid sub-optimization. Additionally considering an individual patient approach, productivity measurement is examined at the unit level, the organizational level and the system level.

  11. Accessibility and use of primary healthcare for immigrants living in the Niagara Region.

    Science.gov (United States)

    Lum, Irene D; Swartz, Rebecca H; Kwan, Matthew Y W

    2016-05-01

    Although the challenges of accessing and using primary healthcare for new immigrants to Canada have been fairly well documented, the focus has primarily been on large cities with significant immigrant populations. The experiences of immigrants living in smaller, less diverse urban centres remain largely unknown. The purpose of this study was to examine the lived experiences of immigrants living in a small urban centre with regards to the primary healthcare system. A total of 13 immigrants living in the Greater Niagara Region participated in semi-structured interviews. All interviews were recorded, transcribed, and then coded and analyzed for emergent themes using NVivo. Five factors were found to impact primary care access and use: lack of social contacts, lack of universal healthcare coverage during their initial arrival, language as a barrier, treatment preferences, and geographic distance to primary care. Overall findings suggest that immigrants moving to smaller areas such as the Niagara Region face similar barriers to primary care as those moving into large cities. Some barriers, however, appear to be specific to the context of smaller urban centres, further exacerbated by living in a small city due to a smaller immigrant population, fewer services for immigrants, and less diversity in practicing physicians. More research is required to understand the contextual factors inhibiting primary care access and use among immigrants moving to smaller urban centres, and determine effective strategies to overcome these barriers. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Forging a Frailty-Ready Healthcare System to Meet Population Ageing.

    Science.gov (United States)

    Lim, Wee Shiong; Wong, Sweet Fun; Leong, Ian; Choo, Philip; Pang, Weng Sun

    2017-11-24

    The beginning of the 21st century has seen health systems worldwide struggling to deliver quality healthcare amidst challenges posed by ageing populations. The increasing prevalence of frailty with older age and accompanying complexities in physical, cognitive, social and psychological dimensions renders the present modus operandi of fragmented, facility-centric, doctor-based, and illness-centered care delivery as clearly unsustainable. In line with the public health framework for action in the World Health Organization's World Health and Ageing Report, meeting these challenges will require a systemic reform of healthcare delivery that is integrated, patient-centric, team-based, and health-centered. These reforms can be achieved through building partnerships and relationships that engage, empower, and activate patients and their support systems. To meet the challenges of population ageing, Singapore has reorganised its public healthcare into regional healthcare systems (RHSs) aimed at improving population health and the experience of care, and reducing costs. This paper will describe initiatives within the RHS frameworks of the National Health Group (NHG) and the Alexandra Health System (AHS) to forge a frailty-ready healthcare system across the spectrum, which includes the well healthy ("living well"), the well unhealthy ("living with illness"), the unwell unhealthy ("living with frailty"), and the end-of-life (EoL) ("dying well"). For instance, the AHS has adopted a community-centered population health management strategy in older housing estates such as Yishun to build a geographically-based care ecosystem to support the self-management of chronic disease through projects such as "wellness kampungs" and "share-a-pot". A joint initiative by the Lien Foundation and Khoo Teck Puat Hospital aims to launch dementia-friendly communities across the island by building a network comprising community partners, businesses, and members of the public. At the National

  13. Consumer response to a report card comparing healthcare systems.

    Science.gov (United States)

    Braun, Barbara L; Kind, Elizabeth A; Fowles, Jinnet B; Suarez, Walter G

    2002-06-01

    Report cards to date have focused on quality of care in health plans rather than within healthcare delivery systems. The purpose of this study was to evaluate consumer response to the first healthcare system-level report card. Qualitative assessment of consumer response. We conducted 5 focus groups of community members to evaluate consumer response to the report card; 2 included community club members, 3 included community-dwelling retired persons. Discussions were audiotaped and transcribed; comments were categorized by topic area from the script, and common themes identified. Focus group participants, in general, were unaware of the current emphasis on medical quality improvement initiatives. However, they believed that the opinion that the descriptive clinic information and patient survey data contained in the report card would be most useful mainly for choosing a healthcare system if they were dissatisfied with current medical care, if their healthcare options changed, or if they were in poor health. Personal experience was considered a more trustworthy measure of healthcare quality than were patient survey results. Trustworthiness was perceived to be higher if the report card sponsor was not affiliated with the healthcare systems being evaluated. Participants also believed care system administrators should use the data to enact positive clinic-level and physician-level changes. Healthcare consumers appreciated the attention to patient experiences and supported healthcare quality improvement initiatives. Report cards were considered important for choosing a healthcare system in certain circumstances and for guiding quality improvement efforts at all levels.

  14. Engineering Value-Effective Healthcare Solutions: A Systems Design Perspective

    DEFF Research Database (Denmark)

    Patou, François; Maier, Anja

    2017-01-01

    Our modern healthcare systems commonly face an important dilemma. While they depend on innovation to provide continuously greater healthcare value, they also struggle financially with the burden of adopting a continuous flow of new products and services. Although several disruptive healthcare...... of Design for Evolvability and by elaborating on two examples: MRI systems and Point-of-Care in-vitro diagnostics solutions. We specifically argue that Design for Evolvability can realign the agendas of various healthcare stakeholders, serving both individual and national interests. We finally acknowledge...... the limitations of current engineering design practices and call for new theoretical and empirical research initiatives taking a systems perspective on healthcare product and service design....

  15. Mapping healthcare systems: a policy relevant analytic tool.

    Science.gov (United States)

    Sekhri Feachem, Neelam; Afshar, Ariana; Pruett, Cristina; Avanceña, Anton L V

    2017-07-01

    In the past decade, an international consensus on the value of well-functioning systems has driven considerable health systems research. This research falls into two broad categories. The first provides conceptual frameworks that take complex healthcare systems and create simplified constructs of interactions and functions. The second focuses on granular inputs and outputs. This paper presents a novel translational mapping tool - the University of California, San Francisco mapping tool (the Tool) - which bridges the gap between these two areas of research, creating a platform for multi-country comparative analysis. Using the Murray-Frenk framework, we create a macro-level representation of a country's structure, focusing on how it finances and delivers healthcare. The map visually depicts the fundamental policy questions in healthcare system design: funding sources and amount spent through each source, purchasers, populations covered, provider categories; and the relationship between these entities. We use the Tool to provide a macro-level comparative analysis of the structure of India's and Thailand's healthcare systems. As part of the systems strengthening arsenal, the Tool can stimulate debate about the merits and consequences of different healthcare systems structural designs, using a common framework that fosters multi-country comparative analyses. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

  16. Requirements for Interoperability in Healthcare Information Systems

    Directory of Open Access Journals (Sweden)

    Rita Noumeir

    2012-01-01

    Full Text Available Interoperability is a requirement for the successful deployment of Electronic Health Records (EHR. EHR improves the quality of healthcare by enabling access to all relevant information at the diagnostic decision moment, regardless of location. It is a system that results from the cooperation of several heterogeneous distributed subsystems that need to successfully exchange information relative to a specific healthcare process. This paper analyzes interoperability impediments in healthcare by first defining them and providing concrete healthcare examples, followed by discussion of how specifications can be defined and how verification can be conducted to eliminate those impediments and ensure interoperability in healthcare. This paper also analyzes how Integrating the Healthcare Enterprise (IHE has been successful in enabling interoperability, and identifies some neglected aspects that need attention.

  17. Efficiency vs Effectiveness: a Benchmarking Study on European Healthcare Systems

    Directory of Open Access Journals (Sweden)

    Corrado lo Storto

    2017-10-01

    Full Text Available ABSTRACT. This paper illustrates a benchmarking study concerning the healthcare systems in 32 European countries as of 2011 and 2014. Particularly, this study proposes a two-dimensional approach (efficiency/effectiveness models to evaluate the performance of national healthcare systems. Data Envelopment Analysis has been adopted to compute two performance indices, measuring efficiency and effectiveness of these healthcare systems. The results of the study emphasize that the national healthcare systems achieve different efficiency and effectiveness levels. Their performance indices are uncorrelated and behave differently over time, suggesting that there might be no real trade-off between them. The healthcare systems’ efficiencies remain generally stable, while the effectiveness values significantly improved from 2011 to 2014. However, comparing the efficiency and effectiveness scores, the authors identified a group of countries with the lowest performing healthcare systems that includes Ukraine, Bulgaria, Switzerland, Lithuania, and Romania. These countries need to implement healthcare reforms aimed at reducing resource intensity and increasing the quality of medical services. The results also showed the benefits of the proposed approach, which can help policy makers to identify shortcomings in national healthcare systems and justify the need for their reform.

  18. Healthcare system information at language schools for newly arrived immigrants

    DEFF Research Database (Denmark)

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

    2017-01-01

    a language school in Copenhagen in 2012 received either a course or written information on the Danish healthcare system and subsequently evaluated this quantitatively. Results: The evaluation revealed a positive appraisal of the course/information provided. Conclusion: In times of austerity, incorporating......Objective: In most European countries, immigrants do not systematically learn about the host countries’ healthcare system when arriving. This study investigated how newly arrived immigrants perceived the information they received about the Danish healthcare system. Method: Immigrants attending...... healthcare information into an already existing language programme may be pertinent for providing immigrants with knowledge on the healthcare system....

  19. Assessment and improvement of the Italian healthcare system: first evidence from a pilot national performance evaluation system.

    Science.gov (United States)

    Nuti, Sabina; Seghieri, Chiara; Vainieri, Milena; Zett, Silvia

    2012-01-01

    The Italian National Health System (NHS), established in 1978, follows a model similar to the Beveridge model developed by the British NHS (Beveridge 1942; Musgrove 2000). Like the British NHS, healthcare coverage for the Italian population is provided and financed by the government through taxes. Universal coverage provides uniform healthcare access to citizens and is the characteristic usually considered the added value of a welfare system financed by tax revenues. Nonetheless, in Italy the strong policy of decentralization, which has been taking place since the early 1990s, has gradually shifted powers from the state to the 21 Italian regions. Consequently, the state now retains limited supervisory control and continues to have overall responsibility for the NHS in order to ensure uniform and essential levels of health services across the country. In this context, it has become essential, both for the ministry and for regions, to adopt a common performance evaluation system (PES). This article reports the definition, implementation, and first evidences of a pilot PES at a national level. It shows how this PES can be viewed as a strategic tool supporting the Ministry of Health (MoH) in ensuring uniform levels of care for the population and assisting regional managers to evaluate performance in benchmarking. Finally, lessons for other health systems, based on the Italian experience, are provided.

  20. Exploring the Barriers: A Qualitative Study about the Experiences of Mid-SES Roma Navigating the Spanish Healthcare System.

    Science.gov (United States)

    Aiello, Emilia; Flecha, Ainhoa; Serradell, Olga

    2018-02-22

    Whereas the topic of the 'cultural sensitivity' of healthcare systems has been addressed extensively in the US and the UK, literature on the subject in most European countries, specifically looking at the situation of Roma, is still scarce. Drawing on qualitative research conducted mainly in the city of Barcelona under the communicative approach with Roma subjects who have stable socioeconomic positions and higher cultural capitals (end-users, professionals of the healthcare system, and key informants of a regional policy oriented to the improvement of Roma living conditions), the present study aims to fill this gap. We explore the barriers that the Roma face in accessing the healthcare system, reflecting on how these barriers are accentuated by the existing anti-Roma prejudices and institutional arrangements that do not account for minority cultures. Our results point out a series of obstacles at two levels, in the interaction with healthcare professionals, and in relation to existing institutional arrangements, which prevent Roma families from having equal access to the healthcare system. Education stands up as a mechanism to contest anti-Roma sentiments among healthcare professionals.

  1. Army Healthcare Enterprise Management System

    National Research Council Canada - National Science Library

    2001-01-01

    .... The complaint alleged that the Army Healthcare Enterprise Management System was not properly competed, potential conflicts of interest existed, and possible contract performance problems existed...

  2. System integrational and migrational concepts and methods within healthcare

    DEFF Research Database (Denmark)

    Endsleff, F; Loubjerg, P

    1997-01-01

    In this paper an overview and comparison of the basic concepts and methods behind different system integrational implementations is given, including the DHE, which is based on the coming Healthcare Information Systems Architecture pre-standard HISA, developed by CEN TC251. This standard and the DHE...... (Distributed Healthcare Environment) not only provides highly relevant standards, but also provides an efficient and well structured platform for Healthcare IT Systems....

  3. Regionalizing healthcare: a vision for transforming Lebanon into a regional academic hub

    Directory of Open Access Journals (Sweden)

    Akl Elie A

    2010-06-01

    Full Text Available Abstract Background Lebanon suffers from a large scale emigration of physicians coupled with an oversaturation of the physician job market. Lebanon is currently witnessing an expansion of its medical education capacity with the establishment of new private medical schools, raising the fears of a worsening market oversaturation. Discussion The neighboring Arabian Gulf countries are suffering from a serious shortage of clinicians and academicians. In spite of their enormous investments in educational, clinical and research collaborative initiatives with some of the most renowned North American medical schools and institutions, their ability to recruit and retain highly qualified clinicians and academicians remains a major challenge. Lebanese universities have the opportunity to establish triangular collaborations with the Gulf regional medical centers and their North American partners. They could achieve this goal by tapping into the globalized and high quality Lebanese physician workforce and consequently regionalize healthcare delivery in the Middle East. Summary By recruiting its globalized and high quality physician workforce to establish collaborations with the Gulf regional, Lebanon could become a regional "academic hub".

  4. Regionalizing healthcare: a vision for transforming Lebanon into a regional academic hub.

    Science.gov (United States)

    Badr, Kamal F; Akl, Elie A

    2010-06-16

    Lebanon suffers from a large scale emigration of physicians coupled with an oversaturation of the physician job market. Lebanon is currently witnessing an expansion of its medical education capacity with the establishment of new private medical schools, raising the fears of a worsening market oversaturation. The neighboring Arabian Gulf countries are suffering from a serious shortage of clinicians and academicians. In spite of their enormous investments in educational, clinical and research collaborative initiatives with some of the most renowned North American medical schools and institutions, their ability to recruit and retain highly qualified clinicians and academicians remains a major challenge. Lebanese universities have the opportunity to establish triangular collaborations with the Gulf regional medical centers and their North American partners. They could achieve this goal by tapping into the globalized and high quality Lebanese physician workforce and consequently regionalize healthcare delivery in the Middle East. By recruiting its globalized and high quality physician workforce to establish collaborations with the Gulf regional, Lebanon could become a regional "academic hub".

  5. Demand for private healthcare in a universal public healthcare system: empirical evidence from Sri Lanka.

    Science.gov (United States)

    Pallegedara, Asankha; Grimm, Michael

    2017-11-01

    This paper examines healthcare utilization behaviour in Sri Lanka with special emphasis on the choice between costly private and free public healthcare services. We use a data set that combines nationwide household survey data and district level healthcare supply data. Our findings suggest that even with universal public healthcare policy, richer people tend to use private sector healthcare services rather than public services. We also find significant regional and ethnic discrepancies in healthcare access bearing the risk of social tensions if these are further amplified. Latent class analysis shows in addition that the choice between private and public sector healthcare significantly differs between people with and without chronic diseases. We find in particular that chronically ill people rely for their day-to-day care on the public sector, but for their inpatient care they turn more often than non-chronically ill people to the private sector, implying an additional financial burden for the chronically ill. If the observed trend continues it may not only increase further the health-income gradient in Sri Lanka but also undermine the willingness of the middle class to pay taxes to finance public healthcare. © 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.

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

    Science.gov (United States)

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

    2016-03-11

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

  7. Knowledge management systems success in healthcare: Leadership matters.

    Science.gov (United States)

    Ali, Nor'ashikin; Tretiakov, Alexei; Whiddett, Dick; Hunter, Inga

    2017-01-01

    To deliver high-quality healthcare doctors need to access, interpret, and share appropriate and localised medical knowledge. Information technology is widely used to facilitate the management of this knowledge in healthcare organisations. The purpose of this study is to develop a knowledge management systems success model for healthcare organisations. A model was formulated by extending an existing generic knowledge management systems success model by including organisational and system factors relevant to healthcare. It was tested by using data obtained from 263 doctors working within two district health boards in New Zealand. Of the system factors, knowledge content quality was found to be particularly important for knowledge management systems success. Of the organisational factors, leadership was the most important, and more important than incentives. Leadership promoted knowledge management systems success primarily by positively affecting knowledge content quality. Leadership also promoted knowledge management use for retrieval, which should lead to the use of that better quality knowledge by the doctors, ultimately resulting in better outcomes for patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Diffusion and use of health technology assessment in policy making: what lessons for decentralised healthcare systems?

    Science.gov (United States)

    Ciani, Oriana; Tarricone, Rosanna; Torbica, Aleksandra

    2012-12-01

    The Italian National Healthcare System (NHS) is one of the most decentralised systems since the devolution reform approved in 2001. HTA is spreading as an important tool for decision-making processes both at central and local levels. The aims of this study were to review the state of the health technology assessment (HTA) programmes in Italy - with a focus on regional and central initiatives - and to discuss consequences of a multi-level structure of HTA agencies in highly regionalised healthcare systems. Our method combined documentary review with interviews. We reviewed scientific literature about HTA's activities in decentralised systems, legislative and administrative documents from national as well as regional authorities. Semi-structured interviews were conducted with 18 key individuals associated with HTA both at the national and regional levels. Data on HTA programmes implemented or under development in nine regions were collected and analysed according to key principles for the improved conduct of health technology assessments for resource allocation decisions. HTA is in the early stage of development in Italy, although with great heterogeneity across regions. The National Agency for Health Services has certainly contributed to HTA diffusion through supporting and training activities. However, the multi-level structure of HTA in Italy has not yet provided full coordination and harmonisation of practices and outcomes across the country, with a consequent exacerbate inequality of access to services and technologies. There is probably need to rethink the multi-layer organizational framework of HTA in Italy by leveraging on current knowledge and efficient redistribution of activities across regions. We would advise for different jurisdictions playing different roles while achieving similar health outcomes for their patients, rather than jurisdictions aiming at doing exactly the same things resulting in unequal access to healthcare service provision. Copyright

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

    Science.gov (United States)

    Harries, David; Yellowlees, Peter M

    2013-01-01

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

  10. Healthcare waste management practices and risk perceptions: findings from hospitals in the Algarve region, Portugal.

    Science.gov (United States)

    Ferreira, Vera; Teixeira, Margarida Ribau

    2010-12-01

    The management of healthcare wastes is receiving greater attention because of the risks to both human health and the environment caused by inadequate waste management practices. In that context, the objective of this study was to analyse the healthcare waste management practices in hospitals of the Algarve region, Portugal, and in particular to assess the risk perceptions of, and actual risk to, healthcare staff. The study included three of the six hospitals in the region, covering 41% of the bed capacity. Data were collected via surveys, interviews, and on-site observations. The results indicate that waste separation is the main deficiency in healthcare waste practice, with correct separation being positively related to the degree of daily contact with the waste. Risk perceptions of healthcare staff show the highest levels for the environment (4.24) and waste workers (4.08), and the lowest for patients (3.29) and visitors (2.80), again being positively associated with the degree of daily contact. Risk perceptions of healthcare staff are related to the difficulties of the correct separation of wastes and the lack of knowledge concerning the importance of that separation. The risk of infection with needlesticks/sharps is higher during patient care than during waste handling, and the frequency of these injuries is related to the daily tasks of each healthcare group (doctors, nurses, and housekeepers). Furthermore, legislative definitions and classifications of healthcare wastes appear to have conditioned the management practices associated with, and the perceptions of risk concerning, healthcare wastes. Copyright © 2010 Elsevier Ltd. All rights reserved.

  11. Healthcare systems--an international review: an overview.

    Science.gov (United States)

    Lameire, N; Joffe, P; Wiedemann, M

    1999-01-01

    Based on the source of their funding, three main models of healthcare can be distinguished. The first is the Beveridge model, which is based on taxation and has many public providers. The second is the Bismarck 'mixed' model, funded by a premium-financed social insurance system and with a mixture of public and private providers. Finally, the 'Private Insurance model' is only in existence in the US. The present report explores the impact of these healthcare models on the access to, quality and cost of healthcare in selected European countries. Access is nearly 100% in countries with a public provider system, while in most of the 'mixed' countries, the difference from 100% is made up by supplementary private insurance. No differences are seen between public and mixed provider systems in terms of quality of care, despite the fact that the countries with the former model spend, in general, less of their Gross National Product on healthcare. The Private Insurance/private provider model of the US produces the highest costs, but is lowest in access and is close to lowest ranking in quality parameters.

  12. Design principles for achieving integrated healthcare information systems.

    Science.gov (United States)

    Jensen, Tina Blegind

    2013-03-01

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

  13. Engineering the system of healthcare delivery

    National Research Council Canada - National Science Library

    Rouse, William B; Cortese, Denis A

    2010-01-01

    "As the United States continues to debate reform of its healthcare system, this book argues that providing health insurance for all without improving the delivery system will not improve the current...

  14. Bridging the knowledge gap: an innovative surveillance system to monitor the health of British Columbia's healthcare workforce.

    Science.gov (United States)

    Gilligan, Tony; Alamgir, Hasanat

    2008-01-01

    Healthcare workers are exposed to a variety of work-related hazards including biological, chemical, physical, ergonomic, psychological hazards; and workplace violence. The Occupational Health and Safety Agency for Healthcare in British Columbia (OHSAH), in conjunction with British Columbia (BC) health regions, developed and implemented a comprehensive surveillance system that tracks occupational exposures and stressors as well as injuries and illnesses among a defined population of healthcare workers. Workplace Health Indicator Tracking and Evaluation (WHITE) is a secure operational database, used for data entry and transaction reporting. It has five modules: Incident Investigation, Case Management, Employee Health, Health and Safety, and Early Intervention/Return to Work. Since the WHITE database was first introduced into BC in 2004, it has tracked the health of 84,318 healthcare workers (120,244 jobs), representing 35,927 recorded incidents, resulting in 18,322 workers' compensation claims. Currently, four of BC's six healthcare regions are tracking and analyzing incidents and the health of healthcare workers using WHITE, providing OHSAH and healthcare stakeholders with comparative performance indicators on workplace health and safety. A number of scientific manuscripts have also been published in peer-reviewed journals. The WHITE database has been very useful for descriptive epidemiological studies, monitoring health risk factors, benchmarking, and evaluating interventions.

  15. Understanding how orthopaedic surgery practices generate value for healthcare systems.

    Science.gov (United States)

    Olson, Steven A; Mather, Richard C

    2013-06-01

    Orthopaedic surgery practices can provide substantial value to healthcare systems. Increasingly, healthcare administrators are speaking of the need for alignment between physicians and healthcare systems. However, physicians often do not understand what healthcare administrators value and therefore have difficulty articulating the value they create in discussions with their hospital or healthcare organization. Many health systems and hospitals use service lines as an organizational structure to track the relevant data and manage the resources associated with a particular type of care, such as musculoskeletal care. Understanding service lines and their management can be useful for orthopaedic surgeons interested in interacting with their hospital systems. We provide an overview of two basic types of value orthopaedic surgeons create for healthcare systems: financial or volume-driven benefits and nonfinancial quality or value-driven patient care benefits. We performed a search of PubMed from 1965 to 2012 using the term "service line." Of the 351 citations identified, 18 citations specifically involved the use of service lines to improve patient care in both nursing and medical journals. A service line is a structure used in healthcare organizations to enable management of a subset of activities or resources in a focused area of patient care delivery. There is not a consistent definition of what resources are managed within a service line from hospital to hospital. Physicians can positively impact patient care through engaging in service line management. There is increasing pressure for healthcare systems and hospitals to partner with orthopaedic surgeons. The peer-reviewed literature demonstrates there are limited resources for physicians to understand the value they create when attempting to negotiate with their hospital or healthcare organization. To effectively negotiate for resources to provide the best care for patients, orthopaedic surgeons need to claim and

  16. Hadoop-Based Healthcare Information System Design and Wireless Security Communication Implementation

    Directory of Open Access Journals (Sweden)

    Hongsong Chen

    2015-01-01

    Full Text Available Human health information from healthcare system can provide important diagnosis data and reference to doctors. However, continuous monitoring and security storage of human health data are challenging personal privacy and big data storage. To build secure and efficient healthcare application, Hadoop-based healthcare security communication system is proposed. In wireless biosensor network, authentication and key transfer should be lightweight. An ECC (Elliptic Curve Cryptography based lightweight digital signature and key transmission method are proposed to provide wireless secure communication in healthcare information system. Sunspot wireless sensor nodes are used to build healthcare secure communication network; wireless nodes and base station are assigned different tasks to achieve secure communication goal in healthcare information system. Mysql database is used to store Sunspot security entity table and measure entity table. Hadoop is used to backup and audit the Sunspot security entity table. Sqoop tool is used to import/export data between Mysql database and HDFS (Hadoop distributed file system. Ganglia is used to monitor and measure the performance of Hadoop cluster. Simulation results show that the Hadoop-based healthcare architecture and wireless security communication method are highly effective to build a wireless healthcare information system.

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

    Science.gov (United States)

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

    2015-01-01

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

  18. Commercial versus in-situ usability testing of healthcare information systems: towards "public" usability testing in healthcare organizations.

    Science.gov (United States)

    Kushniruk, Andre W; Borycki, Elizabeth M; Kannry, Joseph

    2013-01-01

    The need for improved usability in healthcare IT has been widely recognized. In addition, methods from usability engineering, including usability testing and usability inspection have received greater attention. Many vendors of healthcare software are now employing usability testing methods in the design and development of their products. However, despite this, the usability of healthcare IT is still considered to be problematic and many healthcare organizations that have purchased systems that have been tested at vendor testing sites are still reporting a range of usability and safety issues. In this paper we explore the distinction between commercial usability testing (conducted at centralized vendor usability laboratories and limited beta test sites) and usability testing that is carried out locally within healthcare organizations that have purchased vendor systems and products (i.e. public "in-situ" usability testing). In this paper it will be argued that both types of testing (i.e. commercial vendor-based testing) and in-situ testing are needed to ensure system usability and safety.

  19. Development of Intelligent Auxiliary System for Customized Physical Fitness and Healthcare

    Directory of Open Access Journals (Sweden)

    Huang Chung-Chi

    2016-01-01

    Full Text Available With the advent of global high-tech industry and commerce era, the sedentary reduces opportunities of physical activity. And physical fitness and health of people is getting worse and worse. At present, the shortage of physical fitness instructors greatly affected the effectiveness of health promotion. Therefore, it is necessary to develop an auxiliary system which can reduce the workload of instructors and enhance physical fitness and health for people. But current general physical fitness and healthcare system is hard to meet individualized needs. The main purpose of this research is to develop an intelligent auxiliary system for customized physical fitness and healthcare. It records all processes of physical fitness and healthcare system by wireless sensors network. The results of intelligent auxiliary systems for customized physical fitness and healthcare will be generated by fuzzy logic Inference. It will improve individualized physical fitness and healthcare. Finally, we will demonstrate the advantages of the intelligent auxiliary system for customized physical fitness and healthcare.

  20. LIFE CYCLE ASSESSMENT IN HEALTHCARE SYSTEM OPTIMIZATION. INTRODUCTION

    Directory of Open Access Journals (Sweden)

    V. Sarancha

    2015-03-01

    Full Text Available Article describes the life cycle assessment method and introduces opportunities for method performance in healthcare system settings. LSA draws attention to careful use of resources, environmental, human and social responsibility. Modelling of environmental and technological inputs allows optimizing performance of the system. Various factors and parameters that may influence effectiveness of different sectors in healthcare system are detected. Performance optimization of detected parameters could lead to better system functioning, higher patient safety, economic sustainability and reduce resources consumption.

  1. Development of online diary and self-management system on e-Healthcare for asthmatic children in Taiwan.

    Science.gov (United States)

    Lin, Hsueh-Chun; Chiang, Li-Chi; Wen, Tzu-Ning; Yeh, Kuo-Wei; Huang, Jing-Long

    2014-10-01

    Many regional programs of the countries educate asthmatic children and their families to manage healthcare data. This study aims to establish a Web-based self-management system, eAsthmaCare, to promote the electronic healthcare (e-Healthcare) services for the asthmatic children in Taiwan. The platform can perform real time online functionality based upon a five-tier infrastructure with mutually supportive components to acquire asthma diaries, quality of life assessments and health educations. We have designed five multi-disciplinary portions on the interactive interface functioned with the analytical diagrams: (1) online asthma diary, (2) remote asthma assessment, (3) instantaneous asthma alert, (4) diagrammatical clinic support, and (5) asthma health education. The Internet-based asthma diary and assessment program was developed for patients to process self-management healthcare at home. In addition, the online analytical charts can help healthcare professionals to evaluate multi-domain health information of patients immediately. eAsthmaCare was developed by Java™ Servlet/JSP technology upon Apache Tomcat™ web server and Oracle™ database. Forty-one voluntary asthmatic children (and their parents) were intervened to examine the proposed system. Seven domains of satisfiability assessment by using the system were applied for approving the development. The average scores were scaled in the acceptable range for each domain to ensure feasibility of the proposed system. The study revealed the details of system infrastructure and developed functions that can help asthmatic children in self-management for healthcare to enhance communications between patients and hospital professionals. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Enhancing Health-Care Services with Mixed Reality Systems

    Science.gov (United States)

    Stantchev, Vladimir

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

  3. Process-driven selection of information systems for healthcare

    Science.gov (United States)

    Mills, Stephen F.; Yeh, Raymond T.; Giroir, Brett P.; Tanik, Murat M.

    1995-05-01

    Integration of networking and data management technologies such as PACS, RIS and HIS into a healthcare enterprise in a clinically acceptable manner is a difficult problem. Data within such a facility are generally managed via a combination of manual hardcopy systems and proprietary, special-purpose data processing systems. Process modeling techniques have been successfully applied to engineering and manufacturing enterprises, but have not generally been applied to service-based enterprises such as healthcare facilities. The use of process modeling techniques can provide guidance for the placement, configuration and usage of PACS and other informatics technologies within the healthcare enterprise, and thus improve the quality of healthcare. Initial process modeling activities conducted within the Pediatric ICU at Children's Medical Center in Dallas, Texas are described. The ongoing development of a full enterprise- level model for the Pediatric ICU is also described.

  4. Public trust in the healthcare system in a developing country.

    Science.gov (United States)

    Peters, Dexnell; Youssef, Farid F

    2016-04-01

    Broadly defined, trust in the healthcare system is concerned with how the public perceives the system and the actors therein as it pertains to their ability to both deliver services and seek the best interests of their clientele. Trust is important because it impacts upon a range of health behaviors including compliance and ultimately affects the ability of the healthcare system to meet its goals. While several studies exist on public trust within the developed world, few studies have explored this issue in developing countries. This paper therefore assesses public trust in the healthcare system of a developing small island nation, Trinidad and Tobago. A cross-sectional survey of adults was conducted using a questionnaire that has been successfully used across Europe. We report that trust levels in the healthcare system in Trinidad and Tobago are relatively low with less than 50% of persons indicating fair trust in the healthcare system. In addition, individual health professionals also did not score highly with lowest scores found for nurses and complementary therapists. Results on four out of five dimensions of trust also demonstrated scores significantly lower than those reported in more developed nations. Open-ended comments supported these findings with the majority of persons indicating a lack of confidence in the healthcare system. These results may reflect the reality in the wider developing world, and we suggest that bolstering trust is a needed area of focus in the delivery of healthcare services throughout the nation. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.

  5. A review of the Australian healthcare system: A policy perspective

    Science.gov (United States)

    Sambasivan, Murali

    2018-01-01

    This article seeks to review the Australian healthcare system and compare it to similar systems in other countries to highlight the main issues and problems. A literature search for articles relating to the Australian and other developed countries’ healthcare systems was conducted by using Google and the library of Victoria University, Melbourne. Data from the websites of the Commonwealth of Australia, the Australian Institute of Health and Welfare, the Australian Productivity Commission, the Organisation for Economic Co-operation and Development and the World Bank have also been used. Although care within the Australian healthcare system is among the best in the world, there is a need to change the paradigm currently being used to measure the outcomes and allocate resources. The Australian healthcare system is potentially dealing with two main problems: (a) resource allocation, and (b) performance and patient outcomes improvements. An interdisciplinary research approach in the areas of performance measurement, quality and patient outcomes improvement could be adopted to discover new insights, by using the policy implementation error/efficiency and bureaucratic capacity. Hospital managers, executives and healthcare management practitioners could use an interdisciplinary approach to design new performance measurement models, in which financial performance, quality, healthcare and patient outcomes are blended in, for resource allocation and performance improvement. This article recommends that public policy implementation error and the bureaucratic capacity models be applied to healthcare to optimise the outcomes for the healthcare system in Australia. In addition, it highlights the need for evaluation of the current reimbursement method, freedom of choice to patients and a regular scrutiny of the appropriateness of care. PMID:29686869

  6. [Interpretation in the Danish health-care system].

    Science.gov (United States)

    Lund Hansen, Marianne Taulo; Nielsen, Signe Smith

    2013-03-04

    Communication between health professional and patient is central for treatment and patient safety in the health-care system. This systematic review examines the last ten years of specialist literature concerning interpretation in the Danish health-care system. Structural search in two databases, screening of references and recommended literature from two scientists led to identification of seven relevant articles. The review showed that professional interpreters were not used consistently when needed. Family members were also used as interpreters. These results were supported by international investigations.

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

    Science.gov (United States)

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

    2015-09-01

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

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

    Science.gov (United States)

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

    2012-10-01

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

  9. WISH: a Wireless Mobile Multimedia Information System in Healthcare using RFID.

    Science.gov (United States)

    Yu, Weider D; Ray, Pradeep; Motoc, Tiberiu

    2008-05-01

    It is important to improve the efficiency of healthcare-related operations and the associated costs. Healthcare organizations are constantly under increased pressure to streamline operations and provide enhanced services to their patients. Wireless mobile computing technology has the potential to provide the desired benefits and would be a critical part of today's healthcare information system. In this paper, a system is presented to better facilitate the functions of physicians and medical staff in healthcare by using modern wireless mobile technology, Radio Frequency Identification (RFID) tools, and multimedia streaming. The paper includes a case study of the development of such a system in the context of healthcare in the United States. The results of the study show how wireless mobile multimedia systems can be developed for the improvement of the quality and efficiency in healthcare for other nations as well. Our testing data show a time reduction of more than 50% in the daily activities of hospital staff.

  10. The Western New York regional electronic health record initiative: Healthcare informatics use from the registered nurse perspective.

    Science.gov (United States)

    Sackett, Kay M; Erdley, W Scott; Jones, Janice

    2006-01-01

    This paper describes a select population of Western New York (WNY) Registered Nurses' (RN) perspectives on the use of healthcare informatics and the adoption of a regional electronic health record (EHR). A three part class assignment on healthcare informatics used a Strengths, Weaknesses, Opportunities, Threats (SWOT) Analysis, and a Healthcare Informatics Schemata: A paradigm shift over time(c) timeline to determine RN perspectives about healthcare informatics use at their place of employment. Qualitative analysis of 41 RNs who completed the SWOT analysis provided positive and negative themes related to perceptions about healthcare informatics and EHR use at their place of employment. 29 healthcare organizations were aggregated by year on the timeline from 1950 through 2000. Information suggests that, RNs have the capacity to positively drive the adoption of EHRs and healthcare informatics in WNY.

  11. Safe injections and waste management among healthcare workers at a regional hospital in northern Tanzania.

    Science.gov (United States)

    Nilsson, Josefine; Pembe, Andrea B; Urasa, Miriam; Darj, Elisabeth

    2013-01-01

    Unsafe injections and substandard waste management are public health issues exposing healthcare workers and the community to the risk of infections. The objective of this study was to assess the knowledge and practice of safe injections and health care waste management among healthcare workers at a regional hospital in northern Tanzania. This cross sectional descriptive study was conducted in a regional hospital in northern Tanzania. Data was collected through a self-administered questionnaire with additional observations of the incinerator, injections, waste practices, and the availability of medical supplies. Data was analysed in SPSS descriptive statistics and chi-square tests were performed. A total of 223 of 305 (73%) healthcare workers from different cadres were included in the study. The majority of healthcare workers had adequate knowledge and practice of safe injections, but inadequate knowledge about waste management. The majority of the staff reported knowledge of HIV as a risk factor, however, had less knowledge about other blood-borne infections. Guidelines and posters on post exposure prophylaxes and waste management -were present at the hospital, however, the incinerator had no fence or temperature gauge. In conclusion, healthcare workers reported good knowledge and practice of injections, and high knowledge of HIV transmission routes. However, the hospital is in need of a well functioning incinerator and healthcare workers require sufficient medical supplies. There was a need for continual training about health care waste management and avoidance of blood-borne pathogens that may be transmitted through unsafe injections or poor health care waste management.

  12. Shared Learning and the Drive to Improve Patient Safety: Lessons Learned from the Pittsburgh Regional Healthcare Initiative

    National Research Council Canada - National Science Library

    Sirio, Carl A; Keyser, Donna J; Norman, Heidi; Weber, Robert J; Muto, Carlene A

    2005-01-01

    Based on lessons learned through implementation of the Pittsburgh Regional Healthcare Initiative's region-wide shared learning model, we have identified the environmental, cultural, and infrastructure...

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

    Science.gov (United States)

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

    2013-01-01

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

  14. The healthcare experiences of Arab Israeli women in a reformed healthcare system.

    Science.gov (United States)

    Elnekave, Eldad; Gross, Revital

    2004-07-01

    Arab Israeli women are subject to unique social stresses deriving from their status as part of an ethno-political minority and from their position as women in a patriarchal community. Collectively, their health profiles rate poorly in comparison to Jewish Israeli women or to women in the vast majority of developed countries. To examine the experiences of Arab Israeli women in the contemporary Israeli healthcare system, following implementation of the National Health Insurance Law (NHIL). The study combined quantitative and qualitative research methodologies. A telephone survey utilizing a structured questionnaire was conducted during August-September 1998 among a random national sample of 849 women, with a response rate of 83%. Between the months of January and July of 2000, qualitative data was attained via participant-observation, long and short semi-structured interviews, and focus groups in one large Muslim Arab Israeli village. Arab Israeli women in the national survey reported poorer self-assessed health, lower rates of care by a woman primary care physician, lower satisfaction ratings for primary care physicians and more frequently foregoing medical care than did native or immigrant Jewish Israeli women. Three major factors contributing to Arab Israeli women's healthcare experiences were elucidated by the qualitative study: (1) the threat of physical and social exposure (2) difficulties in communicating with male physicians and (3) the stifling effect of family politics and surveillance on healthcare. We discuss our findings in relation to structural changes associated with the recent reform of the Israeli health care system. We conclude by suggesting policy measures for better adapting primary care services to the needs of Arab Israeli women, and note the relevance to other systems that aim to provide service to cultural and ethno-political minorities, in which healthcare delivery is shaped by unique local circumstances.

  15. Patient satisfaction with the healthcare system: Assessing the impact of socio-economic and healthcare provision factors.

    Science.gov (United States)

    Xesfingi, Sofia; Vozikis, Athanassios

    2016-03-15

    Patient satisfaction is an important measure of healthcare quality as it offers information on the provider's success at meeting clients' expectations and is a key determinant of patients' perspective behavioral intention. The aim of this paper is first to assess the degree of patient satisfaction, and second, to study the relationship between patient satisfaction of healthcare system and a set of socio-economic and healthcare provision indicators. This empirical analysis covers 31 countries for the years 2007, 2008, 2009 and 2012. The dependent variable, the satisfaction index, is defined as the patient satisfaction of their country's health system. We first construct an index of patient satisfaction and then, at a second stage, this index is related to socio-economic and healthcare provision variables. Our findings support that there is a strong positive association between patient satisfaction level and healthcare provision indicators, such as nurses and physicians per 100,000 habitants, with the latter being the most important contributor, and a negative association between patient satisfaction level and number of hospital beds. Among the socio-economic variables, public health expenditures greatly shape and positive relate to patient satisfaction, while private spending on health relates negatively. Finally, the elder a patient is, the more satisfied with a country's healthcare system appears to be. We conclude that there is a strong positive association between patient satisfaction and public health expenditures, number of physicians and nurses, and the age of the patient, while there is a negative evidence for private health spending and number of hospital beds.

  16. The Imminent Healthcare and Emergency Care Crisis in Japan

    Directory of Open Access Journals (Sweden)

    Suzuki, Tetsuji

    2008-05-01

    Full Text Available Objectives: Japan has a universal healthcare system, and this paper describes the reality of the healthcare services provided, as well as current issues with the system.Methods: Academic, government, and press reports on Japanese healthcare systems and healthcare guidelines were reviewed.Results: The universal healthcare system of Japan is considered internationally to be both low-cost and effective because the Japanese population enjoys good health status with a long life expectancy, while healthcare spending in Japan is below the average given by the Organization for Economic Corporation and Development (OECD. However, in many regions of Japan the existing healthcare resources are seriously inadequate, especially with regard to the number of physicians and other health professionals. Because healthcare is traditionally viewed as “sacred” work in Japan, healthcare professionals are expected to make large personal sacrifices. Also, public attitudes toward medical malpractice have changed in recent decades, and medical professionals are facing legal issues without experienced support of the government or legal professionals. Administrative response to the lack of resources and collaboration among communities are beginning, and more efficient control and management of the healthcare system is under consideration.Conclusion: The Japanese healthcare system needs to adopt an efficient medical control organization to ease the strain on existing healthcare professionals and to increase the number of physicians and other healthcare resources. Rather than continuing to depend on healthcare professionals being able and willing to make personal sacrifices, the government, the public and medical societies must cooperate and support changes in the healthcare system.

  17. Systems healthcare: a holistic paradigm for tomorrow.

    Science.gov (United States)

    Fiandaca, Massimo S; Mapstone, Mark; Connors, Elenora; Jacobson, Mireille; Monuki, Edwin S; Malik, Shaista; Macciardi, Fabio; Federoff, Howard J

    2017-12-19

    Systems healthcare is a holistic approach to health premised on systems biology and medicine. The approach integrates data from molecules, cells, organs, the individual, families, communities, and the natural and man-made environment. Both extrinsic and intrinsic influences constantly challenge the biological networks associated with wellness. Such influences may dysregulate networks and allow pathobiology to evolve, resulting in early clinical presentation that requires astute assessment and timely intervention for successful mitigation. Herein, we describe the components of relevant biological systems and the nature of progression from at-risk to manifest disease. We illustrate the systems approach by examining two relevant clinical examples: Alzheimer's and cardiovascular diseases. The implications of systems healthcare management are examined through the lens of economics, ethics, policy and the law. Finally, we propose the need to develop new educational paradigms to enhance the training of the health professional in an era of systems medicine.

  18. Evaluating Complex Healthcare Systems: A Critique of Four Approaches

    Directory of Open Access Journals (Sweden)

    Heather Boon

    2007-01-01

    Full Text Available The purpose of this paper is to bring clarity to the emerging conceptual and methodological literature that focuses on understanding and evaluating complex or ‘whole’ systems of healthcare. An international working group reviewed literature from interdisciplinary or interprofessional groups describing approaches to the evaluation of complex systems of healthcare. The following four key approaches were identified: a framework from the MRC (UK, whole systems research, whole medical systems research described by NCCAM (USA and a model from NAFKAM (Norway. Main areas of congruence include acknowledgment of the inherent complexity of many healthcare interventions and the need to find new ways to evaluate these; the need to describe and understand the components of complex interventions in context (as they are actually practiced; the necessity of using mixed methods including randomized clinical trials (RCTs (explanatory and pragmatic and qualitative approaches; the perceived benefits of a multidisciplinary team approach to research; and the understanding that methodological developments in this field can be applied to both complementary and alternative medicine (CAM as well as conventional therapies. In contrast, the approaches differ in the following ways: terminology used, the extent to which the approach attempts to be applicable to both CAM and conventional medical interventions; the prioritization of research questions (in order of what should be done first especially with respect to how the ‘definitive’ RCT fits into the process of assessing complex healthcare systems; and the need for a staged approach. There appears to be a growing international understanding of the need for a new perspective on assessing complex healthcare systems.

  19. The road to reorganization. A system keeps its regional network all in the family.

    Science.gov (United States)

    Haglund, C

    1989-11-01

    One prominent strategy health-care institutions are pursuing today is the formation of regional networks providing comprehensive continuums of care. Regional activities can be organized according to several distinct geographical parameters: city, county, state, or multistate regions. Although the different types of regionalization may be beneficial, they will generate different types of activities and benefits. Another consideration is that regional structures can range from very loose affiliations to complete ownership. In 1987 the Sisters of Providence health system, Seattle, initiated efforts to create a functionally integrated regional healthcare system in the Portland, OR, market, which had a good framework in place for developing a vertically and horizontally linked comprehensive continuum of care. The Oregon Management Committee, composed of local administrators, was established to identify issues and develop common objectives. The group developed a regional strategic plan and identified eight key areas to begin regionally coordinated activities. It began creating working relationships among institutional counterparts and program integration in several outpatient service areas where duplication was evident. Another effort involved greater coordination of marketing activities.

  20. Corruption in the Nigerian healthcare system | Buowari | Nigerian ...

    African Journals Online (AJOL)

    Corruption is the use of public resources for private gain. This is common in most countries though reduced in some and alarming in others. It affects all sectors of the economy and the healthcare system is not spared. Medical corruption is increasing in countries with high rates of corruption and all healthcare professionals ...

  1. Oral healthcare systems in the extended European union.

    Science.gov (United States)

    Widström, Eeva; Eaton, Kenneth A

    2004-01-01

    This article reports a survey of the systems for the provision of oral healthcare in the 28 member and accession states of the EU/EEA in 2003. Descriptions of the systems were collected from the principal dental advisers to governments in the individual states. In many states these were the Chief Dental Officers (CDOs). In states without a CDO, descriptions were gathered from CDO equivalents or senior academics. A template (model description) was used to guide all respondents. Additional statistical information on oral healthcare costs and workforce was collected from the Council of European Chief Dental Officers, WHO and World Bank websites. The study showed that in broad terms there were six patterns (Beveridgian, Bismarkian, The Eastern European (in transition), Nordic, Southern European and Hybrid) for the administration and financing of oral healthcare in the expanding EU. The extent and nature of government involvement in planning and coordinating oral healthcare services and the numbers and pay of the oral healthcare workforce varied between the different models. The biggest recent changes in European oral healthcare were found to have occurred in Eastern Europe, where there has been wide scale privatization of the previously public dental services. However, most of the EU accession (Eastern European) states seemed to be slowly developing insurance systems to cover oral health treatment costs. In the existing EU/EEA, the public dental services such as those in the Nordic countries still have strong political support and some expansion has occurred. In Southern Europe public dental services seemed to have gained some acceptance for the treatment of children and special needs groups. In UK, which has a unique public dental service system, there are plans to make big changes in the delivery, commissioning and remuneration of dental services in the near future. Some EU member states which operate the Bismarkian system with health insurances offering wide

  2. Development of Wearable Systems for Ubiquitous Healthcare Service Provisioning

    OpenAIRE

    Ogunduyile, O.O.; Olugbara, O.O.; Lall, M.

    2013-01-01

    This paper reports on the development of a wearable system using wireless biomedical sensors for ubiquitous healthcare service provisioning. The prototype system is developed to address current healthcare challenges such as increasing cost of services, inability to access diverse services, low quality services and increasing population of elderly as experienced globally. The biomedical sensors proactively collect physiological data of remote patients to recommend diagnostic services. The prot...

  3. Health and health-care systems in southeast Asia: diversity and transitions.

    Science.gov (United States)

    Chongsuvivatwong, Virasakdi; Phua, Kai Hong; Yap, Mui Teng; Pocock, Nicola S; Hashim, Jamal H; Chhem, Rethy; Wilopo, Siswanto Agus; Lopez, Alan D

    2011-01-29

    Southeast Asia is a region of enormous social, economic, and political diversity, both across and within countries, shaped by its history, geography, and position as a major crossroad of trade and the movement of goods and services. These factors have not only contributed to the disparate health status of the region's diverse populations, but also to the diverse nature of its health systems, which are at varying stages of evolution. Rapid but inequitable socioeconomic development, coupled with differing rates of demographic and epidemiological transitions, have accentuated health disparities and posed great public health challenges for national health systems, particularly the control of emerging infectious diseases and the rise of non-communicable diseases within ageing populations. While novel forms of health care are evolving in the region, such as corporatised public health-care systems (government owned, but operating according to corporate principles and with private-sector participation) and financing mechanisms to achieve universal coverage, there are key lessons for health reforms and decentralisation. New challenges have emerged with rising trade in health services, migration of the health workforce, and medical tourism. Juxtaposed between the emerging giant economies of China and India, countries of the region are attempting to forge a common regional identity, despite their diversity, to seek mutually acceptable and effective solutions to key regional health challenges. In this first paper in the Lancet Series on health in southeast Asia, we present an overview of key demographic and epidemiological changes in the region, explore challenges facing health systems, and draw attention to the potential for regional collaboration in health. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Quality of the ophthalmological service to outpatients of the public and private healthcare systems.

    Science.gov (United States)

    Hercos, Benigno Vicente Santos; Berezovsky, Adriana

    2017-01-01

    To compare perceptions of the quality of ophthalmological services offered to outpatients from the public healthcare system to those from the private healthcare system, and to determine which measures are seen as necessary and a priority for improving the quality of care. This was a prospective observational study on 200 patients, 101 and 99 of whom were from the public and private healthcare systems, respectively. All patients underwent an ophthalmological examination at an ophthalmology hospital in Belo Horizonte, Minas Gerais, Brazil. Personal interviews were conducted using two structured questionnaires adapted from the modified SERVQUAL scale. Overall, patients from the private healthcare system were significantly more dissatisfied than those from the public healthcare system. In both systems, reliability was considered to be the most important determinant of quality, and it presented the highest level of dissatisfaction. Satisfaction with the public healthcare system was significantly greater than that with the private healthcare system in terms of the tangibles, reliability, responsiveness, and assurance determinants of the SERVQUAL scale. Institutions must plan, execute, evaluate, and monitor measures that seek to improve the overall patient satisfaction with the quality of services provided, particularly in the private healthcare system, and special attention must be paid to reliability in both healthcare systems. The identification and monitoring of the quality of healthcare services through the periodic use of the SERVQUAL scale may provide healthcare managers with information so that they can identify, plan, and monitor necessary and priority measures. This could be a key strategy for improving the quality of outpatient health services in the public and private systems.

  5. A scalable healthcare information system based on a service-oriented architecture.

    Science.gov (United States)

    Yang, Tzu-Hsiang; Sun, Yeali S; Lai, Feipei

    2011-06-01

    Many existing healthcare information systems are composed of a number of heterogeneous systems and face the important issue of system scalability. This paper first describes the comprehensive healthcare information systems used in National Taiwan University Hospital (NTUH) and then presents a service-oriented architecture (SOA)-based healthcare information system (HIS) based on the service standard HL7. The proposed architecture focuses on system scalability, in terms of both hardware and software. Moreover, we describe how scalability is implemented in rightsizing, service groups, databases, and hardware scalability. Although SOA-based systems sometimes display poor performance, through a performance evaluation of our HIS based on SOA, the average response time for outpatient, inpatient, and emergency HL7Central systems are 0.035, 0.04, and 0.036 s, respectively. The outpatient, inpatient, and emergency WebUI average response times are 0.79, 1.25, and 0.82 s. The scalability of the rightsizing project and our evaluation results show that the SOA HIS we propose provides evidence that SOA can provide system scalability and sustainability in a highly demanding healthcare information system.

  6. Using HFACS-Healthcare to Identify Systemic Vulnerabilities During Surgery.

    Science.gov (United States)

    Cohen, Tara N; Francis, Sarah E; Wiegmann, Douglas A; Shappell, Scott A; Gewertz, Bruce L

    2018-03-01

    The Human Factors Analysis and Classification System for Healthcare (HFACS-Healthcare) was used to classify surgical near miss events reported via a hospital's event reporting system over the course of 1 year. Two trained analysts identified causal factors within each event narrative and subsequently categorized the events using HFACS-Healthcare. Of 910 original events, 592 could be analyzed further using HFACS-Healthcare, resulting in the identification of 726 causal factors. Most issues (n = 436, 60.00%) involved preconditions for unsafe acts, followed by unsafe acts (n = 257, 35.39%), organizational influences (n = 27, 3.72%), and supervisory factors (n = 6, 0.82%). These findings go beyond the traditional methods of trending incident data that typically focus on documenting the frequency of their occurrence. Analyzing near misses based on their underlying contributing human factors affords a greater opportunity to develop process improvements to reduce reoccurrence and better provide patient safety approaches.

  7. CMOS Enabled Microfluidic Systems for Healthcare Based Applications

    KAUST Repository

    Khan, Sherjeel M.; Gumus, Abdurrahman; Nassar, Joanna M.; Hussain, Muhammad Mustafa

    2018-01-01

    With the increased global population, it is more important than ever to expand accessibility to affordable personalized healthcare. In this context, a seamless integration of microfluidic technology for bioanalysis and drug delivery and complementary metal oxide semiconductor (CMOS) technology enabled data-management circuitry is critical. Therefore, here, the fundamentals, integration aspects, and applications of CMOS-enabled microfluidic systems for affordable personalized healthcare systems are presented. Critical components, like sensors, actuators, and their fabrication and packaging, are discussed and reviewed in detail. With the emergence of the Internet-of-Things and the upcoming Internet-of-Everything for a people-process-data-device connected world, now is the time to take CMOS-enabled microfluidics technology to as many people as possible. There is enormous potential for microfluidic technologies in affordable healthcare for everyone, and CMOS technology will play a major role in making that happen.

  8. CMOS Enabled Microfluidic Systems for Healthcare Based Applications

    KAUST Repository

    Khan, Sherjeel M.

    2018-02-27

    With the increased global population, it is more important than ever to expand accessibility to affordable personalized healthcare. In this context, a seamless integration of microfluidic technology for bioanalysis and drug delivery and complementary metal oxide semiconductor (CMOS) technology enabled data-management circuitry is critical. Therefore, here, the fundamentals, integration aspects, and applications of CMOS-enabled microfluidic systems for affordable personalized healthcare systems are presented. Critical components, like sensors, actuators, and their fabrication and packaging, are discussed and reviewed in detail. With the emergence of the Internet-of-Things and the upcoming Internet-of-Everything for a people-process-data-device connected world, now is the time to take CMOS-enabled microfluidics technology to as many people as possible. There is enormous potential for microfluidic technologies in affordable healthcare for everyone, and CMOS technology will play a major role in making that happen.

  9. Return Migrants’ Experience of Access to Care in Corrupt Healthcare Systems

    DEFF Research Database (Denmark)

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

    2016-01-01

    unstudied, even though return migrants may be particularly vulnerable to problems related to corruption due to their period of absence from their country of origin. This article investigates how corruption in the healthcare sector affects access to healthcare for refugees who repatriated to Bosnia......Equal and universal access to healthcare services is a core priority for a just health system. A key societal determinant seen to create inequality in access to healthcare is corruption in the healthcare system. How return migrants’ access to healthcare is affected by corruption is largely......, a country with a high level of corruption, from Denmark, a country with a low level of corruption. The study is based on 18 semi-structured interviews with 33 refugees who returned after long-term residence in Denmark. We found that the returned refugees faced greater problems with corruption than...

  10. The implementation of mindfulness in healthcare systems: a theoretical analysis.

    Science.gov (United States)

    Demarzo, M M P; Cebolla, A; Garcia-Campayo, J

    2015-01-01

    Evidence regarding the efficacy of mindfulness-based interventions (MBIs) is increasing exponentially; however, there are still challenges to their integration in healthcare systems. Our goal is to provide a conceptual framework that addresses these challenges in order to bring about scholarly dialog and support health managers and practitioners with the implementation of MBIs in healthcare. This is an opinative narrative review based on theoretical and empirical data that address key issues in the implementation of mindfulness in healthcare systems, such as the training of professionals, funding and costs of interventions, cost effectiveness and innovative delivery models. We show that even in the United Kingdom, where mindfulness has a high level of implementation, there is a high variability in the access to MBIs. In addition, we discuss innovative approaches based on "complex interventions," "stepped-care" and "low intensity-high volume" concepts that may prove fruitful in the development and implementation of MBIs in national healthcare systems, particularly in Primary Care. In order to better understand barriers and opportunities for mindfulness implementation in healthcare systems, it is necessary to be aware that MBIs are "complex interventions," which require innovative approaches and delivery models to implement these interventions in a cost-effective and accessible way. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Jenkins, E K; Christenson, E

    2001-05-01

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

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

    Science.gov (United States)

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

    2013-09-01

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

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

    Science.gov (United States)

    Wawrzyniak, Zbigniew M.; Lisiecka-Biełanowicz, Mira

    2013-10-01

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

  14. Method for selecting e-health standards to support interoperability of healthcare information systems

    CSIR Research Space (South Africa)

    Adebesin, F

    2014-05-01

    Full Text Available There is growing concern over the fragmentation and inability of healthcare information systems (e-health systems) to exchange pertinent healthcare information that can empower healthcare professionals to make informed decisions regarding the care...

  15. The Healthcare Future for the iGeneration: Integrating the Patient and the Healthcare System

    Directory of Open Access Journals (Sweden)

    Kristina D. Wood

    2013-01-01

    Full Text Available Objective: To propose a vision to integrate patients, their health-related data, and their wellness plans into the healthcare system using smartphone and tablet computer technology. Setting: Ambulatory care and community practice Practice Innovation: Utilization of smartphone and tablet computer technology to assess health care conditions, educate and involve patients, and facilitate seamless communication between the patient, electronic health record, pharmacy system, third-party payers, point-of-care testing, and all health-care providers. Main Outcome Measures: By providing integrated and customized information at the point of use, medication adherence and access to care will be increased and patients will engage in healthy behaviors more often resulting in an improved level of care for patients. Results: In the future, the authors believe if the vision is achieved, the health care system and patients will see improved health outcomes and more efficient utilization of the healthcare system. Conclusions: Our proposed use of technology provides an opportunity to empower patients to positively improve their own health which could be a vital advancement in health care, especially in the areas of medication adherence, improving access to care, and health behavior support. As pharmacists, we may also embrace technology opportunities to expand our roles as health care professionals as we continue to partner with patients and the health care team to improve outcomes.   Type: Idea Paper

  16. The Healthcare Future for the iGeneration: Integrating the Patient and the Healthcare System

    Directory of Open Access Journals (Sweden)

    Cathy H. Ficzere, PharmD, BCPS

    2013-01-01

    Full Text Available Objective: To propose a vision to integrate patients, their health-related data, and their wellness plans into the healthcare system using smartphone and tablet computer technology.Setting: Ambulatory care and community practicePractice Innovation: Utilization of smartphone and tablet computer technology to assess health care conditions, educate and involve patients, and facilitate seamless communication between the patient, electronic health record, pharmacy system, third-party payers, point-of-care testing, and all health-care providers.Main Outcome Measures: By providing integrated and customized information at the point of use, medication adherence and access to care will be increased and patients will engage in healthy behaviors more often resulting in an improved level of care for patients.Results: In the future, the authors believe if the vision is achieved, the health care system and patients will see improved health outcomes and more efficient utilization of the healthcare system.Conclusions: Our proposed use of technology provides an opportunity to empower patients to positively improve their own health which could be a vital advancement in health care, especially in the areas of medication adherence, improving access to care, and health behavior support. As pharmacists, we may also embrace technology opportunities to expand our roles as health care professionals as we continue to partner with patients and the health care team to improve outcomes.

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

    Science.gov (United States)

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

    2012-04-01

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

  18. Task-role-based Access Control Model in Smart Health-care System

    OpenAIRE

    Wang Peng; Jiang Lingyun

    2015-01-01

    As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for...

  19. Task-role-based Access Control Model in Smart Health-care System

    Directory of Open Access Journals (Sweden)

    Wang Peng

    2015-01-01

    Full Text Available As the development of computer science and smart health-care technology, there is a trend for patients to enjoy medical care at home. Taking enormous users in the Smart Health-care System into consideration, access control is an important issue. Traditional access control models, discretionary access control, mandatory access control, and role-based access control, do not properly reflect the characteristics of Smart Health-care System. This paper proposes an advanced access control model for the medical health-care environment, task-role-based access control model, which overcomes the disadvantages of traditional access control models. The task-role-based access control (T-RBAC model introduces a task concept, dividing tasks into four categories. It also supports supervision role hierarchy. T-RBAC is a proper access control model for Smart Health-care System, and it improves the management of access rights. This paper also proposes an implementation of T-RBAC, a binary two-key-lock pair access control scheme using prime factorization.

  20. Effects of an incinerator project on a healthcare-waste management system.

    Science.gov (United States)

    Khammaneechan, Patthanasak; Okanurak, Kamolnetr; Sithisarankul, Pornchai; Tantrakarnapa, Kraichat; Norramit, Poonsup

    2011-10-01

    This evaluative research study aimed to assess the effects of the central healthcare incinerator project on waste management in Yala Province. The study data were collected twice: at baseline and during the operational phase. A combination of structured interview and observation were used during data collection. The study covered 127 healthcare facilities: government hospitals, healthcare centres, and private clinics. The results showed 63% of healthcare risk waste (HCRW) handlers attended the HCRW management training. Improvements in each stage of the HCRW management system were observed in all groups of facilities. The total cost of the HCRW management system did not change, however; the costs for hospitals decreased, whereas those for clinics increased significantly. It was concluded that the central healthcare waste incinerator project positively affected HCRW management in the area, although the costs of management might increase for a particular group. However, the benefits of changing to a more appropriately managed HCRW system will outweigh the increased costs.

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

    Science.gov (United States)

    Newman-Valentine, Douglas; Duma, Sinegugu

    2014-11-21

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

  2. The healthcare system in the Caucasus at the beginning of the XX century: the development features

    Directory of Open Access Journals (Sweden)

    Tatiana E. Gvarliani

    2016-03-01

    Full Text Available The article based on the archival material deals with the healthcare system in the Caucasus at the beginning of the XX century. In writing this article, the authors made use of reports from national archives of Georgia (Tbilisi, Georgia, the archival department of administration of Sochi (Sochi, Russian Federation. There is given the statistics from the works of Russian and foreign authors, and also reference literature. The authors’ use of the principles of objectivity, historicism, systematic, the integrated consideration of socio-subjective in the subject of study and the maximum possible neutrality of the relationship of the researcher to interpret and evaluate the factual material. In conclusion, the authors stated that in the late of XIX – early XX centuries the healthcare system in the Caucasus has experienced a period of significant development. In this time, taking into account the regional peculiarities, there were developed the institutions of the health system, and have been taken measures of anti-epidemic struggle. Despite the difficulties of conducting the health activities in a multinational region the Russian administration managed to significantly reduce the number of patients in the Caucasus.

  3. Strategies for healthcare information systems

    NARCIS (Netherlands)

    Stegwee, R.A.; Spil, Antonius A.M.

    2001-01-01

    Information technologies of the past two decades have created significant fundamental changes in the delivery of healthcare services by healthcare provider organizations. Many healthcare organizations have been in search of ways and strategies to keep up with continuously emerging information

  4. Improving Healthcare through Lean Management: Experiences from the Danish healthcare system

    DEFF Research Database (Denmark)

    Edwards, Kasper; Nielsen, Anders Paarup

    still is in its infancy and it is just a matter of letting sufficient time pass in order have a successful implementation of lean in all areas of healthcare. The second hypothesis states that a major barrier to lean management in healthcare simply is lacking understanding of the lean concepts leading......The ideas and principles from lean management are now widely being adopted within the healthcare sector. The analysis in this paper shows that organizations within healthcare most often only implement a limited set of tools and methods from the lean tool-box. Departing from a theoretical analysis...... of the well-known and universal lean management principles in the context of the healthcare this paper will attempt to formulate and test four hypotheses about possible barriers to the successful implementation of lean management in healthcare. The first hypothesis states that lean management in healthcare...

  5. An Attribute Based Access Control Framework for Healthcare System

    Science.gov (United States)

    Afshar, Majid; Samet, Saeed; Hu, Ting

    2018-01-01

    Nowadays, access control is an indispensable part of the Personal Health Record and supplies for its confidentiality by enforcing policies and rules to ensure that only authorized users gain access to requested resources in the system. In other words, the access control means protecting patient privacy in healthcare systems. Attribute-Based Access Control (ABAC) is a new access control model that can be used instead of other traditional types of access control such as Discretionary Access Control, Mandatory Access Control, and Role-Based Access Control. During last five years ABAC has shown some applications in both recent academic fields and industry purposes. ABAC by using user’s attributes and resources, makes a decision according to an access request. In this paper, we propose an ABAC framework for healthcare system. We use the engine of ABAC for rendering and enforcing healthcare policies. Moreover, we handle emergency situations in this framework.

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

    Science.gov (United States)

    Nardon, Fabiane Bizinella; de A Moura, Lincoln

    2007-01-01

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

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

    Science.gov (United States)

    Karampelas, Vasilios; Pallikarakis, Nicholas; Mantas, John

    2013-01-01

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

  8. CMOS Enabled Microfluidic Systems for Healthcare Based Applications.

    Science.gov (United States)

    Khan, Sherjeel M; Gumus, Abdurrahman; Nassar, Joanna M; Hussain, Muhammad M

    2018-04-01

    With the increased global population, it is more important than ever to expand accessibility to affordable personalized healthcare. In this context, a seamless integration of microfluidic technology for bioanalysis and drug delivery and complementary metal oxide semiconductor (CMOS) technology enabled data-management circuitry is critical. Therefore, here, the fundamentals, integration aspects, and applications of CMOS-enabled microfluidic systems for affordable personalized healthcare systems are presented. Critical components, like sensors, actuators, and their fabrication and packaging, are discussed and reviewed in detail. With the emergence of the Internet-of-Things and the upcoming Internet-of-Everything for a people-process-data-device connected world, now is the time to take CMOS-enabled microfluidics technology to as many people as possible. There is enormous potential for microfluidic technologies in affordable healthcare for everyone, and CMOS technology will play a major role in making that happen. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  9. The orthopaedist's role in healthcare system governance.

    Science.gov (United States)

    Probe, Robert A

    2013-06-01

    Historically, physicians as participants in healthcare governance were shunned because of perceived potential for conflict of interest. This maxim is being revisited as health systems begin to appreciate the value presented by physician leaders. This overview of the orthopaedist's role in healthcare governance will be addressed in three sections: first to identify the need for change in American healthcare, second to examine the role that physicians should play in governing over this inevitable change, and third to outline strategies for effective participation for those physicians wishing to play a role in healthcare governance. The PubMed data set was queried applying the search commands "governance AND (healthcare OR hospital) AND (doctor OR physician OR surgeon)" for the time period 1969 to 2012. In addition, the bibliographies of relevant articles were reviewed. This search strategy returned 404 titles. Abstract and article review identified 19 relevant to the topic. Bibliographic review identified five more articles of relevance forming the foundation for this review. The delivery of American health care will require change to face current economic realities. Organizations that embrace this change guided by the insight of physician governors are well positioned to recognize the simultaneous improvement in value and quality. Although few physicians are formally trained for these roles, multiple paths to becoming effective governors are available. In this environment of rapid change in healthcare delivery, the medical insight of physician leadership will prove invaluable. Governing bodies should reach out to talented physicians and administratively talented physicians should rise to this challenge.

  10. Service models for remote healthcare monitoring systems.

    Science.gov (United States)

    Moorman, Bridget A

    2010-01-01

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

  11. Ensuring healthcare system integrity with blockchain

    OpenAIRE

    I. L?hmus

    2016-01-01

    Blockchain, the underlying protocol behind Bitcoin, has received a tremendous amount of attention over the last two years. Whilst initially focused on financial services, the technology holds much promise for addressing challenges in health-care system. Electronic health records and related information systems have several advantages over historical paper-based management - smooth data transfer between medical care providers, patient empowerment etc. While being convenient and effient these s...

  12. Households' choices of healthcare services in the north west region ...

    African Journals Online (AJOL)

    Health can either be optimised households' choices between preventive and curative ... In Cameroon like other developing countries, domestic healthcare service is ... specific characteristics such as the reputation of the healthcare providers are ... healthcare can be improved with efficient healthcare support programs and ...

  13. Assessment of healthcare measures, healthcare resource use, and cost of care among severe hemophilia A patients in Mumbai region of India.

    Science.gov (United States)

    Jadhav, U; Mukherjee, K

    2017-10-23

    In India, the low public health priority given to rare disorders such as hemophilia hinders their management and optimal care, leading to relatively poor health outcomes. This study aims to profile the multidimensional health status of patients with severe hemophilia A, and its association with the use of healthcare resources and the cost of care in Mumbai region of India. A cross-sectional, single-center study was conducted during January-May 2011, among 160 patients diagnosed with severe hemophilia A in Mumbai region of India. Their health status was documented using the Hemophilia Utilization Group Study's validated instrument of Functional Health Status Measure (FHS) and a single item of Self-care Measure. Of 160 patients, 55% (n = 88) scored on the lower side on the FHS, with an average score of 6.65 ± 2.85. The use of healthcare resources and cost of treatment were considerable for patients with a lower mean rank score on the FHS and a higher mean rank score on the self-care measure. The consumption of clotting factor concentrates (CFCs), number of visits to a health facility and incidence of inpatient episodes were significantly associated with a relatively low score on the FHS. Similarly, a higher cost of treatment, in terms of the cost of CFCs, direct cost, emergency room cost, and indirect cost, were significantly associated with a lower score on the FHS. The health status of patients with severe hemophilia A is compromised and has a significant impact on the use of healthcare resources and the cost of treatment.

  14. [Governance in a project addressing care of disabled elderly persons within the regional healthcare system of Tuscany, Italy].

    Science.gov (United States)

    Pedace, Claudio; Rosa, Antonella; Francesconi, Paolo; Acampora, Anna; Ricciardi, Walter; Damiani, Gianfranco

    2017-01-01

    Population aging and the concurrent increase of age-related chronic degenerative diseases and disability are associated with an increased proportion of elderly persons who are dependent in activities of daily living (ADL). ADL-dependent persons need continuous and long-term health and social care according to the "taking charge" rationale, in order to warrant access and continuity of care. A healthcare system needs to respond to the long-term and complex needs, such as those of disabled elderly people, by providing appropriate health and social care services in Primary Care. A Primary Health Care system is organized according to two governance levels have distinct aims but are closely inter-dependent in their operational mechanisms. The system governance is accountable for the community and individual health protection while the delivery governance is accountable for the provision of services in accordance with appropriateness, safety and economic criteria. Delivery governance can be considered "integrated governance" as a synergy exists between two decision-making systems guiding provider choices, which are corporate governance and clinical governance. The aim of this study was to analyse the abovementioned governance levels within the healthcare system in Tuscany (Italy) referring to long-term residential care for disabled elderly people. The case of excessive accesses to emergency departments from different types of Nursing Homes (NH) is used as an example to analyse different levels of responsibility involved in the management of a critical phenomenon. Suggestions for improvement in the different levels of governance for disabled elderly people are provided, in order to support institutional programming activities.

  15. [Current legislation in the healthcare system 2015/2016].

    Science.gov (United States)

    Martenstein, I; Wienke, A

    2016-05-01

    The energy of the legislator in the healthcare system was barely stoppable in 2015. Many new laws have been brought into force and legal initiatives have also been implemented. The Hospital Structure Act, the Treatment Enhancement Act, amendments of the official medical fee schedules for physicians, the Prevention Act, the E-Health Act, the Anti-corruption Act, the hospital admission guidelines and amendments of the model specialty training regulations are just some of the essential alterations that lie ahead of the medical community. This article gives a review of the most important new legislative regulations in the healthcare system and presents the fundamental consequences for the practice.

  16. Teaching at primary healthcare services within the Brazilian national health system (SUS in Brazilian healthcare professionals' training

    Directory of Open Access Journals (Sweden)

    Ramona Fernanda Ceriotti Toassi

    2013-06-01

    Full Text Available The aim of this study was to analyze the role of teaching at primary healthcare services within the Brazilian National Health System (SUS in dentists' training, at a public university in the south of Brazil. A qualitative methodological approach (case study was used. Interviews were conducted with 12 dentistry students, six dentists who were preceptors working in public primary healthcare services and three teachers connected with this curricular training. Our findings showed that the curricular training in SUS primary healthcare services had an impact on the dentists' education through establishment of bonds, autonomy in problem-solving and multiprofessional teamwork. It was seen that they learned about how healthcare services function, about healthcare and about development of cultural competence. There is a need to maintain constant questioning regarding these practices, and to ensure the presence of infrastructure and qualified professionals for teaching at these services.

  17. E-health and healthcare enterprise information system leveraging service-oriented architecture.

    Science.gov (United States)

    Hsieh, Sung-Huai; Hsieh, Sheau-Ling; Cheng, Po-Hsun; Lai, Feipei

    2012-04-01

    To present the successful experiences of an integrated, collaborative, distributed, large-scale enterprise healthcare information system over a wired and wireless infrastructure in National Taiwan University Hospital (NTUH). In order to smoothly and sequentially transfer from the complex relations among the old (legacy) systems to the new-generation enterprise healthcare information system, we adopted the multitier framework based on service-oriented architecture to integrate the heterogeneous systems as well as to interoperate among many other components and multiple databases. We also present mechanisms of a logical layer reusability approach and data (message) exchange flow via Health Level 7 (HL7) middleware, DICOM standard, and the Integrating the Healthcare Enterprise workflow. The architecture and protocols of the NTUH enterprise healthcare information system, especially in the Inpatient Information System (IIS), are discussed in detail. The NTUH Inpatient Healthcare Information System is designed and deployed on service-oriented architecture middleware frameworks. The mechanisms of integration as well as interoperability among the components and the multiple databases apply the HL7 standards for data exchanges, which are embedded in XML formats, and Microsoft .NET Web services to integrate heterogeneous platforms. The preliminary performance of the current operation IIS is evaluated and analyzed to verify the efficiency and effectiveness of the designed architecture; it shows reliability and robustness in the highly demanding traffic environment of NTUH. The newly developed NTUH IIS provides an open and flexible environment not only to share medical information easily among other branch hospitals, but also to reduce the cost of maintenance. The HL7 message standard is widely adopted to cover all data exchanges in the system. All services are independent modules that enable the system to be deployed and configured to the highest degree of flexibility

  18. Flexible solution for interoperable cloud healthcare systems.

    Science.gov (United States)

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

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Borgi Lea

    2010-11-01

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

  20. Establishing values-based leadership and value systems in healthcare organizations.

    Science.gov (United States)

    Graber, David R; Kilpatrick, Anne Osborne

    2008-01-01

    The importance of values in organizations is often discussed in management literature. Possessing strong or inspiring values is increasingly considered to be a key quality of successful leaders. Another common theme is that organizational values contribute to the culture and ultimate success of organizations. These conceptions or expectations are clearly applicable to healthcare organizations in the United States. However, healthcare organizations have unique structures and are subject to societal expectations that must be accommodated within an organizational values system. This article describes theoretical literature on organizational values. Cultural and religious influences on Americans and how they may influence expectations from healthcare providers are discussed. Organizational cultures and the training and socialization of the numerous professional groups in healthcare also add to the considerable heterogeneity of value systems within healthcare organizations. These contribute to another challenge confronting healthcare managers--competing or conflicting values within a unit or the entire organization. Organizations often fail to reward members who uphold or enact the organization's values, which can lead to lack of motivation and commitment to the organization. Four key elements of values-based leadership are presented for healthcare managers who seek to develop as values-based leaders. 1) Recognize your personal and professional values, 2) Determine what you expect from the larger organization and what you can implement within your sphere of influence, 3) Understand and incorporate the values of internal stakeholders, and 4) Commit to values-based leadership.

  1. [Public health stewardship and governance regarding the Colombian healthcare system, 2012-2013].

    Science.gov (United States)

    Roth-Deubel, André N; Molina-Marín, Gloria

    2013-01-01

    Analysing decision-making concerning public health issues regarding the Colombian healthcare system from a market economy-based approach. This study involved applying Glaser and Strauss's grounded theory in six Colombian cities during 2012: Bogotá, Barranquilla, Bucaramanga, Leticia, Medellin and Pasto. 120 individual interviews were conducted with professionals involved in decision-making, running public healthcare programmes and making policy within public and private institutions. Fourteen focus groups were held with community organisation leaders. The findings suggested national and municipal health authorities' weak stewardship and ineffective governance regarding public healthcare policy and programmes, related to a lack of staff trained in public health management issues. In turn, this was related to political parties' interference and private insurers' particular interests and the structural fragmentation of functions and actors within the health system, thereby limiting public health development. A new axiology is necessary for achieving effective governance (I.e. cooperation between Colombian Healthcare Social Security System actors) to overcome current incompetence and financial self-interest predominating within the Colombian healthcare system.

  2. Using grey literature to prepare pharmacy students for an evolving healthcare delivery system.

    Science.gov (United States)

    Happe, Laura E; Walker, Desiree'

    2013-05-13

    To assess the impact of using "grey literature" (information internally produced in print or electronic format by agencies such as hospitals, government, businesses, etc) rather than a textbook in a course on healthcare delivery systems on students' perception of the relevance of healthcare delivery system topics and their ability to identify credible sources of this information. A reading from the grey literature was identified and assigned to the students for each topic in the course. Pre- and post-course survey instruments were used for the assessment. Students reported healthcare delivery systems topics to be moderately relevant to the profession of pharmacy on both the pre- and post-course survey instruments. Students' knowledge of current and credible sources of information on healthcare delivery system topics significantly improved based on self-reports and scores on objective assessments (pgrey literature in a course on healthcare delivery systems can be used to ensure that information in the pharmacy school curriculum is the most current and credible information available.

  3. Asan medical information system for healthcare quality improvement.

    Science.gov (United States)

    Ryu, Hyeon Jeong; Kim, Woo Sung; Lee, Jae Ho; Min, Sung Woo; Kim, Sun Ja; Lee, Yong Su; Lee, Young Ha; Nam, Sang Woo; Eo, Gi Seung; Seo, Sook Gyoung; Nam, Mi Hyun

    2010-09-01

    This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. AMIS CONSISTED OF SEVERAL DISTINCTIVE SYSTEMS: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system. AMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed.

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

    Science.gov (United States)

    Liao, Wen-Hwa; Qiu, Wan-Li

    2016-01-01

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

  5. Using ESB and BPEL for Evolving Healthcare Systems Towards Pervasive, Grid-Enabled SOA

    Science.gov (United States)

    Koufi, V.; Malamateniou, F.; Papakonstantinou, D.; Vassilacopoulos, G.

    Healthcare organizations often face the challenge of integrating diverse and geographically disparate information technology systems to respond to changing requirements and to exploit the capabilities of modern technologies. Hence, systems evolution, through modification and extension of the existing information technology infrastructure, becomes a necessity. Moreover, the availability of these systems at the point of care when needed is a vital issue for the quality of healthcare provided to patients. This chapter takes a process perspective of healthcare delivery within and across organizational boundaries and presents a disciplined approach for evolving healthcare systems towards a pervasive, grid-enabled service-oriented architecture using the enterprise system bus middleware technology for resolving integration issues, the business process execution language for supporting collaboration requirements and grid middleware technology for both addressing common SOA scalability requirements and complementing existing system functionality. In such an environment, appropriate security mechanisms must ensure authorized access to integrated healthcare services and data. To this end, a security framework addressing security aspects such as authorization and access control is also presented.

  6. Improvement of emotional healthcare system with stress detection from ECG signal.

    Science.gov (United States)

    Tivatansakul, S; Ohkura, M

    2015-01-01

    Our emotional healthcare system is designed to cope with users' negative emotions in daily life. To make the system more intelligent, we integrated emotion recognition by facial expression to provide appropriate services based on user's current emotional state. Our emotion recognition by facial expression has confusion issue to recognize some positive, neutral and negative emotions that make the emotional healthcare system provide a relaxation service even though users don't have negative emotions. Therefore, to increase the effectiveness of the system to provide the relaxation service, we integrate stress detection from ECG signal. The stress detection might be able to address the confusion issue of emotion recognition by facial expression to provide the service. Indeed, our results show that integration of stress detection increases the effectiveness and efficiency of the emotional healthcare system to provide services.

  7. Discourse analysis: A useful methodology for health-care system researches.

    Science.gov (United States)

    Yazdannik, Ahmadreza; Yousefy, Alireza; Mohammadi, Sepideh

    2017-01-01

    Discourse analysis (DA) is an interdisciplinary field of inquiry and becoming an increasingly popular research strategy for researchers in various disciplines which has been little employed by health-care researchers. The methodology involves a focus on the sociocultural and political context in which text and talk occur. DA adds a linguistic approach to an understanding of the relationship between language and ideology, exploring the way in which theories of reality and relations of power are encoded in such aspects as the syntax, style, and rhetorical devices used in texts. DA is a useful and productive qualitative methodology but has been underutilized within health-care system research. Without a clear understanding of discourse theory and DA it is difficult to comprehend important research findings and impossible to use DA as a research strategy. To redress this deficiency, in this article, represents an introduction to concepts of discourse and DA, DA history, Philosophical background, DA types and analysis strategy. Finally, we discuss how affect to the ideological dimension of such phenomena discourse in health-care system, health beliefs and intra-disciplinary relationship in health-care system.

  8. Private health care expenditure and quality in Beveridge systems: cross-regional differences in the Italian NHS.

    Science.gov (United States)

    Del Vecchio, Mario; Fenech, Lorenzo; Prenestini, Anna

    2015-03-01

    Private health care expenditure ranges from 15% to 30% of total healthcare spending in OECD countries. The literature suggests that there should be an inverse correlation between quality of public services and private expenditures. The main objective of this study is to explore the association between quality of public healthcare and private expenditures in the Italian Regional Healthcare Systems (RHSs). The institutional framework offered by the Italian NHS allows to investigate on the differences among the regions while controlling for institutional factors. The study uses micro-data from the ISTAT Household Consumption Survey (HCS) and a rich set of regional quality indicators. The results indicate that there is a positive and significant correlation between quality and private spending per capita across regions. The study also points out the strong association between the distribution of private consumption and income. In order to account for the influence of income, the study segmented data in three socio-economic classes and computed cross-regional correlations of RHSs quality and household healthcare expenditure per capita, within each class. No correlation was found between the two variables. These findings are quite surprising and call into question the theory that better quality of public services crowds out private spending, or, at the very least, it undermines the simplistic notions that higher levels of private spending are a direct consequence of poor quality in the public sector. This suggests that policies should avoid to simplistically link private spending with judgements or assessments about the functioning or efficacy of the public system and its organizations. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  9. Value-Based Approaches to Healthcare Systems and Pharmacoeconomics Requirements in Asia: South Korea, Taiwan, Thailand and Japan

    OpenAIRE

    Isao Kamae

    2010-01-01

    Asian healthcare systems are very diverse, representing cultures, political systems and economies from more than 30 countries with varying histories. Despite the diversity in the region, there has been enormous growth in health economics and outcomes research since the beginning of the 21st century. Whilst Japan has seen very limited use of health technology assessment (HTA), South Korea, Taiwan and Thailand have had remarkable success in establishing government agencies for HTA, employing HT...

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

    Science.gov (United States)

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

    2015-08-01

    At the government, hospital, and health-care provider level, corruption plays a major role in health-care systems in Africa. The returns on health investments of international financial institutions, health organisations, and donors might be very low when mismanagement and dysfunctional structures of health-care systems are not addressed. More funding might even aggravate corruption. We discuss corruption and its effects on cancer care within the African health-care system in a sociocultural context. The contribution of high-income countries in stimulating corruption is also described. Corrupt African governments cannot be expected to take the initiative to eradicate corruption. Therefore, international financial institutions, health organisations, and financial donors should use their power to demand policy reforms of health-care systems in Africa troubled by the issue of corruption. These modifications will ameliorate the access and quality of cancer care for patients across the continent, and ultimately improve the outcome of health care to all patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Seven Guiding Commitments: Making the U.S. Healthcare System More Compassionate

    Directory of Open Access Journals (Sweden)

    Beth A. Lown MD

    2014-11-01

    Full Text Available Despite the current focus on patient centeredness, healthcare professionals face numerous challenges that impede their ability to provide compassionate care that ameliorates concerns, distress, or suffering. These include fragmentation and discontinuity of care, technologies that both help and hinder communication and relationship-building, burgeoning operational and administrative requirements, inadequate communication skills training, alarming rates of burnout, and increased cost and market pressures. A compassionate healthcare system begins with compassionate people, but the organizations in which they train and work must reliably enable them to express and act on their compassion rather than impede it. We present a set of guiding commitments and recommendations to foster a more compassionate healthcare system. We urge healthcare organizations to adopt these commitments and take action to embed compassionate care in all aspects of training, research, patient care and organizational life.

  12. Public perceptions of key performance indicators of healthcare in Alberta, Canada.

    Science.gov (United States)

    Northcott, Herbert C; Harvey, Michael D

    2012-06-01

    To examine the relationship between public perceptions of key performance indicators assessing various aspects of the health-care system. Cross-sequential survey research. Annual telephone surveys of random samples of adult Albertans selected by random digit dialing and stratified according to age, sex and region (n = 4000 for each survey year). The survey questionnaires included single-item measures of key performance indicators to assess public perceptions of availability, accessibility, quality, outcome and satisfaction with healthcare. Cronbach's α and factor analysis were used to assess the relationship between key performance indicators focusing on the health-care system overall and on a recent interaction with the health-care system. The province of Alberta, Canada during the years 1996-2004. Four thousand adults randomly selected each survey year. Survey questions measuring public perceptions of healthcare availability, accessibility, quality, outcome and satisfaction with healthcare. Factor analysis identified two principal components with key performance indicators focusing on the health system overall loading most strongly on the first component and key performance indicators focusing on the most recent health-care encounter loading most strongly on the second component. Assessments of the quality of care most recently received, accessibility of that care and perceived outcome of care tended to be higher than the more general assessments of overall health system quality and accessibility. Assessments of specific health-care encounters and more general assessments of the overall health-care system, while related, nevertheless comprise separate dimensions for health-care evaluation.

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

    Science.gov (United States)

    Azar, Jose; Adams, Nadia; Boustani, Malaz

    2015-01-01

    In the United States, it is estimated that 75,000 deaths every year could be averted if the healthcare system implemented high quality care more effectively and efficiently. Patient harm in the hospital occurs as a consequence of inadequate procedures, medications and other therapies, nosocomial infections, diagnostic evaluations and patient falls. Implementation science, a new emerging field in healthcare, is the development and study of methods and tools aimed at enhancing the implementation of new discoveries and evidence into daily healthcare delivery. The Indiana University Center for Healthcare Innovation and Implementation Science (IU-CHIIS) was launched in September 2013 with the mission to use implementation science and innovation to produce great-quality, patient-centered and cost-efficient healthcare delivery solutions for the United States of America. Within the first 24 months of its initiation, the IU-CHIIS successfully scaled up an evidence-based collaborative care model for people with dementia and/or depression, successfully expanded the Accountable Care Unit model positively impacting the efficiency and quality of care, created the first Certificate in Innovation and Implementation Science in the US and secured funding from National Institutes of Health to investigate innovations in dementia care. This article summarizes the establishment of the IU-CHIIS, its impact and outcomes and the lessons learned during the journey. Copyright © 2015. Published by Elsevier GmbH.

  14. [Fact-finding survey on regional healthcare services for patients with epilepsy based on a questionnaire administered to public health centers in Japan].

    Science.gov (United States)

    Fujii, Masami; Ishimaru, Yasutaka; Takahashi, Hiroyuki; Egami, Hirofumi; Nishida, Hideki; Oka, Shinji; Shirabe, Komei

    2015-01-01

    Epilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizures. The prevalence of epilepsy is about 1%, and its incidence is increasing with the aging population. In addition to their medical problems, epilepsy patients face many social problems, including schooling, working, and maintaining their driver's licenses. However, these problems are not fully recognized by the regional healthcare centers (HCCs), and the inadequacy of collaboration between medical services, healthcare, and welfare is sometimes pointed out. Under these circumstances, this fact-finding survey was administered in the form of a questionnaire to HCCs across the nation for the purpose of improving the support system and educational activities for epilepsy in Japan. A mail-back survey on regional healthcare services for epilepsy patients was sent out to 490 HCCs across the nation. Public health nurses (PHNs) responded to the self-completed questionnaire on behalf of each HCC. The questionnaire was comprised of the presence or absence of consultations on epilepsy, content of the consultations, and holding of workshops, lectures, or conferences in the community covered by the HCC. We obtained responses from 347 HCCs (response rate 71%). Seventy-three percent of the PHNs had experience with consultations regarding the medical and healthcare issues associated with epilepsy. However, only 10% of the PHNs responded that they could provide appropriate consultation for these issues. The content of the consultations mainly included medical services, clinical symptoms of epilepsy, and anxieties about their social life and their future. Workshops, lectures, or conferences on epilepsy were held for residents or health and welfare professionals in only 8% of the communities. This percentage is lower than those (21-70%) for other intractable or mental disorders that are mainly managed by HCCs (Prestrictions. To improve these situations, regional education programs for

  15. Explaining public satisfaction with health-care systems: findings from a nationwide survey in China.

    Science.gov (United States)

    Munro, Neil; Duckett, Jane

    2016-06-01

    To identify factors associated with health-care system satisfaction in China. Recent research suggests that socio-demographic characteristics, self-reported health, income and insurance, ideological beliefs, health-care utilization, media use and perceptions of services may affect health-care system satisfaction, but the relative importance of these factors is poorly understood. New data from China offer the opportunity to test theories about the sources of health-care system satisfaction. Stratified nationwide survey sample analysed using multilevel logistic regression. 3680 Chinese adults residing in family dwellings between 1 November 2012 and 17 January 2013. Satisfaction with the way the health-care system in China is run. We find only weak associations between satisfaction and socio-demographic characteristics, self-reported health and income. We do, however, find that satisfaction is strongly associated with having insurance and belief in personal responsibility for meeting health-care costs. We also find it is negatively associated with utilization, social media use, perceptions of access as unequal and perceptions of service providers as unethical. To improve satisfaction, Chinese policymakers - and their counterparts in countries with similar health-care system characteristics - should improve insurance coverage and the quality of health services, and tackle unethical medical practices. © 2015 The Authors. Health Expectations published by John Wiley & Sons Ltd.

  16. Components of Maternal Healthcare Delivery System Contributing to ...

    African Journals Online (AJOL)

    Components of Maternal Healthcare Delivery System Contributing to Maternal Deaths ... transcripts were analyzed using a directed approach to content analysis. Excerpts were categorized according to three main components of the maternal ...

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

    Science.gov (United States)

    Kamel Boulos, Maged N; Berry, Geoff

    2012-06-28

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

  18. A cloud-based home health care information sharing system to connect patients with home healthcare staff -A case report of a study in a mountainous region.

    Science.gov (United States)

    Nomoto, Shinichi; Utsumi, Momoe; Sasayama, Satoshi; Dekigai, Hiroshi

    2017-01-01

    We have developed a cloud system, the e-Renraku Notebook (e-RN) for sharing of home care information based on the concept of "patient-centricity". In order to assess the likelihood that our system will enhance the communication and sharing of information between home healthcare staff members and home-care patients, we selected patients who were residing in mountainous regions for inclusion in our study. We herein report the findings.Eighteen staff members from 7 medical facilities and 9 patients participated in the present study.The e-RN was developed for two reasons: to allow patients to independently report their health status and to have staff members view and respond to the information received. The patients and staff members were given iPads with the pre-installed applications and the information being exchanged was reviewed over a 54-day period.Information was mainly input by the patients (61.6%), followed by the nurses who performed home visits (19.9%). The amount of information input by patients requiring high-level nursing care and their corresponding staff member was significantly greater than that input by patients who required low-level of nursing care.This patient-centric system in which patients can independently report and share information with a member of the healthcare staff provides a sense of security. It also allows staff members to understand the patient's health status before making a home visit, thereby giving them a sense of security and confidence. It was also noteworthy that elderly patients requiring high-level nursing care and their staff counterpart input information in the system significantly more frequently than patients who required low-level care.

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

    Science.gov (United States)

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

    2010-03-01

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

  20. Healthcare system simulation using Witness

    International Nuclear Information System (INIS)

    Khakdaman, Masoud; Zeinahvazi, Milad; Zohoori, Bahareh; Nasiri, Fardokht; Wong, Kuan Yew

    2013-01-01

    Simulation techniques have a proven track record in manufacturing industry as well as other areas such as healthcare system improvement. In this study, simulation model of a health center in Malaysia is developed through the application of WITNESS simulation software which has shown its flexibility and capability in manufacturing industry. Modelling procedure is started through process mapping and data collection and continued with model development, verification, validation and experimentation. At the end, final results and possible future improvements are demonstrated.

  1. East Midlands healthcare and bioscience sector strategy appendix 1: healthcare and bioscience res implementation plan

    OpenAIRE

    East Midlands Development Agency

    2007-01-01

    The healthcare and bioscience sector is one of four priority sectors identified in the regional economic strategy, A Flourishing Region. This document sets out the implementation plan for maximising the contribution of the healthcare and biosciences sector to the economic development of the East Midlands.

  2. The Erasure of Sex and Gender Minorities in the Healthcare System

    Directory of Open Access Journals (Sweden)

    Marianne LeBreton

    2013-09-01

    Full Text Available Socio-cultural notions of gender and sex influence the structuring of healthcare systems. This case study exemplifies how the Western gender binary, and cisnormativity in particular, can create barriers to accessing healthcare services for transgender populations and lead to erasure.

  3. Security And Privacy Issues in Healthcare Monitoring Systems: A Case Study

    DEFF Research Database (Denmark)

    Handler, Daniel Tolboe; Hauge, Lotte; Spognardi, Angelo

    2017-01-01

    Security and privacy issues are rarely taken into account in automated systems for monitoring elderly people in their home, exposing inhabitants to a number of threats they are usually not aware of. As a case study to expose the major vulnerabilities these systems are exposed to, this paper reviews...... a generic example of automated healthcare monitoring system. The security and privacy issues identified in this case study can be easily generalised and regarded as alarm bells for all the pervasive healthcare professionals....

  4. The Healthcare Future for the iGeneration: Integrating the Patient and the Healthcare System

    OpenAIRE

    Cathy H. Ficzere, PharmD, BCPS; Traci M. Poole, PharmD, BCACP; Rachel B. Franks, PharmD, BCACP; Elisa M. Greene, PharmD, BCACP; Kristina D. Wood, PharmD, BCACP; Philip E. Johnston, PharmD

    2013-01-01

    Objective: To propose a vision to integrate patients, their health-related data, and their wellness plans into the healthcare system using smartphone and tablet computer technology. Setting: Ambulatory care and community practice Practice Innovation: Utilization of smartphone and tablet computer technology to assess health care conditions, educate and involve patients, and facilitate seamless communication between the patient, electronic health record, pharmacy system, third-party p...

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

    Science.gov (United States)

    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.

  6. The Learning Healthcare System: Where are we now? A systematic review.

    Science.gov (United States)

    Budrionis, Andrius; Bellika, Johan Gustav

    2016-12-01

    The Learning Healthcare System paradigm has attracted the attention of researchers worldwide. The great potential originating from high-scale health data reuse and the inclusion of patient perspectives into care models promises personalized care, lower costs of health services and minimized consumption of resources. The aim of this review is to summarize the attempts to adopt the novel paradigm, putting emphasis on implementations and evaluating the impact on current medical practices. PRISMA methodology was followed for structuring the review process. Three major research databases (PubMed, IEEE Xplore and ACM DL) were queried with the predefined search terms "learning healthcare" and "learning health". Publications containing specific theoretical or empirical results were considered. Three hundred and fifty-eight publications were identified; however, only 32 met the inclusion criteria. Nineteen papers were characterized as theoretical contributions, while the rest presented empirical achievements. Only one paper described the initial estimates of impact and economy. Individualistic communication of studies ignoring popular frameworks for assessing and reporting research achievements prevents the systematic generation of knowledge. Evaluating the impact of the Learning Healthcare System instances where it is implemented could work as a catalyst in reaching higher acceptance and adoption of the proposed ideas by healthcare worldwide; however, it mostly remains described in theory. The review demonstrated the interest of researchers in exploring the Learning Healthcare System ideas. However, it also revealed minimal focus on evaluating the impact of the novel paradigm on both healthcare service delivery and patient outcome. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Ownership, control, and contention: challenges for the future of healthcare in Malaysia.

    Science.gov (United States)

    Chee, Heng Leng

    2008-05-01

    The recent history of healthcare privatisation and corporatisation in Malaysia, an upper middle-income developing country, highlights the complicit role of the state in the rise of corporate healthcare. Following upon the country's privatisation policy in the 1980s, private capital made significant inroads into the healthcare provider sector. This paper explores the various ownership interests in healthcare provision: statist capital, rentier capital, and transnational capital, as well as the contending social and political forces that lie behind state interests in the privatisation of healthcare, the growing prominence of transnational activities in healthcare, and the regional integration of capital in the healthcare provider industry. Civil society organizations provide a small but important countervailing force in the contention over the future of healthcare in the country. It is envisaged that the healthcare financing system will move towards a social insurance model, in which the state has an important regulating role. The important question, therefore, is whether the Malaysian government, with its vested interests, will have the capacity and the will to play this role in a social insurance system. The issues of ownership and control have important implications for governance more generally in a future healthcare system.

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

    Science.gov (United States)

    Sajid, Anam; Abbas, Haider

    2016-06-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

  10. An Intelligent Virtual Human System For Providing Healthcare Information And Support

    Science.gov (United States)

    2011-01-01

    healthcare system, and also to other SMs and Veterans by way of a variety of social networking tools (e.g., 2nd Life, Facebook, etc.). The user can progress... CyberPsychology and Behavior 8, 3 (2005), 187-211. [2] T. Parsons & A.A. Rizzo, Affective Outcomes of Virtual Reality Exposure Therapy for Anxiety...VH System for Providing Healthcare Information and Support508 [4] G. Riva, Virtual Reality in Psychotherapy: Review, CyberPsychology and Behavior 8

  11. Healthcare Systems and Other Applications

    NARCIS (Netherlands)

    van Kasteren, T.L.M.; Kröse, B.J.A.

    2007-01-01

    This Works in Progress department discusses eight projects related to healthcare. The first project aims to aid people with mild dementia. The second project plans to simplify the delivery of healthcare services to the elderly and cognitively disabled, while the third project is developing models

  12. The effect of healthcare delivery privatisation on avoidable mortality: longitudinal cross-regional results from Italy, 1993-2003.

    Science.gov (United States)

    Quercioli, Cecilia; Messina, Gabriele; Basu, Sanjay; McKee, Martin; Nante, Nicola; Stuckler, David

    2013-02-01

    During the 1990s, Italy privatised a significant portion of its healthcare delivery. The authors compared the effectiveness of private and public sector healthcare delivery in reducing avoidable mortality (deaths that should not occur in the presence of effective medical care). The authors calculated the average rate of change in age-standardised avoidable mortality rates in 19 of Italy's regions from 1993 to 2003. Multivariate regression models were used to analyse the relationship between rates of change in avoidable mortality and levels of spending on public versus private healthcare delivery, controlling for potential demographic and economic confounders. Greater spending on public delivery of health services corresponded to faster reductions in avoidable mortality rates. Each €100 additional public spending per capita on NHS delivery was independently associated with a 1.47% reduction in the rate of avoidable mortality (p=0.003). In contrast, spending on private sector services had no statistically significant effect on avoidable mortality rates (p=0.557). A higher percentage of spending on private sector delivery was associated with higher rates of avoidable mortality (p=0.002). The authors found that neither public nor private sector delivery spending was significantly associated with non-avoidable mortality rates, plausibly because non-avoidable mortality is insensitive to healthcare services. Public spending was significantly associated with reductions in avoidable mortality rates over time, while greater private sector spending was not at the regional level in Italy.

  13. A study of the transferability of influenza case detection systems between two large healthcare systems.

    Science.gov (United States)

    Ye, Ye; Wagner, Michael M; Cooper, Gregory F; Ferraro, Jeffrey P; Su, Howard; Gesteland, Per H; Haug, Peter J; Millett, Nicholas E; Aronis, John M; Nowalk, Andrew J; Ruiz, Victor M; López Pineda, Arturo; Shi, Lingyun; Van Bree, Rudy; Ginter, Thomas; Tsui, Fuchiang

    2017-01-01

    This study evaluates the accuracy and transferability of Bayesian case detection systems (BCD) that use clinical notes from emergency department (ED) to detect influenza cases. A BCD uses natural language processing (NLP) to infer the presence or absence of clinical findings from ED notes, which are fed into a Bayesain network classifier (BN) to infer patients' diagnoses. We developed BCDs at the University of Pittsburgh Medical Center (BCDUPMC) and Intermountain Healthcare in Utah (BCDIH). At each site, we manually built a rule-based NLP and trained a Bayesain network classifier from over 40,000 ED encounters between Jan. 2008 and May. 2010 using feature selection, machine learning, and expert debiasing approach. Transferability of a BCD in this study may be impacted by seven factors: development (source) institution, development parser, application (target) institution, application parser, NLP transfer, BN transfer, and classification task. We employed an ANOVA analysis to study their impacts on BCD performance. Both BCDs discriminated well between influenza and non-influenza on local test cases (AUCs > 0.92). When tested for transferability using the other institution's cases, BCDUPMC discriminations declined minimally (AUC decreased from 0.95 to 0.94, pdetection performance in two large healthcare systems in two geographically separated regions, providing evidentiary support for the use of automated case detection from routinely collected electronic clinical notes in national influenza surveillance. The transferability could be improved by training Bayesian network classifier locally and increasing the accuracy of the NLP parser.

  14. Embracing uncertainty, managing complexity: applying complexity thinking principles to transformation efforts in healthcare systems.

    Science.gov (United States)

    Khan, Sobia; Vandermorris, Ashley; Shepherd, John; Begun, James W; Lanham, Holly Jordan; Uhl-Bien, Mary; Berta, Whitney

    2018-03-21

    Complexity thinking is increasingly being embraced in healthcare, which is often described as a complex adaptive system (CAS). Applying CAS to healthcare as an explanatory model for understanding the nature of the system, and to stimulate changes and transformations within the system, is valuable. A seminar series on systems and complexity thinking hosted at the University of Toronto in 2016 offered a number of insights on applications of CAS perspectives to healthcare that we explore here. We synthesized topics from this series into a set of six insights on how complexity thinking fosters a deeper understanding of accepted ideas in healthcare, applications of CAS to actors within the system, and paradoxes in applications of complexity thinking that may require further debate: 1) a complexity lens helps us better understand the nebulous term "context"; 2) concepts of CAS may be applied differently when actors are cognizant of the system in which they operate; 3) actor responses to uncertainty within a CAS is a mechanism for emergent and intentional adaptation; 4) acknowledging complexity supports patient-centred intersectional approaches to patient care; 5) complexity perspectives can support ways that leaders manage change (and transformation) in healthcare; and 6) complexity demands different ways of implementing ideas and assessing the system. To enhance our exploration of key insights, we augmented the knowledge gleaned from the series with key articles on complexity in the literature. Ultimately, complexity thinking acknowledges the "messiness" that we seek to control in healthcare and encourages us to embrace it. This means seeing challenges as opportunities for adaptation, stimulating innovative solutions to ensure positive adaptation, leveraging the social system to enable ideas to emerge and spread across the system, and even more important, acknowledging that these adaptive actions are part of system behaviour just as much as periods of stability are. By

  15. An eConsent-based System Architecture Supporting Cooperation in Integrated Healthcare Networks.

    Science.gov (United States)

    Bergmann, Joachim; Bott, Oliver J; Hoffmann, Ina; Pretschner, Dietrich P

    2005-01-01

    The economical need for efficient healthcare leads to cooperative shared care networks. A virtual electronic health record is required, which integrates patient related information but reflects the distributed infrastructure and restricts access only to those health professionals involved into the care process. Our work aims on specification and development of a system architecture fulfilling these requirements to be used in concrete regional pilot studies. Methodical analysis and specification have been performed in a healthcare network using the formal method and modelling tool MOSAIK-M. The complexity of the application field was reduced by focusing on the scenario of thyroid disease care, which still includes various interdisciplinary cooperation. Result is an architecture for a secure distributed electronic health record for integrated care networks, specified in terms of a MOSAIK-M-based system model. The architecture proposes business processes, application services, and a sophisticated security concept, providing a platform for distributed document-based, patient-centred, and secure cooperation. A corresponding system prototype has been developed for pilot studies, using advanced application server technologies. The architecture combines a consolidated patient-centred document management with a decentralized system structure without needs for replication management. An eConsent-based approach assures, that access to the distributed health record remains under control of the patient. The proposed architecture replaces message-based communication approaches, because it implements a virtual health record providing complete and current information. Acceptance of the new communication services depends on compatibility with the clinical routine. Unique and cross-institutional identification of a patient is also a challenge, but will loose significance with establishing common patient cards.

  16. IoT-based Asset Management System for Healthcare-related Industries

    Directory of Open Access Journals (Sweden)

    Lee Carman Ka Man

    2015-11-01

    Full Text Available The healthcare industry has been focusing efforts on optimizing inventory management procedures through the incorporation of Information and Communication Technology, in the form of tracking devices and data mining, to establish ideal inventory models. In this paper, a roadmap is developed towards a technological assessment of the Internet of Things (IoT in the healthcare industry, 2010–2020. According to the roadmap, an IoT-based healthcare asset management system (IoT-HAMS is proposed and developed based on Artificial Neural Network (ANN and Fuzzy Logic (FL, incorporating IoT technologies for asset management to optimize the supply of resources.

  17. A home healthcare system in the cloud - Addressing security and privacy challenges

    OpenAIRE

    Deng M.; Petkovic M.; Nalin M.; Baroni I.

    2011-01-01

    Cloud computing is an emerging technology that is expected to support Internet scale critical applications which could be essential to the healthcare sector. Its scalability, resilience, adaptability, connectivity, cost reduction, and high performance features have high potential to lift the efficiency and quality of healthcare. However,it is also important to understand specific risks related to security and privacy that this technology brings. This paper focuses on a home healthcare system ...

  18. Listening to Those at the Frontline: Patient and Healthcare Personnel Perspectives on Tuberculosis Treatment Barriers and Facilitators in High TB Burden Regions of Argentina

    Directory of Open Access Journals (Sweden)

    Sarah J. Iribarren

    2014-01-01

    Full Text Available Purpose. In Argentina, tuberculosis (TB control measures have not achieved key treatment targets. The purpose of this study was to identify modes of treatment delivery and explore patient and healthcare personnel perceptions of barriers and facilitators to treatment success. Methods. We used semistructured group and individual interviews for this descriptive qualitative study. Eight high burden municipalities were purposively selected. Patients in treatment for active TB (n=16, multidisciplinary TB team members (n=26, and TB program directors (n=12 at local, municipal, regional, and national levels were interviewed. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Results. Modes of treatment delivery varied across municipalities and types of healthcare facility and were highly negotiated with patients. Self-administration of treatment was common in hospital-based and some community clinics. Barriers to TB treatment success were concentrated at the system level. This level relied heavily on individual personal commitment, and many system facilitators were operating in isolation or in limited settings. Conclusions. We outline experiences and perspectives of the facilitating and challenging factors at the individual, structural, social, and organizational levels. Establishing strong patient-healthcare personnel relationships, responding to patient needs, capitalizing on community resources, and maximizing established decentralized system could mitigate some of the barriers.

  19. Medical data transmission system for remote healthcare centres

    International Nuclear Information System (INIS)

    Gonzalez, E A; Cagnolo, F J; Olmos, C E; Centeno, C A; Riva, G G; Zerbini, C A

    2007-01-01

    The main motivation of this project is to improve the healthcare centres equipment and human resources efficiency, enabling those centres for transmission of parameters of medical interest. This system facilitates remote consultation, in particular between specialists and remote healthcare centres. Likewise it contributes to the qualification of professionals. The electrocardiographic (ECG) and electroencephalographic (EEG) signals are acquired, processed and then sent, fulfilling the effective norms, for application in the hospital network of Cordoba Province, which has nodes interconnected by phone line. As innovative aspects we emphasized the low cost of development and maintenance, great versatility and handling simplicity with a modular design for interconnection with diverse data transmission media (Wi-Fi, GPRS, etc.). Successfully experiences were obtained during the acquisition of the signals and transmissions on wired LAN networks. As improvements, we can mention: energy consumption optimization and mobile communication systems usage, in order to offer more autonomy

  20. Awareness and implementation of tobacco dependence treatment guidelines in Arizona: Healthcare Systems Survey 2000

    Directory of Open Access Journals (Sweden)

    Menke J Michael

    2008-12-01

    Full Text Available Abstract Background This paper presents findings from the Tobacco Control in Arizona Healthcare Systems Survey, conducted in 2000. The purpose of the survey was to assess the status of Arizona healthcare systems' awareness and implementation of tobacco cessation and prevention measures. Methods The 20-item survey was developed by The University of Arizona HealthCare Partnership in collaboration with the Arizona Department of Health Services Bureau of Tobacco Education and Prevention. It was mailed to representatives of Arizona's 40 healthcare systems, including commercial and Medicare managed care organizations, "managed Medicaid" organizations, Veterans Affairs Health Care Systems, and Indian Health Service Medical Centers. Thirty-three healthcare systems (83% completed the survey. Results The majority of healthcare systems reported awareness of at least one tobacco cessation and prevention clinical practice guideline, but only one third reported full guideline implementation. While a majority covered some form of behavioral therapy, less than half reported covering tobacco treatment medications. "Managed Medicaid" organizations administered through the Arizona Health Care Cost Containment System were significantly less likely to offer coverage for behavioral therapy and less likely to cover pharmacotherapy than were their non-Medicaid counterparts in managed care, Veterans Affairs Health Care Systems and Indian Health Service Medical Centers. Conclusion Arizona healthcare system coverage for tobacco cessation in the year 2000 was comparable to national survey findings of the same year. The findings that only 10% of "Managed Medicaid" organizations covered tobacco treatment medication and were significantly less likely to cover behavioral therapy were important given the nearly double smoking prevalence among Medicaid patients. Throughout the years of the program, the strategic plan of the Arizona Department of Health Services Bureau of Tobacco

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

    Science.gov (United States)

    ROBBINS, JACOB A.

    2015-01-01

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

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

    Science.gov (United States)

    Potančok, Martin; Voříšek, Jiří

    2016-09-01

    Healthcare facilities use a number of information system/information and communication technologies. Each healthcare facility faces a need to choose sourcing strategies most suitable to ensure provision of information system/information and communication technology services, processes and resources. Currently, it is possible to observe an expansion of sourcing possibilities in healthcare informatics, which creates new requirements for sourcing strategies. Thus, the aim of this article is to identify factors influencing information system/information and communication technology sourcing strategies in healthcare facilities. The identification was based on qualitative research, namely, a case study. This study provides a set of internal and external factors with their impact levels. The findings also show that not enough attention is paid to these factors during decision-making. © The Author(s) 2015.

  3. [The quality of the German health-care system in an international comparison - a systematic review].

    Science.gov (United States)

    Lauerer, M; Emmert, M; Schöffski, O

    2013-08-01

    Studies assessing the quality of the German health-care system in an international comparison come to different results. Therefore, this review aims to investigate how the German health-care system is evaluated in comparison to other health-care systems by reviewing international publications. Results show starting points for ways to improve the German health-care system, to maintain and expand its strengths as well as to derive strategies for solving identified problems. A systematic review searching different databases [library catalogues, WorldCat (including MEDLINE and OAIster-search), German National Library, Google Scholar and others]. Search requests were addressed to English or German language publications for the time period 2000-2010 (an informal search was conducted in October 2011 for an update). Results of the identified studies were aggregated and main statements derived. In total, 13 publications assessing the German health-care system in an international comparison were identified. These comparisons are based on 377 measures. After aggregation, 244 substantially different indicators remained, which were dedicated to 14 categories. It became apparent that the German health-care system can be characterised by a high level of expenses, a well-developed health-care infrastructure as well as a high availability of personal and material resources. Outcome measures demonstrate heterogeneous results. It can be stated that, particularly in this field, there is potential for further improvement. The utilisation of health-care services is high, the access is mostly not regulated and out of pocket payments can pose a barrier for patients. Waiting times are not regarded as a major weakness. Although civic satisfaction seems to be acceptable, a large portion of the citizens calls for elementary modifications. Especially, more patient-centred health-care delivery should be addressed as well as management of information and the adoption of meaningful electronic

  4. Incentives for vertical integration in healthcare: the effect of reimbursement systems.

    Science.gov (United States)

    Byrne, M M; Ashton, C M

    1999-01-01

    In the United States, many healthcare organizations are being transformed into large integrated delivery systems, even though currently available empirical evidence does not provide strong or unequivocal support for or against vertical integration. Unfortunately, the manager cannot delay organizational changes until further research has been completed, especially when further research is not likely to reveal a single, correct solution for the diverse healthcare systems in existence. Managers must therefore carefully evaluate the expected effects of integration on their individual organizations. Vertical integration may be appropriate if conditions facing the healthcare organization provide opportunities for efficiency gains through reorganization strategies. Managers must consider (1) how changes in the healthcare market have affected the dynamics of production efficiency and transaction costs; (2) the likelihood that integration strategies will achieve increases in efficiency or reductions in transaction costs; and (3) how vertical integration will affect other costs, and whether the benefits gained will outweigh additional costs and efficiency losses. This article presents reimbursement systems as an example of how recent changes in the industry may have changed the dynamics and efficiency of production. Evaluation of the effects of vertical integration should allow for reasonable adjustment time, but obviously unsuccessful strategies should not be followed or maintained.

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

    Science.gov (United States)

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

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

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

    Science.gov (United States)

    Kaplan, Gary S; Patterson, Sarah H

    2008-01-01

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

  7. Free versus subsidised healthcare: options for fee exemptions, access to care for vulnerable groups and effects on the health system in Burkina Faso.

    Science.gov (United States)

    Yaogo, Maurice

    2017-07-12

    The many forms of healthcare fee exemptions implemented in Burkina Faso since the 2000s have varied between total exemption (free) and cost subsidisation. This article examines both options, their contextual variations and the ways in which they affect access to healthcare for vulnerable people as well as the operation of the health system. This research is part of an interdisciplinary regional program on the elimination of user fees for health services in West Africa (Burkina Faso, Mali and Niger). A conceptual framework and a chronological review of policy interventions are used as references to summarise the results of the three qualitative studies presented. Historical reference points are used to describe the emergence of healthcare fee exemption policies in Burkina Faso and the events that influenced their adoption. The joint analysis of opinions on options for fee exemption focuses on the different types of repercussions on access to healthcare and the operation of the health system. In conjunction with the twists and turns of the gradual development of a national health policy and in response to international recommendations, healthcare fee exemptions have evolved since colonisation. The limitations of the changes introduced with cost recovery and the barriers to healthcare access for the poorest people led to the adoption of the current sectorial fee exemptions. The results provide information on the reasons for the changes that have occurred over time. The nuanced perspectives of different categories of people surveyed about fee exemption options show that, beyond the perceived effects on healthcare access and the health system, the issue is one of more equitable governance. In principle, the fee exemption measures are intended to provide improved healthcare access for vulnerable groups. In practice, the negative effects on the operation of the health system advocate for reforms to harmonise the changes to multifaceted fee exemptions and the actual needs

  8. Private investment in hospitals: a comparison of three healthcare systems and possible implications for real estate strategies.

    Science.gov (United States)

    van der Zwart, Johan; van der Voordt, Theo; Jonge, Hans de

    2010-01-01

    This article explores lessons to be learned from three different healthcare systems and the possible implications for the management of healthcare real estate, in particular in connection to the Dutch system. It discusses similarities and differences among the different systems, in search of possible consequences on cost, financing, and design innovation. To keep healthcare affordable in the future, the Dutch government is currently in the process of changing legislation to move from a centrally directed system to a so-called regulated market system. The deregulation of real estate investment that accompanies the new healthcare delivery system offers healthcare organizations new opportunities, but also more responsibility and greater risk in return on investment. Consequently, healthcare organizations must find new methods of financing. Private investment is one of the options. Three healthcare systems were analyzed on the basis of a literature review and document analysis, then schematized to show similarities and dissimilarities with regard to private investment in hospitals. Observations are based on a selection of recently published articles on private-sector financing and its implications for healthcare real estate decision making in the Netherlands, the United Kingdom, and Germany. The strengths and weaknesses of three healthcare systems with differing proportions of private and public investment in hospitals were explored. Research revealed a gap between intended effects and actual effects with regard to quality and cost. Costly private finance does not necessarily lead to "value for money." Transferring real estate decisions to private investors decreases the influence of the healthcare organization on future costs and quality. The three healthcare systems show substantial differences between public and private responsibilities. Less governmental involvement affords both opportunities and risks for hospitals. Private investment may lead to innovation

  9. Lean healthcare.

    Science.gov (United States)

    Weinstock, Donna

    2008-01-01

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

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

    Science.gov (United States)

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

    2016-11-01

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

  11. Maternal healthcare in context: A qualitative study of women's tactics to improve their experience of public healthcare in rural Burkina Faso

    DEFF Research Database (Denmark)

    Østergaard, Lise Rosendal

    2015-01-01

    their chances of having a positive experience with public maternal healthcare. The synthesis of the cases shows that, in a context of poverty and social insecurity, women employ five tactics: establishing good relations with health workers, being mindful of their ‘health booklet’, attending prenatal care......Improving the use of public maternal health facilities to prevent maternal death is a priority in developing countries. Accumulating evidence suggests that a key factor in choosing a facility-based delivery is the collaboration and the communication between healthcare providers and women....... This article attempts to provide a fine-grained understanding of health system deficiencies, healthcare provider practices and women's experiences with maternal public healthcare. This article presents findings from ethnographic research conducted in the Central-East Region of Burkina Faso over a period...

  12. Sustainability of midwifery practice within the South African healthcare system

    OpenAIRE

    2012-01-01

    M.Cur. The study on ‘Sustainability of midwifery practice within the South African healthcare system’ is stimulated by the lack of research that influences policy to support midwifery practice in South Africa. The poor database and health information systems for midwives result in the poor performance of maternal healthcare in the public sector (Parkhurst, Penn- Kekana, Blaauw, Balabanova, Danishevski, Rahman, Onama, & Ssengooba 2005) in spite of meeting the Safe Motherhood Initiative of t...

  13. Critical success factors in implementing an e-rostering system in a healthcare organisation.

    Science.gov (United States)

    Soomro, Zahoor A; Ahmed, Javed; Muhammad, Raza; Hayes, Dawn; Shah, Mahmood H

    2017-01-01

    Effective and efficient staff scheduling has always been a challenging issue, especially in health service organisations. Both the extremes of staff shortage and overage have an adverse impact on the performance of healthcare organisations. In this case, an electronic and systematic staff scheduling (e-rostering) system is the often seen as the best solution. Unless an organisation has an effective implementation of such a system, possible cost savings, efficiency, and benefits could be minimal. This study is aimed to research key success factors for the successful effective implementation of an electronic rostering system, especially at healthcare organisations. A case study research method was used to evaluate critical success factors for effectively implementing an e-rostering system. The data were collected through interviews and observations. The findings indicate that technical support, an effective policy, leadership, clear goals and objectives, gradual change, evidence of the advantages of the new system, senior management support, and effective communication are the critical success factors in implementing an e-rostering system in healthcare organisations. Prior to this study, no such factors were grounded in the current context, so this research would help in bridging the gap towards effective implementation of an e-rostering system in the healthcare sector. This research also suggests future studies in different cultures and contexts.

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

    Science.gov (United States)

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

    2006-01-01

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

  15. Accounting System in Croatian Public Healthcare Organizations: an Empirical Analysis

    Directory of Open Access Journals (Sweden)

    Davor VAŠIČEK

    2010-06-01

    Full Text Available In considering the adequacy of adopting accruals and IPSASs, this paper tests the appropriateness of existing modified accrual accounting and financial reporting system in Croatian public healthcare sector. The paper indicates that accounting information system contains discrepancies and constraints in assuring true and fair view of organization’s financial position and performance. Our statistics confirms low level of cost and managerial accounting methods development, and external and internal financial reporting convergence.Having in mind its specificities, we argue that Croatian public healthcare sector represents a segmental accounting subsystem within the integral public sector accounting framework, where accruals implementation might prove justifiable.

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

    Directory of Open Access Journals (Sweden)

    Ignacio José Godinho Delgado

    Full Text Available Abstract: This article discusses the relations between healthcare systems and the pharmaceutical industry, focusing on state support for pharmaceutical innovation. The study highlights the experiences of the United States, United Kingdom, and Germany, developed countries and paradigms of modern health systems (liberal, universal, and corporatist, in addition to Japan, a case of successful catching up. The study also emphasizes the experiences of China, India, and Brazil, large developing countries that have tried different catching up strategies, with diverse histories and profiles in their healthcare systems and pharmaceutical industries. Finally, with a focus on state forms of support for health research, the article addresses the mechanisms for linkage between health systems and the pharmaceutical industry, evaluating the possibilities of Brazil strengthening a virtuous interaction, favoring the expansion and consolidation of the Brazilian health system - universal but segmented ‒ and the affirmation of the innovative national pharmaceutical industry.

  17. PALLIATIVE CARE – ITS ROLE IN HEALTHCARE SYSTEMS

    Directory of Open Access Journals (Sweden)

    Urška Lunder

    2003-11-01

    Full Text Available Background. In the last decades a palliative care has been well established in the majority of West European countries. However, majority of these countries are not able to follow needs for palliative care because of demographic changes (older population, changes of morbidity pattern (increase of chronic progressive diseases and social changes (disability of families to care for their relatives at their homes. Research is showing evidence on palliative care effectiveness at end of life and in bereavement. There is still a great need for healthcare professionals’ change in their attitudes, knowledge and skills. In many National strategic plans (United Kingdom, Ireland, Sweden, Australia, New Zealand and Canada palliative care becomes a priority in the national public health. New organizational planning supports establishement of palliative care departments in hospitals and other healthcare settings and consultant teams at all levels of healthcare system. Hospices, caritative and independent organizations, will remain as a source of good clinical practice and philosophy of care at the end of life also in the future.

  18. Healthcare Data Gateways: Found Healthcare Intelligence on Blockchain with Novel Privacy Risk Control.

    Science.gov (United States)

    Yue, Xiao; Wang, Huiju; Jin, Dawei; Li, Mingqiang; Jiang, Wei

    2016-10-01

    Healthcare data are a valuable source of healthcare intelligence. Sharing of healthcare data is one essential step to make healthcare system smarter and improve the quality of healthcare service. Healthcare data, one personal asset of patient, should be owned and controlled by patient, instead of being scattered in different healthcare systems, which prevents data sharing and puts patient privacy at risks. Blockchain is demonstrated in the financial field that trusted, auditable computing is possible using a decentralized network of peers accompanied by a public ledger. In this paper, we proposed an App (called Healthcare Data Gateway (HGD)) architecture based on blockchain to enable patient to own, control and share their own data easily and securely without violating privacy, which provides a new potential way to improve the intelligence of healthcare systems while keeping patient data private. Our proposed purpose-centric access model ensures patient own and control their healthcare data; simple unified Indicator-Centric Schema (ICS) makes it possible to organize all kinds of personal healthcare data practically and easily. We also point out that MPC (Secure Multi-Party Computing) is one promising solution to enable untrusted third-party to conduct computation over patient data without violating privacy.

  19. BSNCare+: A Robust IoT-Oriented Healthcare System with Non-Repudiation Transactions

    Directory of Open Access Journals (Sweden)

    Kuo-Hui Yeh

    2016-12-01

    Full Text Available Recently, the rapid advancement in technologies of modern intelligent objects has led to a new network paradigm, called the Internet of Things (IoT, in which every networked and automated object has been connected in a pervasive manner. New types of IoT-based application services are thus presented. In a healthcare oriented environment, the usage of IoT has brought opportunities for assisting physicians (or nurses to provide on-demand and real-time body-care services to patients with higher accuracy and better efficiency. However, while IoT-oriented techniques deliver such advantages, they may encounter system security vulnerabilities and patient privacy threats not seen in the past. In this paper, we propose a robust IoT-based healthcare system, called BSNCare+, in which body sensor networks (BSNs are adopted as the underlying communication architecture. In the proposed healthcare system, we exploit lightweight crypto-primitives to construct a secure communication mechanism that does achieve data confidentiality and entity authentication among intelligent body sensors, the mobile gateway and the backend BSN-Care server. In addition, we evaluate the performance of the proposed healthcare system using the Raspberry PI series platform. The results show the practicability and feasibility of BSNCare+.

  20. A Systems Approach to Healthcare Innovation Using the MIT Hacking Medicine Model.

    Science.gov (United States)

    Gubin, Tatyana A; Iyer, Hari P; Liew, Shirlene N; Sarma, Aartik; Revelos, Alex; Ribas, João; Movassaghi, Babak; Chu, Zen M; Khalid, Ayesha N; Majmudar, Maulik D; Lee, Christopher Xiang

    2017-07-26

    MIT Hacking Medicine is a student, academic, and community-led organization that uses systems-oriented "healthcare hacking" to address challenges around innovation in healthcare. The group has organized more than 80 events around the world that attract participants with diverse backgrounds. These participants are trained to address clinical needs from the perspective of multiple stakeholders and emphasize utility and implementation viability of proposed solutions. We describe the MIT Hacking Medicine model as a potential method to integrate collaboration and training in rapid innovation techniques into academic medical centers. Built upon a systems approach to healthcare innovation, the time-compressed but expertly guided nature of the events could enable more widely accessible preliminary training in systems-level innovation methodology, as well as creating a structured opportunity for interdisciplinary congregation and collaboration. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Executable Design Models for a Pervasive Healthcare Middleware System

    DEFF Research Database (Denmark)

    Jørgensen, Jens Bæk; Christensen, Søren

    2002-01-01

     UML is applied in the design of a pervasive healthcare middleware system for the hospitals in Aarhus County, Denmark. It works well for the modelling of static aspects of the system, but with respect to describing the behaviour, UML is not sufficient. This paper explains why and, as a remedy, su...

  2. Yoga Therapy in the German Healthcare System.

    Science.gov (United States)

    Cramer, Holger

    2018-05-09

    An estimated 15.7 million Germans are currently practicing yoga or are at least interested in starting to practice, and they often perceive yoga as a therapeutic approach. From a healthcare system perspective, the situation is less clear. Here, yoga is only recognized as a recreational or preventive activity. When yoga teachers fulfill specific qualifications, their preventive yoga classes are covered by the statutory health insurances. Only those with additional qualifications in medicine or psychotherapy, however, can independently use and promote "yoga therapy." The general perception of yoga in Germany as a preventive practice is reflected in the professional organization of yoga providers. Most providers are considered to be yoga teachers rather than yoga therapists and are organized mainly in yoga teacher associations. Despite the uncertain legal framework, yoga is now considered in a number of medical guidelines; in a number of hospitals, yoga is part of multimodal inpatient treatment programs and is delivered by physical therapists or members of other health professions. An increasing number of yoga therapy clinical trials are conducted in Germany, and efforts are underway to establish yoga therapy as an accepted adjunct treatment approach for selected medical conditions within the German healthcare system.

  3. Agent-Oriented Privacy-Based Information Brokering Architecture for Healthcare Environments

    Directory of Open Access Journals (Sweden)

    Abdulmutalib Masaud-Wahaishi

    2009-01-01

    Full Text Available Healthcare industry is facing a major reform at all levels—locally, regionally, nationally, and internationally. Healthcare services and systems become very complex and comprise of a vast number of components (software systems, doctors, patients, etc. that are characterized by shared, distributed and heterogeneous information sources with varieties of clinical and other settings. The challenge now faced with decision making, and management of care is to operate effectively in order to meet the information needs of healthcare personnel. Currently, researchers, developers, and systems engineers are working toward achieving better efficiency and quality of service in various sectors of healthcare, such as hospital management, patient care, and treatment. This paper presents a novel information brokering architecture that supports privacy-based information gathering in healthcare. Architecturally, the brokering is viewed as a layer of services where a brokering service is modeled as an agent with a specific architecture and interaction protocol that are appropriate to serve various requests. Within the context of brokering, we model privacy in terms of the entities ability to hide or reveal information related to its identities, requests, and/or capabilities. A prototype of the proposed architecture has been implemented to support information-gathering capabilities in healthcare environments using FIPA-complaint platform JADE.

  4. Agent-oriented privacy-based information brokering architecture for healthcare environments.

    Science.gov (United States)

    Masaud-Wahaishi, Abdulmutalib; Ghenniwa, Hamada

    2009-01-01

    Healthcare industry is facing a major reform at all levels-locally, regionally, nationally, and internationally. Healthcare services and systems become very complex and comprise of a vast number of components (software systems, doctors, patients, etc.) that are characterized by shared, distributed and heterogeneous information sources with varieties of clinical and other settings. The challenge now faced with decision making, and management of care is to operate effectively in order to meet the information needs of healthcare personnel. Currently, researchers, developers, and systems engineers are working toward achieving better efficiency and quality of service in various sectors of healthcare, such as hospital management, patient care, and treatment. This paper presents a novel information brokering architecture that supports privacy-based information gathering in healthcare. Architecturally, the brokering is viewed as a layer of services where a brokering service is modeled as an agent with a specific architecture and interaction protocol that are appropriate to serve various requests. Within the context of brokering, we model privacy in terms of the entities ability to hide or reveal information related to its identities, requests, and/or capabilities. A prototype of the proposed architecture has been implemented to support information-gathering capabilities in healthcare environments using FIPA-complaint platform JADE.

  5. Preferred Primary Healthcare Provider Choice Among Insured Persons in Ashanti Region, Ghana

    Directory of Open Access Journals (Sweden)

    Micheal Kofi Boachie

    2016-03-01

    Full Text Available Background In early 2012, National Health Insurance Scheme (NHIS members in Ashanti Region were allowed to choose their own primary healthcare providers. This paper investigates the factors that enrolees in the Ashanti Region considered in choosing preferred primary healthcare providers (PPPs and direction of association of such factors with the choice of PPP. Methods Using a cross-sectional study design, the study sampled 600 NHIS enrolees in Kumasi Metro area and Kwabre East district. The sampling methods were a combination of simple random and systematic sampling techniques at different stages. Descriptive statistics were used to analyse demographic information and the criteria for selecting PPP. Multinomial logistic regression technique was used to ascertain the direction of association of the factors and the choice of PPP using mission PPPs as the base outcome. Results Out of the 600 questionnaires administered, 496 were retained for further analysis. The results show that availability of essential drugs (53.63% and doctors (39.92%, distance or proximity (49.60%, provider reputation (39.52%, waiting time (39.92, additional charges (37.10%, and recommendations (48.79% were the main criteria adopted by enrolees in selecting PPPs. In the regression, income (-0.0027, availability of doctors (-1.82, additional charges (-2.14 and reputation (-2.09 were statistically significant at 1% in influencing the choice of government PPPs. On the part of private PPPs, availability of drugs (2.59, waiting time (1.45, residence (-2.62, gender (-2.89, and reputation (-2.69 were statistically significant at 1% level. Presence of additional charges (-1.29 was statistically significant at 5% level. Conclusion Enrolees select their PPPs based on such factors as availability of doctors and essential drugs, reputation, waiting time, income, and their residence. Based on these findings, there is the need for healthcare providers to improve on their quality levels by

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

    Science.gov (United States)

    Englebright, Jane; Perlin, Jonathan

    2008-01-01

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

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

    Science.gov (United States)

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

    2013-02-01

    The research project 'An Evaluation of Transformational Change in NHS North East' examines the progress and success of National Health Service (NHS) organisations in north east England in implementing and embedding the North East Transformation System (NETS), a region-wide programme to improve healthcare quality and safety, and to reduce waste, using a combination of Vision, Compact, and Lean-based Method. This paper concentrates on findings concerning the role of leadership in enabling tranformational change, based on semi-structured interviews with a mix of senior NHS managers and quality improvement staff in 14 study sites. Most interviewees felt that implementing the NETS requires committed, stable leadership, attention to team-building across disciplines and leadership development at many levels. We conclude that without senior leader commitment to continuous improvement over a long time scale and serious efforts to distribute leadership tasks to all levels, healthcare organisations are less likely to achieve positive changes in managerial-clinical relations, sustainable improvements to organisational culture and, ultimately, the region-wide step change in quality, safety and efficiency that the NETS was designed to deliver. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  10. Pathways towards chronic care-focused healthcare systems: evidence from Spain.

    Science.gov (United States)

    García-Goñi, Manuel; Hernández-Quevedo, Cristina; Nuño-Solinís, Roberto; Paolucci, Francesco

    2012-12-01

    Increasing healthcare expenditure is a matter of concern in many countries, particularly in relation to the underlying drivers of such escalation that include ageing, medical innovation, and changes in the burden of disease, such as the growing prevalence of chronic diseases. Most healthcare systems in developed countries have been designed to 'cure' acute episodes, rather than to 'manage' chronic conditions, and therefore they are not suitably or efficiently organized to respond to the changing needs and preferences of users. New models of chronic care provision have been developed to respond to the changing burden of disease and there is already considerable practical experience in several different countries showing their advantages but also the difficulties associated with their implementation. In this paper, we focus on the Spanish experience in terms of policy changes and pilot studies focused on testing the feasibility of moving towards chronic care models. In particular, we discuss a framework that identifies and analyses ten key prerequisites to achieving high performing chronic care-based healthcare systems and apply it to the current Spanish National Health System (NHS). We find that the design of the Spanish NHS already meets some of these pre-requisites. However, other features are still in their early stages of development or are being applied only in limited geographical and clinical contexts. We outline the policies that are being implemented and the pathway that the Spanish NHS is taking to address the crucial challenge of the transition towards an optimal health system focused on chronic care. Given the current evidence and trends, we expect that the pathway for developing a chronicity strategy being followed by the Spanish NHS will significantly transform its current healthcare delivery model in the next few years. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  11. Use of healthcare services in the region of origin among patients with an immigrant background in Denmark

    DEFF Research Database (Denmark)

    Lokdam, Nicoline; Kristiansen, Maria; Handlos, Line Neerup

    2016-01-01

    : the perception of availability, in terms of quantity and access; familiarity, conceptualised as feeling comfortable within the healthcare system; perception of quality of services; and finally, the perceived need for a second opinion. All motives emerged simultaneously as push factors, motivating immigrants...... to explore healthcare services abroad, and pull factors, attracting them to their country of origin. Affordability did not emerge as an independent motive but influenced the other factors. Conclusion: The use of healthcare services abroad by patients with an immigrant background constitutes active health...

  12. The Value That Infectious Diseases Physicians Bring to the Healthcare System.

    Science.gov (United States)

    McQuillen, Daniel P; MacIntyre, Ann T

    2017-09-15

    While a career in infectious diseases (ID) has always been challenging and exciting, recognition of the value that ID physicians provide to the healthcare system as a whole, over and above the value they provide to individual patients, has been poor in this system. In response to this disparity, the Infectious Diseases Society of America Clinical Affairs Committee has long endeavored to quantify the value of ID physicians to the system, which is challenging in part because of the many avenues through which they influence healthcare. We discuss data showing that ID physicians improve clinical outcomes, positively impact transitions of care, and direct system-level improvements through infection prevention and antimicrobial stewardship. We identify areas where value-based care provides additional future opportunities for ID physicians. A Clinical Affairs Committee-sponsored study of ID physicians' positive impact on patient outcomes shows that few medical specialties are better positioned to positively impact the Triple Aim approach-better health, better care, and lower per capita cost-that is the principle tenet of healthcare system reform. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  13. A post-Bertalanffy Systemics Healthcare Competitive Framework Proposal.

    Science.gov (United States)

    Fiorini, Rodolfo A; Santacroce, Giulia F

    2014-01-01

    Health Information community can take advantage of a new evolutive categorization cybernetic framework. A systemic concept of principles organizing nature is proposed. It can be used as a multiscaling reference framework to develop successful and competitive antifragile system and new HRO information management strategies in advanced healthcare organization (HO) and high reliability organization (HRO) conveniently. Expected impacts are multifarious and quite articulated at different system scale level: major one is that, for the first time, Biomedical Engineering ideal system categorization levels can be matched exactly to practical system modeling interaction styles, with no paradigmatic operational ambiguity and information loss.

  14. The Design and Analysis of a Secure Personal Healthcare System Based on Certificates

    Directory of Open Access Journals (Sweden)

    Jungho Kang

    2016-11-01

    Full Text Available Due to the development of information technology (IT, it has been applied to various fields such as the smart home, medicine, healthcare, and the smart car. For these fields, IT has been providing continuous prevention and management, including health conditions beyond the mere prevention of disease, improving the quality of life. e-Healthcare is a health management and medical service to provide prevention, diagnosis, treatment, and the follow-up management of diseases at any time and place in connection with information communication technology, without requiring patients to visit hospitals. However, e-Healthcare has been exposed to eavesdropping, manipulation, and the forgery of information that is personal, biological, medical, etc., and is a security threat from malicious attackers. This study suggests a security service model to exchange personal health records (PHRs for e-Healthcare environments. To be specific, this study suggests a scheme in which communicators are able to securely authorize and establish security channels by constituting the infrastructure each organization relies on. In addition, the possibility of establishing a security service model is indicated by suggesting an e-Healthcare system for a secure e-Healthcare environment as a secure personal health record system. This is anticipated to provide securer communication in e-Healthcare environments in the future through the scheme suggested in this study.

  15. Transitioning from learning healthcare systems to learning health care communities.

    Science.gov (United States)

    Mullins, C Daniel; Wingate, La'Marcus T; Edwards, Hillary A; Tofade, Toyin; Wutoh, Anthony

    2018-02-26

    The learning healthcare system (LHS) model framework has three core, foundational components. These include an infrastructure for health-related data capture, care improvement targets and a supportive policy environment. Despite progress in advancing and implementing LHS approaches, low levels of participation from patients and the public have hampered the transformational potential of the LHS model. An enhanced vision of a community-engaged LHS redesign would focus on the provision of health care from the patient and community perspective to complement the healthcare system as the entity that provides the environment for care. Addressing the LHS framework implementation challenges and utilizing community levers are requisite components of a learning health care community model, version two of the LHS archetype.

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

    Science.gov (United States)

    Maskileyson, Dina

    2014-10-01

    The present study provides a comparative analysis of the association between wealth and health in six healthcare systems (Sweden, the United Kingdom, Germany, the Czech Republic, Israel, the United States). National samples of individuals fifty years and over reveal considerable cross-country variations in health outcomes. In all six countries wealth and health are positively associated. The findings also show that state-based healthcare systems produce better population health outcomes than private-based healthcare systems. The results indicate that in five out of the six countries studied, the wealth-health gradients were remarkably similar, despite significant variations in healthcare system type. Only in the United States was the association between wealth and health substantially different from, and much greater than that in the other five countries. The findings suggest that private-based healthcare system in the U.S. is likely to promote stronger positive associations between wealth and health. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Masseroli, Marco; Marchente, Mario

    2008-07-01

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

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

    Science.gov (United States)

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

    2010-07-01

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

  19. Healthcare seeking behaviour among Chinese elderly.

    Science.gov (United States)

    Lu, Hui; Wang, Wei; Xu, Ling; Li, Zhenhong; Ding, Yan; Zhang, Jian; Yan, Fei

    2017-04-18

    Purpose The Chinese population is rapidly ageing before they are rich. The purpose of this paper is to describe healthcare seeking behaviour and the critical factors associated with healthcare seeking behaviour. Design/methodology/approach Using a purposive sampling method, the authors recruited 44 adults aged 60 years or older from three provinces, representing the developed (Shanghai), undeveloped (Ningxia) regions and the regions in between (Hubei). From July to September 2008, using a semi-structured guide, the authors interviewed participants in focus group discussions. Findings The healthcare needs for chronic and catastrophic diseases were high; however, the healthcare demands were low and healthcare utilizations were even lower owing to the limited accessibility to healthcare services, particularly, in underdeveloped rural areas. "Too expensive to see a doctor" was a prime complaint, explaining substantial discrepancies between healthcare needs, demands and use. Care seeking behaviour varied depending on insurance availability, perceived performance, particularly hospital services, and prescription medications. Participants consistently rated increasing healthcare accessibility as a high priority, including offering financial aid, and improving service convenience. Improving social security fairness was the first on the elderly's wish list. Originality/value Healthcare demand and use were lower than needs, and were influenced by multiple factors, primarily, service affordability and efficiency, perceived performance and hospital service quality.

  20. Deaf New Zealand Sign Language users' access to healthcare.

    Science.gov (United States)

    Witko, Joanne; Boyles, Pauline; Smiler, Kirsten; McKee, Rachel

    2017-12-01

    The research described was undertaken as part of a Sub-Regional Disability Strategy 2017-2022 across the Wairarapa, Hutt Valley and Capital and Coast District Health Boards (DHBs). The aim was to investigate deaf New Zealand Sign Language (NZSL) users' quality of access to health services. Findings have formed the basis for developing a 'NZSL plan' for DHBs in the Wellington sub-region. Qualitative data was collected from 56 deaf participants and family members about their experiences of healthcare services via focus group, individual interviews and online survey, which were thematically analysed. Contextual perspective was gained from 57 healthcare professionals at five meetings. Two professionals were interviewed, and 65 staff responded to an online survey. A deaf steering group co-designed the framework and methods, and validated findings. Key issues reported across the health system include: inconsistent interpreter provision; lack of informed consent for treatment via communication in NZSL; limited access to general health information in NZSL and the reduced ability of deaf patients to understand and comply with treatment options. This problematic communication with NZSL users echoes international evidence and other documented local evidence for patients with limited English proficiency. Deaf NZSL users face multiple barriers to equitable healthcare, stemming from linguistic and educational factors and inaccessible service delivery. These need to be addressed through policy and training for healthcare personnel that enable effective systemic responses to NZSL users. Deaf participants emphasise that recognition of their identity as members of a language community is central to improving their healthcare experiences.

  1. East Midlands healthcare and bioscience sector strategy

    OpenAIRE

    East Midlands Development Agency

    2007-01-01

    The healthcare and bioscience sector is one of four priority sectors identified in the regional economic strategy, A Flourishing Region. This document sets out a strategy for maximising the contribution of the healthcare and biosciences sector to the economic development of the East Midlands.

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

    Science.gov (United States)

    Aggarwal, Vinod

    2002-10-01

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

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

    Science.gov (United States)

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

    2016-10-01

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

  4. Healthcare waste generation and its management system: the case ...

    African Journals Online (AJOL)

    Healthcare waste generation and its management system: the case of health ... of an environmental risk to health care workers, the public and the environment at large. ... Only four out of ten health centers used local type of incinerators, while ...

  5. [Barriers to the normalization of telemedicine in a healthcare system model based on purchasing of healthcare services using providers' contracts].

    Science.gov (United States)

    Roig, Francesc; Saigí, Francesc

    2011-01-01

    Despite the clear political will to promote telemedicine and the large number of initiatives, the incorporation of this modality in clinical practice remains limited. The objective of this study was to identify the barriers perceived by key professionals who actively participate in the design and implementation of telemedicine in a healthcare system model based on purchasing of healthcare services using providers' contracts. We performed a qualitative study based on data from semi-structured interviews with 17 key informants belonging to distinct Catalan health organizations. The barriers identified were grouped in four areas: technological, organizational, human and economic. The main barriers identified were changes in the healthcare model caused by telemedicine, problems with strategic alignment, resistance to change in the (re)definition of roles, responsibilities and new skills, and lack of a business model that incorporates telemedicine in the services portfolio to ensure its sustainability. In addition to suitable management of change and of the necessary strategic alignment, the definitive normalization of telemedicine in a mixed healthcare model based on purchasing of healthcare services using providers' contracts requires a clear and stable business model that incorporates this modality in the services portfolio and allows healthcare organizations to obtain reimbursement from the payer. 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

  6. Infrastructuring Multicultural Healthcare Information Systems

    DEFF Research Database (Denmark)

    Dreessen, Katrien; Huybrechts, Liesbeth; Grönvall, Erik

    2017-01-01

    This paper stresses the need for more research in the field of Participatory Design (PD) and in particular into how to design Health Information Technology (HIT) together with care providers and -receivers in multicultural settings. We contribute to this research by describing a case study...... of this study, we point to the need and the ways of taking spatio-historical aspects of a specific healthcare situation into account in the PD of HIT to support multicultural perspectives on healthcare....

  7. Does advanced practice in radiography benefit the healthcare system? A literature review.

    Science.gov (United States)

    Thom, S E

    2018-02-01

    With ever-increasing demands on the National Health Service (NHS), members of staff are blurring their professional boundaries in the attempt to benefit the healthcare system. This review aims to establish whether advancing practice within radiography does benefit the healthcare system by examining published literature. Key words were input into databases such as: CINAHL, Science Direct and PubMed. Various filters were applied to narrow down the articles. Key themes were identified within the literature: cost, job satisfaction, patient benefits, restrictions and workload. Having advanced practitioners undertake some of the radiologists' workload was potentially cost effective whilst continuing/increasing the standard of quality. Patients benefitted from the quality of their examinations, the high accuracy of their reports and the speed those reports were attained. Evidence within the literature emphasises that advanced practice does benefit the healthcare system by means of: cost reduction, job satisfaction, patient benefits and workload. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  8. Accounting Information Systems in Healthcare: A Review of the Literature.

    Science.gov (United States)

    Hammour, Hadal; Househ, Mowafa; Razzak, Hira Abdul

    2017-01-01

    As information technology progresses in Saudi Arabia, the manual accounting systems have become graduallyinadequate for decision needs. Subsequently, private and public healthcare divisions in Saudi Arabia perceive Computerized accounting information system (CAIS) as a vehicle to safeguard efficient and effective flow of information during the analysis, processes, and recording of financial data. Efficient and effective flow of information improvesthe decision making of staff, thereby improving the capability of health care sectors to reduce cost of the medical services.In this paper, we define computerized accounting systems from the point of view of health informatics. Also, the challenges and benefits of supporting CAIS applications in hospitals of Saudi Arabia. With these elements, we conclude that CAIS in Saudi Arabia can serve as a valuable tool for evaluating and controlling the cost of medical services in healthcare sectors. Supplementary education on the significance of having systems of computerized accounting within hospitals for nurses, doctors, and accountants with other health care staff is warranted in future.

  9. A system dynamics approach for healthcare waste management: a case study in Istanbul Metropolitan City, Turkey.

    Science.gov (United States)

    Ciplak, Nesli; Barton, John R

    2012-06-01

    Healthcare waste consists of various types of waste materials generated at hospitals, medical research centres, clinics and laboratories. Although 75-90% of this waste is classified as 'domestic' in nature, 20-25% is deemed to be hazardous, which if not disposed of appropriately, poses a risk to healthcare workers, patients, the environment and even the whole community. As long as healthcare waste is mixed with municipal waste and not segregated prior to disposal, costs will increase substantially. In this study, healthcare waste increases along with the potential to decrease the amounts by implementing effective segregation at healthcare facilities are projected to 2040. Our long-term aim is to develop a system to support selection and planning of the future treatment capacity. Istanbul in Turkey was used as the case study area. In order to identify the factors affecting healthcare waste generation in Istanbul, observations were made and interviews conducted in Istanbul over a 3 month period. A system dynamics approach was adopted to build a healthcare waste management model using a software package, Vensim Ple Plus. Based on reported analysis, the non-hazardous municipal fraction co-disposed with healthcare waste is around 65%. Using the projected waste generation flows, reducing a municipal fraction to 30% has the potential to avoid some 8000 t year(-1) of healthcare waste by 2025 and almost 10 000 t year(-1) by 2035. Furthermore, if segregation practices ensured healthcare waste requiring incineration was also selectively managed, 77% of healthcare waste could be diverted to alternative treatment technologies. As the throughput capacity of the only existing healthcare waste treatment facility in Istanbul, Kemerburgaz Incinerator, has already been exceeded, it is evident that improved management could not only reduce overall flows and costs but also permit alternative and cheaper treatment systems (e.g. autoclaving) to be adopted for the healthcare waste.

  10. Healthcare waste management: current practices in selected healthcare facilities, Botswana.

    Science.gov (United States)

    Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

    2008-01-01

    Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

  11. Urban-rural difference in satisfaction with primary healthcare services in Ghana

    Directory of Open Access Journals (Sweden)

    Sanni Yaya

    2017-11-01

    Full Text Available Abstract Background Understanding regional variation in patient satisfaction about healthcare systems (PHCs on the quality of services provided is instrumental to improving quality and developing a patient-centered healthcare system by making it more responsive especially to the cultural aspects of health demands of a population. Reaching to the innovative National Health Insurance Scheme (NHIS in Ghana, surpassing several reforms in healthcare financing has been a milestone. However, the focus of NHIS is on the demand side of healthcare delivery. Studies focusing on the supply side of healthcare delivery, particularly the quality of service as perceived by the consumers are required. A growing number of studies have focused on regional differences of patient satisfaction in developed countries, however little research has been conducted concerning patient satisfaction in resource-poor settings like in Ghana. This study was therefore dedicated to examining the variation in satisfaction across rural and urban women in Ghana. Methods Data for the present study were obtained from the latest demographic and health survey in Ghana (GDHS 2014. Participants were 3576 women aged between 15 and 49 years living in non-institutional settings in Ghana. Summary statistics in percentages was used to present respondents’ demographic, socioeconomic characteristics. Chi-square test was used to find association between urban-rural differentials with socio-economic variables. Multiple logistic regression was performed to measure the association of being satisfied with primary healthcare services with study variables. Model fitness was tested by pseudo R 2. Statistical significance was set at p < 0.05. Results The findings in this study revealed that about 57.1% were satisfied with primary health care services. The urban and rural areas reported 57.6 and 56.6% respectively which showed no statistically significant difference (z = 0.64; p = 0.523; 95

  12. Physician leadership: a health-care system's investment in the future of quality care.

    Science.gov (United States)

    Orlando, Rocco; Haytaian, Marcia

    2012-08-01

    The current state of health care and its reform will require physician leaders to take on greater management responsibilities, which will require a set of organizational and leadership competencies that traditional medical education does not provide. Physician leaders can form a bridge between the clinical and administrative sides of a health-care organization, serving to further the organization's strategy for growth and success. Recognizing that the health-care industry is rapidly changing and physician leaders will play a key role in that transformation, Hartford HealthCare has established a Physician Leadership Development Institute that provides advanced leadership skills and management education to select physicians practicing within the health-care system.

  13. Ensuring the security and privacy of information in mobile health-care communication systems

    Directory of Open Access Journals (Sweden)

    Ademola P. Abidoye

    2011-09-01

    Full Text Available The sensitivity of health-care information and its accessibility via the Internet and mobile technology systems is a cause for concern in these modern times. The privacy, integrity and confidentiality of a patient’s data are key factors to be considered in the transmission of medical information for use by authorised health-care personnel. Mobile communication has enabled medical consultancy, treatment, drug administration and the provision of laboratory results to take place outside the hospital. With the implementation of electronic patient records and the Internet and Intranets, medical information sharing amongst relevant health-care providers was made possible. But the vital issue in this method of information sharing is security: the patient’s privacy, as well as the confidentiality and integrity of the health-care information system, should not be compromised. We examine various ways of ensuring the security and privacy of a patient’s electronic medical information in order to ensure the integrity and confidentiality of the information.

  14. Hand hygiene and healthcare system change within multi-modal promotion: a narrative review.

    Science.gov (United States)

    Allegranzi, B; Sax, H; Pittet, D

    2013-02-01

    Many factors may influence the level of compliance with hand hygiene recommendations by healthcare workers. Lack of products and facilities as well as their inappropriate and non-ergonomic location represent important barriers. Targeted actions aimed at making hand hygiene practices feasible during healthcare delivery by ensuring that the necessary infrastructure is in place, defined as 'system change', are essential to improve hand hygiene in healthcare. In particular, access to alcohol-based hand rubs (AHRs) enables appropriate and timely hand hygiene performance at the point of care. The feasibility and impact of system change within multi-modal strategies have been demonstrated both at institutional level and on a large scale. The introduction of AHRs overcomes some important barriers to best hand hygiene practices and is associated with higher compliance, especially when integrated within multi-modal strategies. Several studies demonstrated the association between AHR consumption and reduction in healthcare-associated infection, in particular, meticillin-resistant Staphylococcus aureus bacteraemia. Recent reports demonstrate the feasibility and success of system change implementation on a large scale. The World Health Organization and other investigators have reported the challenges and encouraging results of implementing hand hygiene improvement strategies, including AHR introduction, in settings with limited resources. This review summarizes the available evidence demonstrating the need for system change and its importance within multi-modal hand hygiene improvement strategies. This topic is also discussed in a global perspective and highlights some controversial issues. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  15. Intercultural and Interlinguistical Mediation in the Healthcare System: The Challenge of Conflict Management

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    Federico Farini

    2008-09-01

    Full Text Available Nowadays, young women and their children are the most important migrant users of health-care services. In particular, these people may encounter different cultural constructions of health, disease, therapy, and motherhood. The observed difficulties in intercultural communication encourage healthcare systems to promote mediation. Mediation consists of the intervention of a third person, who promotes reciprocal understanding and acceptance between participants. The research presented in this article focuses on the intercultural communication that is produced in these services between health-care personnel and migrant patients. To achieve this goal, the research aims at integrating different theoretical and methodological approaches: conversation analysis, in order to observe the interaction between healthcare personnel and patients, pointing out the cues of the participants’ turn-taking sequences; analysis of the cultural presuppositions of the healthcare system as a communication system with a specific function in society, by highlighting contextualization cues, that is, cultural presuppositions that steer the interaction system, which result from the wider social context and are cues of the cultural identities that characterize it. It was observed that the patients in most cases have very few opportunities to answer the physicians’ questions or to pose questions or doubts. Substituting the patients as the main participants in interactions, the mediator never refuses the physicians’ indications, never expresses doubts, and never asks the patients if they have some reason to doubt or refuse. In these cases, interlinguistic and intercultural mediation de-emphasizes the importance of the larger social context, of the durability of relationships between the parties, and of their social and political recognition.

  16. Scaling of an information system in a public healthcare market--infrastructuring from the vendor's perspective.

    Science.gov (United States)

    Johannessen, Liv Karen; Obstfelder, Aud; Lotherington, Ann Therese

    2013-05-01

    The purpose of this paper is to explore the making and scaling of information infrastructures, as well as how the conditions for scaling a component may change for the vendor. The first research question is how the making and scaling of a healthcare information infrastructure can be done and by whom. The second question is what scope for manoeuvre there might be for vendors aiming to expand their market. This case study is based on an interpretive approach, whereby data is gathered through participant observation and semi-structured interviews. A case study of the making and scaling of an electronic system for general practitioners ordering laboratory services from hospitals is described as comprising two distinct phases. The first may be characterized as an evolving phase, when development, integration and implementation were achieved in small steps, and the vendor, together with end users, had considerable freedom to create the solution according to the users' needs. The second phase was characterized by a large-scale procurement process over which regional healthcare authorities exercised much more control and the needs of groups other than the end users influenced the design. The making and scaling of healthcare information infrastructures is not simply a process of evolution, in which the end users use and change the technology. It also consists of large steps, during which different actors, including vendors and healthcare authorities, may make substantial contributions. This process requires work, negotiation and strategies. The conditions for the vendor may change dramatically, from considerable freedom and close relationships with users and customers in the small-scale development, to losing control of the product and being required to engage in more formal relations with customers in the wider public healthcare market. Onerous procurement processes may be one of the reasons why large-scale implementation of information projects in healthcare is difficult

  17. Healthcare Utilization and Costs of Systemic Lupus Erythematosus in Medicaid

    Directory of Open Access Journals (Sweden)

    Hong J. Kan

    2013-01-01

    Full Text Available Objective. Healthcare utilization and costs associated with systemic lupus erythematosus (SLE in a US Medicaid population were examined. Methods. Patients ≥ 18 years old with SLE diagnosis (ICD-9-CM 710.0x were extracted from a large Medicaid database 2002–2009. Index date was date of the first SLE diagnosis. Patients with and without SLE were matched. All patients had a variable length of followup with a minimum of 12 months. Annualized healthcare utilization and costs associated with SLE and costs of SLE flares were assessed during the followup period. Multivariate regressions were conducted to estimate incremental healthcare utilization and costs associated with SLE. Results. A total of 14,777 SLE patients met the study criteria, and 14,262 were matched to non-SLE patients. SLE patients had significantly higher healthcare utilization per year than their matched controls. The estimated incremental annual cost associated with SLE was $10,984, with the highest increase in inpatient costs (P<0.001. Cost per flare was $11,716 for severe flares, $562 for moderate flares, and $129 for mild flares. Annual total costs for patients with severe flares were $49,754. Conclusions. SLE patients had significantly higher healthcare resource utilization and costs than non-SLE patients. Patients with severe flares had the highest costs.

  18. [Awareness survey of Healthcare Number System pros and cons according to medical doctors in Japan].

    Science.gov (United States)

    Takahashi, Yoshimitsu; Uryuhara, Yoko; Inoue, Machiko; Okamoto, Shigeru; Kashihara, Hidenori; Kito, Kumiko; Shinohara, Keiko; Mandai, Marie; Morioka, Miho; Tanaka, Shiro; Kawakami, Koji; Nakayama, Takeo

    2015-01-01

    After bills to launch the Social Security and Tax Number System were enacted in 2013, health and political officials have considered the Healthcare Number System (the System). However, little is known about doctors' awareness and concerns about the System. This study aimed to measure how many doctors disagree with the System, examine the doctors' characteristics, and analyze the benefits and harms of the System that they identified. A cross-sectional survey was conducted of doctors via the Internet. The participants were selected from a convenience sample of a panel of doctors based on stratified sampling including four groups: working at a hospital and content analysis. There were 562 respondents (68%). By group, 16/143 (11%), 25/138 (18%), 31/132 (23%), and 43/149 (29%) doctors, respectively, thought that the System was unnecessary. The variables that correlated with the main outcome were age (per 5 years; odds ratio [95% confidence interval], 1.14 [1.01-1.29]) and type of medical facility (working at a clinic; 1.99 [1.30-3.08]). The doctors identified that unifying information could decrease administrative duties, facilitate inter-facility collaboration, and prevent inappropriate medical consultations. This could result in decreased healthcare costs and personalized healthcare. However, the doctors also identified that integrating information and dealing with big data could increase information leakage and information management, cause over-monitoring of doctors, and enable the inappropriate use of integrated information. This could result in deteriorating healthcare. Since some information should not be integrated, the System raises ethical considerations about privacy. Among the doctors surveyed here, 10-30% thought the System was unnecessary. These respondents tended to be older and work at a clinic. The System could decrease the cost of healthcare and enable personalized healthcare but could also increase information leakage and information management, cause

  19. Healthcare financing in Croatia

    Directory of Open Access Journals (Sweden)

    Nevenka Kovač

    2013-12-01

    Full Text Available Healthcare financing system is of crucial importance for the functioning of any healthcare system, especially because there is no country in the world that is able to provide all its residents with access to all the benefits afforded by modern medicine. Lack of resources in general and rising healthcare expenditures are considered a difficult issue to solve in Croatia as well. Since Croatia gained its independence, its healthcare system has undergone a number of reforms, the primary objective of which was to optimize healthcare services to the actual monetary capacity of the Croatian economy. The objectives of the mentioned re - forms were partially achieved. The solutions that have been offered until now, i.e. consolidation measures undertaken in the last 10 years were necessary; however, they have not improved the operating conditions. There is still the issue of the deficit from the previous years, i.e. outstanding payments, the largest in the last decade. Analysis of the performance of healthcare institutions in 2011 shows that the decision makers will have to take up a major challenge of finding a solution to the difficulties the Croatian healthcare system has been struggling with for decades, causing a debt of 7 billion kuna. At the same time, they will need to uphold the basic principles of the Healthcare Act, i.e. to provide access to healthcare and ensure its continuity, comprehensiveness and solidarity, keeping in mind that the National Budget Act and Fiscal Responsibility Act have been adopted.

  20. Electronic healthcare information security

    CERN Document Server

    Dube, Kudakwashe; Shoniregun, Charles A

    2010-01-01

    The ever-increasing healthcare expenditure and pressing demand for improved quality and efficiency of patient care services are driving innovation in healthcare information management. The domain of healthcare has become a challenging testing ground for information security due to the complex nature of healthcare information and individual privacy. ""Electronic Healthcare Information Security"" explores the challenges of e-healthcare information and security policy technologies. It evaluates the effectiveness of security and privacy implementation systems for anonymization methods and techniqu

  1. Patient Populations, Clinical Associations, and System Efficiency in Healthcare Delivery System

    Science.gov (United States)

    Liu, Yazhuo

    The efforts to improve health care delivery usually involve studies and analysis of patient populations and healthcare systems. In this dissertation, I present the research conducted in the following areas: identifying patient groups, improving treatments for specific conditions by using statistical as well as data mining techniques, and developing new operation research models to increase system efficiency from the health institutes' perspective. The results provide better understanding of high risk patient groups, more accuracy in detecting disease' correlations and practical scheduling tools that consider uncertain operation durations and real-life constraints.

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

    Science.gov (United States)

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

    2003-05-01

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

  3. A virtual intranet and data-warehousing for healthcare co-operation.

    Science.gov (United States)

    Kerkri, E M; Quantin, C; Grison, T; Allaert, F A; Tchounikine, A; Yétongnon, K

    2001-01-01

    As patient's medical data is disseminated in different health structures, developing a medical or epidemiological patient-oriented data warehouse has some specific requirements compared to intra healthcare structure data-warehousing projects. The difference is that the healthcare structures implicated in a patient-oriented data warehouse project require some considerations about the confidentiality of the patient data and of the activities of healthcare structures. Building a data-warehousing system at a regional level, for example in cancerology, requires the participation of all concerned health structures, as well as different health professionals. The heterogeneity of sources medical data of has to be taken into account for choosing between several organizational configurations of the data warehousing system. In top of data warehousing, we propose a concept of Virtual Intranet, which provides a solution to the problem of medical information security arising from heterogeneous sources.

  4. Putting E-government to work in healthcare environment: a multiregional project funded by the Italian Innovation & Technology Ministry.

    Science.gov (United States)

    Ballardini, Luigi; Germagnoli, Fabio; Pagani, Marco; Picchi, Marco; Stoppini, Andrea; Cristiani, Paolo

    2004-01-01

    In 2002, the Italian Ministry of Innovation promoted a national bid for e-government projects. Specifically it allocated a budget of 120 M euro. One of the four project approved in healthcare sector was the "Information, Care ("Assistenza" in Italian) and healthcare Education by the Web" (IAEW), with a global budget of 2580 k euro, partially financed by Ministry with a quota of 830 k euro. The project involves 12 medical structures (both national excellences centers and local regional hospitals) located in two different Region of North Italy, dealing with two different healthcare regional systems (Lombardia and Emilia-Romagna), with potentially 3 millions of users.

  5. Modelling vital success factors in adopting personalized medicine system in healthcare technology and management

    Directory of Open Access Journals (Sweden)

    Subhas C. Misra

    2018-06-01

    Full Text Available Biomedical engineering has grown as a vast field of research that includes many areas of engineering and technology also. Personalized Medicine is an emerging approach in today’s medicare system. It bears a very strong potential to consolidate modern e-health systems fundamentally. Scientists have already discovered some of the personalized drugs that can shift the whole medicare system into a new dimension. However, bringing the change in the whole medicare system is not an easy task. There are several factors that can affect the successful adoption of Personalized Medicine systems in the healthcare management sector. This paper aims at identifying the critical factors with the help of an empirical study. A questionnaire was distributed amongst some clinicians, clinical researchers, practitioners in pharmaceutical industries, regulatory board members, and a larger section of patients. The response data collected thereby were analyzed by using appropriate statistical methods. Based on the statistical analysis, an attempt is made to prepare a list of critical success factors in the adoption of personalized medicine in healthcare management. The study indicates that eight of the thirteen hypothesized factors have statistical relationship with “Success”. The important success factors detected are: data management, team work and composition, privacy and confidentiality, mind-set, return on investment, sufficient time, R&D and alignment. To the best of our knowledge, this is the first academic paper in which an attempt has been made to model the vital critical factors for the successful implementation of Personalized Medicine in healthcare management. The study bears the promise of important applications in healthcare engineering and technology. Keywords: Healthcare management, Personalized medicine, E-health, Success factors, Medicare systems, Regression analysis

  6. 3D printing of wearable fractal-based sensor systems for neurocardiology and healthcare

    Science.gov (United States)

    Ramasamy, Mouli; Varadan, Vijay K.

    2017-04-01

    Neurocardiology is the pathophysiological interplay of nervous and cardiovascular systems. The communication between the heart and brain has revealed various methodologies in healthcare that could be investigated to study the heart-brain interactions and other cardiovascular and neurological diseases. A textile based wearable nanosensor system in the form of e-bra, e-shirt, e-headband, e-brief, underwear etc, was presented in this SPIE conferences earlier for noninvasive recording of EEG and EKG, and showing the correlation between the brain and heart signals. In this paper, the technology is expanded further using fractal based geometries using 3D printing system for low cost and flexible wearable sensor system for healthcare.

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

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    Line Neerup Handlos

    2016-09-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-09-19

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

  10. How are homeless people treated in the healthcare system and other societal institutions? Study of their experiences and trust.

    Science.gov (United States)

    Irestig, Robert; Burström, Kristina; Wessel, Maja; Lynöe, Niels

    2010-05-01

    To elucidate the perceived treatment that the homeless have received from the healthcare and other societal organisations and to present homeless persons' trust in the healthcare system and suggestions of necessary changes for improving it. Homeless individuals in special houses and institutions in the County of Stockholm were asked to answer a short version of a public health survey, including added questions about how they experienced the healthcare providers' attitudes towards them and how much trust they had in the healthcare system. A total of 155 homeless persons (123 male and 32 female) were interviewed. Three-quarters of the participants stated that they had fairly or very high trust in healthcare services and also felt that they had been fairly or very well treated. Fewer females than males reported being treated well and they declared a lower degree of trust in the healthcare system. The homeless suggest that extra resources be set aside to organise their healthcare, including a higher level of knowledge of the medical problems prevailing in the group. Those who felt badly treated also asked for less neglect and disrespect from the healthcare staff. Even though a majority experience that they are being well treated within the healthcare system, the study also indicated disadvantages in the treatment of homeless persons in Sweden. The study also reveals an imbalance between the official ethical framework in Sweden and of the specific moral of some individual healthcare providers. One way to facilitate their entry into the healthcare system might be to create special surgeries for the homeless.

  11. Private investments in hospitals : a comparison of three healthcare systems and possible implications for real estate strategies

    NARCIS (Netherlands)

    van der Zwart, J.; van der Voordt, Theo; de Jonge, H.

    2010-01-01

    Objectives: This article explores lessons to be learned from three different healthcare systems and the possible implications for the management of healthcare real estate, in particular in connection to the Dutch system. It discusses similarities and differences among the different systems, in

  12. Planning for the baby boomers' healthcare needs: a case study.

    Science.gov (United States)

    Albert, Terri C; Johnson, Edward; Gasperino, Daniel; Tokatli, Pinar

    2003-01-01

    Will the impact of baby boomers, as they age, be a bonanza or a bust for the healthcare system? A range of perspectives prevail, from increasing in-patient admissions capacity to accommodate the sheer numbers, to the creation of a variety of healthcare services and delivery channels that address their unique requirements. This case study presents a top 100, regional hospital's approach to this dilemma. The strategic marketing process using segmentation, targeting, and positioning (STP) was employed to guide the administration's planning and decision making.

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

    Science.gov (United States)

    Głębocka, Alicja

    2017-01-01

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

  14. A study of the transferability of influenza case detection systems between two large healthcare systems.

    Directory of Open Access Journals (Sweden)

    Ye Ye

    Full Text Available This study evaluates the accuracy and transferability of Bayesian case detection systems (BCD that use clinical notes from emergency department (ED to detect influenza cases.A BCD uses natural language processing (NLP to infer the presence or absence of clinical findings from ED notes, which are fed into a Bayesain network classifier (BN to infer patients' diagnoses. We developed BCDs at the University of Pittsburgh Medical Center (BCDUPMC and Intermountain Healthcare in Utah (BCDIH. At each site, we manually built a rule-based NLP and trained a Bayesain network classifier from over 40,000 ED encounters between Jan. 2008 and May. 2010 using feature selection, machine learning, and expert debiasing approach. Transferability of a BCD in this study may be impacted by seven factors: development (source institution, development parser, application (target institution, application parser, NLP transfer, BN transfer, and classification task. We employed an ANOVA analysis to study their impacts on BCD performance.Both BCDs discriminated well between influenza and non-influenza on local test cases (AUCs > 0.92. When tested for transferability using the other institution's cases, BCDUPMC discriminations declined minimally (AUC decreased from 0.95 to 0.94, p<0.01, and BCDIH discriminations declined more (from 0.93 to 0.87, p<0.0001. We attributed the BCDIH decline to the lower recall of the IH parser on UPMC notes. The ANOVA analysis showed five significant factors: development parser, application institution, application parser, BN transfer, and classification task.We demonstrated high influenza case detection performance in two large healthcare systems in two geographically separated regions, providing evidentiary support for the use of automated case detection from routinely collected electronic clinical notes in national influenza surveillance. The transferability could be improved by training Bayesian network classifier locally and increasing the

  15. [The process of defining the competence profile of the healthcare professions manager in the Veneto Region].

    Science.gov (United States)

    Costa, Claudio; Roncoroni, Elisabetta; Saiani, Luisa; Stevanin, Simone; Fanton, Elena; Mantoan, Domenico

    2018-01-01

    Presented here is the approach used by a multidisciplinary working group fo the drafting of the "core" competence profile of the healthcare professions manager in the Veneto Region. Defining a competence profile allows for specifying a standard for measuring the skills acquired by a professional and the gap level from what is expected by the organization, as well as orienting the preparatory education to carry out the related role.

  16. Two decades of reforms. Appraisal of the financial reforms in the Russian public healthcare sector.

    Science.gov (United States)

    Gordeev, Vladimir S; Pavlova, Milena; Groot, Wim

    2011-10-01

    This paper reviews the empirical evidence on the outcomes of the financial reforms in the Russian public healthcare sector. A systematic literature review identified 37 relevant publications that presented empirical evidence on changes in quality, equity, efficiency and sustainability in public healthcare provision due to the Russian public healthcare financial reforms. Evidence suggests that there are substantial inter-regional inequalities across income groups both in terms of financing and access to public healthcare services. There are large efficiency differences between regions, along with inter-regional variations in payment and reimbursement mechanisms. Informal and quasi-formal payments deteriorate access to public healthcare services and undermine the overall financing sustainability. The public healthcare sector is still underfinanced, although the implementation of health insurance gave some premises for future increases of efficiency. Overall, the available empirical data are not sufficient for an evidence-based evaluation of the reforms. More studies on the quality, equity, efficiency and sustainability impact of the reforms are needed. Future reforms should focus on the implementation of cost-efficiency and cost-control mechanisms; provide incentives for better allocation and distribution of resources; tackle problems in equity in access and financing; implement a system of quality controls; and stimulate healthy competition between insurance companies. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  17. Coherence in the Danish Healthcare System

    DEFF Research Database (Denmark)

    Frederiksen, Jesper; Olivares Bøgeskov, Benjamin Miguel

    2017-01-01

    In this article, we investigate ‘coherence in healthcare’ as a strategy of welfare policy. We conduct our investigation within the theoretical and methodological framework of Scandinavian praxeology, and we construct our empirical data from Danish administrative documents. The tools and terms...... of this tradition are used to generate data from discourse as representations of institutional logics. The aim is to uncover how coherence in healthcare emerges as different strategies in healthcare governance in relation to different institutions seen as positions. Hence, our findings suggest that, although...... the stated aim in policy is to improve coherence in healthcare for the benefit of the patients, various ambiguities within the institutions producing policy tend to maintain a certain order rather than introducing changes. Furthermore, we discuss how this section of the welfare state, examined in relation...

  18. Prevalence and Causes of Sick Leave among Healthcare System Employees of Joibar Province in 2015

    Directory of Open Access Journals (Sweden)

    Siavosh Etemadi neZhad

    2017-09-01

    Full Text Available Introduction and purpose: Absenteeism is defined as being absent from work without a good reason. Sick leave among healthcare providers can have serious negative impacts on organizational performance. This study was conducted to determine the prevalence and causes of sick leave in the healthcare system of Joibar, Iran. Methods: This analytical cross-sectional study was performed on all employees of the healthcare system of Joibar, Iran (n=239. Data was collected using a checklist including demographic data and reasons for absenteeism (the number of absent days, work experience, and  employment status by presenting to the Human Resources Department of the healthcare system. Data was analyzed by using Chi-square test and Spearman’s rank correlation coefficient in SPSS, version 20. Results: The mean age of the employees was 35.72±3.3 years. Sick leave was mostly observed in the age group of 30-39, official staff, married women, and employees with work experience of 6 to 10 years (83 cases. Among the studied diseases, cold and musculoskeletal disorders were the most frequent causes of absenteeism among employees in the healthcare system. Conclusion: Based on our findings, musculoskeletal disorders were the most important causes of absenteeism, which are preventable. To improve the physical and ergonomic conditions of the staff, we suggest healthcare authorities to install ergonomy software (Office Exercise Program and provide standard and adjustable seats and office desks.

  19. The Appliance Pervasive of Internet of Things in Healthcare Systems

    OpenAIRE

    Talpur, Mir Sajjad Hussain

    2013-01-01

    In fact, information systems are the foundation of new productivity sources, medical organizational forms, and erection of a global economy. IoT based healthcare systems play a significant role in ICT and have contribution in growth of medical information systems, which are underpinning of recent medical and economic development strategies. However, to take advantages of IoT, it is essential that medical enterprises and community should trust the IoT systems in terms of performance, security,...

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

    Directory of Open Access Journals (Sweden)

    Inder Kerry

    2009-10-01

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

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

    Science.gov (United States)

    Chuang, Sheuwen; Inder, Kerry

    2009-10-24

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

  2. Healthcare efficiency assessment using DEA analysis in the Slovak Republic.

    Science.gov (United States)

    Stefko, Robert; Gavurova, Beata; Kocisova, Kristina

    2018-03-09

    A regional disparity is becoming increasingly important growth constraint. Policy makers need quantitative knowledge to design effective and targeted policies. In this paper, the regional efficiency of healthcare facilities in Slovakia is measured (2008-2015) using data envelopment analysis (DEA). The DEA is the dominant approach to assessing the efficiency of the healthcare system but also other economic areas. In this study, the window approach is introduced as an extension to the basic DEA models to evaluate healthcare technical efficiency in individual regions and quantify the basic regional disparities and discrepancies. The window DEA method was chosen since it leads to increased discrimination on results especially when applied to small samples and it enables year-by-year comparisons of the results. Two stable inputs (number of beds, number of medical staff), three variable inputs (number of all medical equipment, number of magnetic resonance (MR) devices, number of computed tomography (CT) devices) and two stable outputs (use of beds, average nursing time) were chosen as production variable in an output-oriented 4-year window DEA model for the assessment of technical efficiency in 8 regions. The database was made available from the National Health Information Center and the Slovak Statistical Office, as well as from the online databases Slovstat and DataCube. The aim of the paper is to quantify the impact of the non-standard Data Envelopment Analysis (DEA) variables as the use of medical technologies (MR, CT) on the results of the assessment of the efficiency of the healthcare facilities and their adequacy in the evaluation of the monitored processes. The results of the analysis have shown that there is an indirect dependence between the values of the variables over time and the results of the estimated efficiency in all regions. The regions that had low values of the variables over time achieved a high degree of efficiency and vice versa. Interesting

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

    Science.gov (United States)

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

    2015-02-01

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

  4. The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms.

    Science.gov (United States)

    Intaranongpai, Siranee; Hughes, David; Leethongdee, Songkramchai

    2012-01-01

    This paper examines the implementation of Thailand's universal coverage healthcare reforms in a rural province, using data from field studies undertaken in 2003-2005 and 2008-2011. We focus on the strand of policy that aimed to develop primary care by allocating funds to contracting units for primary care (CUPs) responsible for managing local service networks. The two studies document a striking change in the balance of power in the local healthcare system over the 8-year period. Initially, the newly formed CUPs gained influence as 'power followed the money', and the provincial health offices (PHOs), which had commanded the service units, were left with a weaker co-ordination role. However, the situation changed as a new insurance purchaser, the National Health Security Office, took financial control and established regional outposts. National Health Security Office outposts worked with PHOs to develop rationalised management tools-strategic plans, targets, KPIs and benchmarking-that installed the PHOs as performance managers of local healthcare systems. New lines of accountability and changed budgetary systems reduced the power of the CUPs to control resource allocation and patterns of services within CUP networks. Whereas some CUPs fought to retain limited autonomy, the PHO has been able to regain much of its former control. We suggest that implementation theory needs to take a long view to capture the complexity of a major reform initiative and argue for an analysis that recognises the key role of policy networks and advocacy coalitions that span national and local levels and realign over time. Copyright © 2012 John Wiley & Sons, Ltd.

  5. Reliable in their failure: an analysis of healthcare reform policies in public systems.

    Science.gov (United States)

    Contandriopoulos, Damien; Brousselle, Astrid

    2010-05-01

    In this paper, we analyze recommendations of past governmental commissions and their implementation in Quebec as a case to discuss the obstacles that litter the road to healthcare system reform. Our analysis shows that the obstacles to tackling the healthcare system's main problems may have less to do with programmatic (what to do) than with political and governance (how to do it) questions. We then draw on neo-institutional theory to discuss the causes and effects of this situation. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2013-10-01

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

  7. Integrated secure solution for electronic healthcare records sharing

    Science.gov (United States)

    Yao, Yehong; Zhang, Chenghao; Sun, Jianyong; Jin, Jin; Zhang, Jianguo

    2007-03-01

    The EHR is a secure, real-time, point-of-care, patient-centric information resource for healthcare providers. Many countries and regional districts have set long-term goals to build EHRs, and most of EHRs are usually built based on the integration of different information systems with different information models and platforms. A number of hospitals in Shanghai are also piloting the development of an EHR solution based on IHE XDS/XDS-I profiles with a service-oriented architecture (SOA). The first phase of the project targets the Diagnostic Imaging domain and allows seamless sharing of images and reports across the multiple hospitals. To develop EHRs for regional coordinated healthcare, some factors should be considered in designing architecture, one of which is security issue. In this paper, we present some approaches and policies to improve and strengthen the security among the different hospitals' nodes, which are compliant with the security requirements defined by IHE IT Infrastructure (ITI) Technical Framework. Our security solution includes four components: Time Sync System (TSS), Digital Signature Manage System (DSMS), Data Exchange Control Component (DECC) and Single Sign-On (SSO) System. We give a design method and implementation strategy of these security components, and then evaluate the performance and overheads of the security services or features by integrating the security components into an image-based EHR system.

  8. PKI security in large-scale healthcare networks.

    Science.gov (United States)

    Mantas, Georgios; Lymberopoulos, Dimitrios; Komninos, Nikos

    2012-06-01

    During the past few years a lot of PKI (Public Key Infrastructures) infrastructures have been proposed for healthcare networks in order to ensure secure communication services and exchange of data among healthcare professionals. However, there is a plethora of challenges in these healthcare PKI infrastructures. Especially, there are a lot of challenges for PKI infrastructures deployed over large-scale healthcare networks. In this paper, we propose a PKI infrastructure to ensure security in a large-scale Internet-based healthcare network connecting a wide spectrum of healthcare units geographically distributed within a wide region. Furthermore, the proposed PKI infrastructure facilitates the trust issues that arise in a large-scale healthcare network including multi-domain PKI infrastructures.

  9. Fit for the Future? A New Approach in the Debate about What Makes Healthcare Systems Really Sustainable

    Directory of Open Access Journals (Sweden)

    Matthias Fischer

    2014-12-01

    Full Text Available As healthcare systems face enormous challenges, sustainability is seen as a crucial requirement for making them fit for the future. However, there is no consensus with regard to either the definition of the term or the factors that characterize a “sustainable healthcare system”. Therefore, the aim of this article is twofold. First, it gives examples of the existing literature about sustainable healthcare systems and analyzes this literature with regard to its understanding of sustainability and the strengths and weaknesses of the different approaches. The article then identifies crucial factors for sustainable healthcare systems, and the result, a conceptual framework consisting of five distinct and interacting factors, can be seen as a starting point for further research.

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

    Science.gov (United States)

    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.

  11. Injustice to transsexual women in a hetero-normatie healthcare system

    Directory of Open Access Journals (Sweden)

    Douglas Newman-Valentine

    2014-11-01

    Conclusion: A hetero-normative healthcare system has a negative impact on the health of transsexual women and will cause them to be marginalised. This could contribute to both homoand trans-phobia that will in turn strengthen the belief that transsexual women are un-African.

  12. Healthcare Facilities, US and Territories, 2015, EPA Region 9

    Data.gov (United States)

    U.S. Environmental Protection Agency — This GIS dataset contains point features that represent healthcare facilities associated with a single NAICS code. Establishment-specific information except the...

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

    Science.gov (United States)

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

    2004-01-01

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

  14. Designing an architectural style for Pervasive Healthcare systems.

    Science.gov (United States)

    Rafe, Vahid; Hajvali, Masoumeh

    2013-04-01

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

  15. Do It Yourself solution of Internet of Things Healthcare System: Measuring body parameters and environmental parameters affecting health.

    Directory of Open Access Journals (Sweden)

    Mirjana Maksimović

    2016-03-01

    Full Text Available The rapid advancements in information and communications technologies (ICT and the increasing number of smart things shift an old-fashioned healthcare system to a model better suited for a population of the 21st century. New healthcare approaches based on Internet of Things (IoT/Internet of Medical Things (IoMT powered systems make health monitoring, diagnostics and treatment more personalized, timely and convenient, enabling a global approach to the healthcare system infrastructure development. Commercial systems in this area exist in various forms but usually do not fit the general patient needs, and those that do are usually economically unacceptable due to the high operational and development costs. Do It Yourself (DIY healthcare, including mobile applications and consumer medical devices, nowadays is the top healthcare trend. Therefore, this paper, based on well-known low-cost technologies, presents a DIY IoMT solution for observing human vital parameter as well as environmental factors affecting health.

  16. HL7 and DICOM based integration of radiology departments with healthcare enterprise information systems.

    Science.gov (United States)

    Blazona, Bojan; Koncar, Miroslav

    2007-12-01

    Integration based on open standards, in order to achieve communication and information interoperability, is one of the key aspects of modern health care information systems. However, this requirement represents one of the major challenges for the Information and Communication Technology (ICT) solutions, as systems today use diverse technologies, proprietary protocols and communication standards which are often not interoperable. One of the main producers of clinical information in healthcare settings represent Radiology Information Systems (RIS) that communicate using widely adopted DICOM (Digital Imaging and COmmunications in Medicine) standard, but in very few cases can efficiently integrate information of interest with other systems. In this context we identified HL7 standard as the world's leading medical ICT standard that is envisioned to provide the umbrella for medical data semantic interoperability, which amongst other things represents the cornerstone for the Croatia's National Integrated Healthcare Information System (IHCIS). The aim was to explore the ability to integrate and exchange RIS originated data with Hospital Information Systems based on HL7's CDA (Clinical Document Architecture) standard. We explored the ability of HL7 CDA specifications and methodology to address the need of RIS integration HL7 based healthcare information systems. We introduced the use of WADO service interconnection to IHCIS and finally CDA rendering in widely used Internet explorers. The outcome of our pilot work proves our original assumption of HL7 standard being able to adopt radiology data into the integrated healthcare systems. Uniform DICOM to CDA translation scripts and business processes within IHCIS is desired and cost effective regarding to use of supporting IHCIS services aligned to SOA.

  17. System-Level Shared Governance Structures and Processes in Healthcare Systems With Magnet®-Designated Hospitals: A Descriptive Study.

    Science.gov (United States)

    Underwood, Carlisa M; Hayne, Arlene N

    The purpose was to identify and describe structures and processes of best practices for system-level shared governance in healthcare systems. Currently, more than 64.6% of US community hospitals are part of a system. System chief nurse executives (SCNEs) are challenged to establish leadership structures and processes that effectively and efficiently disseminate best practices for patients and staff across complex organizations, geographically dispersed locations, and populations. Eleven US healthcare SCNEs from the American Nurses Credentialing Center's repository of Magnet®-designated facilities participated in a 35-multiquestion interview based on Kanter's Theory of Organizational Empowerment. Most SCNEs reported the presence of more than 50% of the empowerment structures and processes in system-level shared governance. Despite the difficulties and complexities of growing health systems, SCNEs have replicated empowerment characteristics of hospital shared governance structures and processes at the system level.

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

    Science.gov (United States)

    Zelingher, Julian; Ash, Nachman

    2013-05-01

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

  19. Building a Healthcare System's Innovation Program.

    Science.gov (United States)

    Conger, Michelle D

    2016-01-01

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

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

    Science.gov (United States)

    Juhnke, Christin; Bethge, Susanne

    2016-01-01

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

  1. [Perceived quality in hospitals of the Andalusia Healthcare System. The case of neurosurgery departments].

    Science.gov (United States)

    Cordero Tous, N; Horcajadas Almansa, Á; Bermúdez González, G J; Tous Zamora, D

    2014-01-01

    To analyse the characteristics of the perceived quality in hospitals of the Andalusia healthcare system and compare this with that in Andalusian Neurosurgery departments. Randomised surveys, adjusted for working age, were performed in Andalusia using a telephone questionnaire based on the SERVQUAL model with the appropriate modification, with the subsequent selection of a subgroup associated with neurosurgery. Perceived quality was classified as; technical, functional and infrastructure quality. The overall satisfaction was 76.3%. Frequency analysis found that variables related to the technical quality (good doctors, successful operations, trained staff, etc.) obtained more favourable outcomes. Those related to time (wait, consulting, organizing schedules) obtained worse outcomes. The care of families variables obtained poor results. There was no difference between the overall Andalusian healthcare system and neurosurgery departments. In the mean analysis, women and older people gave more favourable responses, especially for variables related to infrastructure quality. In the "cluster" analysis, there were more favourable responses by elderly people, with no differences in gender (P<.009). There is no difference in perceived quality between the Andalusian healthcare system overall and neurosurgery departments. The perceived quality of the Andalusian healthcare system is higher in the elderly people. The analysis of perceived quality is useful for promoting projects to improve clinical management. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2011-05-01

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

  4. A model and typology of collaboration between professionals in healthcare organizations.

    Science.gov (United States)

    D'Amour, Danielle; Goulet, Lise; Labadie, Jean-François; Martín-Rodriguez, Leticia San; Pineault, Raynald

    2008-09-21

    The new forms of organization of healthcare services entail the development of new clinical practices that are grounded in collaboration. Despite recent advances in research on the subject of collaboration, there is still a need for a better understanding of collaborative processes and for conceptual tools to help healthcare professionals develop collaboration amongst themselves in complex systems. This study draws on D'Amour's structuration model of collaboration to analyze healthcare facilities offering perinatal services in four health regions in the province of Quebec. The objectives are to: 1) validate the indicators of the structuration model of collaboration; 2) evaluate interprofessional and interorganizational collaboration in four health regions; and 3) propose a typology of collaboration A multiple-case research strategy was used. The cases were the healthcare facilities that offer perinatal services in four health regions in the province of Quebec (Canada). The data were collected through 33 semi-structured interviews with healthcare managers and professionals working in the four regions. Written material was also analyzed. The data were subjected to a "mixed" inductive-deductive analysis conducted in two main stages: an internal analysis of each case followed by a cross-sectional analysis of all the cases. The collaboration indicators were shown to be valid, although some changes were made to three of them. Analysis of the data showed great variation in the level of collaboration between the cases and on each dimension. The results suggest a three-level typology of collaboration based on the ten indicators: active collaboration, developing collaboration and potential collaboration. The model and the typology make it possible to analyze collaboration and identify areas for improvement. Researchers can use the indicators to determine the intensity of collaboration and link it to clinical outcomes. Professionals and administrators can use the model to

  5. Designing the future of healthcare.

    Science.gov (United States)

    Fidsa, Gianfranco Zaccai

    2009-01-01

    This paper describes the application of a holistic design process to a variety of problems plaguing current healthcare systems. A design process for addressing complex, multifaceted problems is contrasted with the piecemeal application of technological solutions to specific medical or administrative problems. The goal of this design process is the ideal customer experience, specifically the ideal experience for patients, healthcare providers, and caregivers within a healthcare system. Holistic design is shown to be less expensive and wasteful in the long run because it avoids solving one problem within a complex system at the cost of creating other problems within that system. The article applies this approach to the maintenance of good health throughout life; to the creation of an ideal experience when a person does need medical care; to the maintenance of personal independence as one ages; and to the enjoyment of a comfortable and dignified death. Virginia Mason Medical Center is discussed as an example of a healthcare institution attempting to create ideal patient and caregiver experiences, in this case by applying the principles of the Toyota Production System ("lean manufacturing") to healthcare. The article concludes that healthcare is inherently dedicated to an ideal, that science and technology have brought it closer to that ideal, and that design can bring it closer still.

  6. A study of leading indicators for occupational health and safety management systems in healthcare.

    Science.gov (United States)

    Almost, Joan M; VanDenKerkhof, Elizabeth G; Strahlendorf, Peter; Caicco Tett, Louise; Noonan, Joanna; Hayes, Thomas; Van Hulle, Henrietta; Adam, Ryan; Holden, Jeremy; Kent-Hillis, Tracy; McDonald, Mike; Paré, Geneviève C; Lachhar, Karanjit; Silva E Silva, Vanessa

    2018-04-23

    In Ontario, Canada, approximately $2.5 billion is spent yearly on occupational injuries in the healthcare sector. The healthcare sector has been ranked second highest for lost-time injury rates among 16 Ontario sectors since 2009 with female healthcare workers ranked the highest among all occupations for lost-time claims. There is a great deal of focus in Ontario's occupational health and safety system on compliance and fines, however despite this increased focus, the injury statistics are not significantly improving. One of the keys to changing this trend is the development of a culture of healthy and safe workplaces including the effective utilization of leading indicators within Occupational Health and Safety Management Systems (OHSMSs). In contrast to lagging indicators, which focus on outcomes retrospectively, a leading indicator is associated with proactive activities and consists of selected OHSMSs program elements. Using leading indicators to measure health and safety has been common practice in high-risk industries; however, this shift has not occurred in healthcare. The aim of this project is to conduct a longitudinal study implementing six elements of the Ontario Safety Association for Community and Healthcare (OSACH) system identified as leading indicators and evaluating the effectiveness of this intervention on improving selected health and safety workplace indicators. A quasi-experimental longitudinal research design will be used within two Ontario acute care hospitals. The first phase of the study will focus on assessing current OHSMSs using the leading indicators, determining potential facilitators and barriers to changing current OHSMSs, and identifying the leading indicators that could be added or changed to the existing OHSMS in place. Phase I will conclude with the development of an intervention designed to support optimizing current OHSMSs in participating hospitals based on identified gaps. Phase II will pilot test and evaluate the tailored

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

    Science.gov (United States)

    Cazier, Joseph A; Medlin, B Dawn

    2006-09-27

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

  8. A Distributed Ensemble Approach for Mining Healthcare Data under Privacy Constraints.

    Science.gov (United States)

    Li, Yan; Bai, Changxin; Reddy, Chandan K

    2016-02-10

    In recent years, electronic health records (EHRs) have been widely adapted at many healthcare facilities in an attempt to improve the quality of patient care and increase the productivity and efficiency of healthcare delivery. These EHRs can accurately diagnose diseases if utilized appropriately. While the EHRs can potentially resolve many of the existing problems associated with disease diagnosis, one of the main obstacles in effectively using them is the patient privacy and sensitivity of the medical information available in the EHR. Due to these concerns, even if the EHRs are available for storage and retrieval purposes, sharing of the patient records between different healthcare facilities has become a major concern and has hampered some of the effective advantages of using EHRs. Due to this lack of data sharing, most of the facilities aim at building clinical decision support systems using limited amount of patient data from their own EHR systems to provide important diagnosis related decisions. It becomes quite infeasible for a newly established healthcare facility to build a robust decision making system due to the lack of sufficient patient records. However, to make effective decisions from clinical data, it is indispensable to have large amounts of data to train the decision models. In this regard, there are conflicting objectives of preserving patient privacy and having sufficient data for modeling and decision making. To handle such disparate goals, we develop two adaptive distributed privacy-preserving algorithms based on a distributed ensemble strategy. The basic idea of our approach is to build an elegant model for each participating facility to accurately learn the data distribution, and then can transfer the useful healthcare knowledge acquired on their data from these participators in the form of their own decision models without revealing and sharing the patient-level sensitive data, thus protecting patient privacy. We demonstrate that our

  9. Critical Study Regarding the Evolution of Incomes and Expenses of the Romanian Healthcare System in the Context of Budgetary Decentralization

    Directory of Open Access Journals (Sweden)

    Violeta ISAI

    2016-04-01

    Full Text Available The healthcare system in Romania is continuously under a reform process, in order to make more efficient the medical care and to allow a wide access for the population to the healthcare services. The incomes of the healthcare system mainly come from the contribution to the social healthcare insurance, but also from other taxes, the system also benefits from subsidies from the state budget. The public healthcare expenses have a relatively low percentage from the total public expenses, being mainly oriented towards hospitals, subsidized drugs and primary medical assistance. The integration of Romania into the EU brought for the healthcare system opportunities as well as threats: the increase of the competence and quality of the medical act, the favourable context of decentralization but also the increase of the costs for medical services, the mobility of the patients and the pronounced migration of the qualified medical staff to other countries of the EU. The paper wants to analyse the incomes and expenses from the healthcare, taking into account all these aspects.

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

    Science.gov (United States)

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

    2017-01-01

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

  11. [Fostering LGBT-friendly healthcare services].

    Science.gov (United States)

    Wei, Han-Ting; Chen, Mu-Hong; Ku, Wen-Wei

    2015-02-01

    LGBT (lesbian, gay, bisexual, transgender) patients suffer from stigma and discrimination when seeking healthcare. A large LGBT healthcare survey revealed that 56% of gay patients and 70% of transgender patients suffered some type of discrimination while seeking healthcare in 2014. The fostering of LGBT-friendly healthcare services is not just an advanced step of gender mainstreaming but also a fulfillment of health equality and equity. Additionally, LGBT-friendly healthcare services are expected to provide new opportunities for healthcare workers. Therefore, proactive government policies, education, research, and clinical practice should all encourage the development of these healthcare services. We look forward to a well-developed LGBT-friendly healthcare system in Taiwan.

  12. Innovation in medicine and healthcare 2015

    CERN Document Server

    Torro, Carlos; Tanaka, Satoshi; Howlett, Robert; Jain, Lakhmi

    2016-01-01

    Innovation in medicine and healthcare is an interdisciplinary research area, which combines the advanced technologies and problem solving skills with medical and biological science. A central theme of this proceedings is Smart Medical and Healthcare Systems (modern intelligent systems for medicine and healthcare), which can provide efficient and accurate solution to problems faced by healthcare and medical practitioners today by using advanced information communication techniques, computational intelligence, mathematics, robotics and other advanced technologies. The techniques developed in this area will have a significant effect on future medicine and healthcare.    The volume includes 53 papers, which present the recent trend and innovations in medicine and healthcare including Medical Informatics; Biomedical Engineering; Management for Healthcare; Advanced ICT for Medical and Healthcare; Simulation and Visualization/VR for Medicine; Statistical Signal Processing and Artificial Intelligence; Smart Medic...

  13. Healthcare is primary

    Directory of Open Access Journals (Sweden)

    Raman Kumar

    2015-01-01

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

  14. Levelling vs competition – political trend reversal in the German healthcare system?

    Directory of Open Access Journals (Sweden)

    Sascha Wolf

    2014-12-01

    Full Text Available For almost 20 years, the German federal government has declared that competition is the key to ensuring the financial sustainability of the healthcare system. The aim of this paper is to investigate if German government indeed has followed a direct path to enhancing competition. For this purpose, a qualitative analysis of the most important healthcare reform acts has been conducted. In conclusion, especially since the introduction of the Health Fund in 2009, a clear trend towards more levelling and regulation can be observed. This trend is confirmed by the most recent healthcare reform act in June 2014. The abolishment of flat-rate premiums is the expression of the government’s fear that competitive pressure could endanger the solvency and viability of sickness funds (statutory health insurance funds. In contrast, on the market for selective contracts, an ambivalent picture emerges. On the one hand, several possibilities for establishing new forms of healthcare and strengthening competition have been introduced. On the other hand, sickness funds as well as service providers are often reluctant to enter into selective contracts.

  15. Home-based Healthcare Technology

    DEFF Research Database (Denmark)

    Verdezoto, Nervo

    of these systems target a specific treatment or condition and might not be sufficient to support the care management work at home. Based on a case study approach, my research investigates home-based healthcare practices and how they can inform future design of home-based healthcare technology that better account......Sustaining daily, unsupervised healthcare activities in non-clinical settings such as the private home can challenge, among others, older adults. To support such unsupervised care activities, an increasingly number of reminders and monitoring systems are being designed. However, most...

  16. Primary care training and the evolving healthcare system.

    Science.gov (United States)

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

    2012-01-01

    With growing numbers of patient-centered medical homes and accountable care organizations, and the potential implementation of the Patient Protection and Affordable Care Act, the provision of primary care in the United States is expanding and changing. Therefore, there is an urgent need to create more primary-care physicians and to train physicians to practice in this environment. In this article, we review the impact that the changing US healthcare system has on trainees, strategies to recruit and retain medical students and residents into primary-care internal medicine, and the preparation of trainees to work in the changing healthcare system. Recruitment methods for medical students include early preclinical exposure to patients in the primary-care setting, enhanced longitudinal patient experiences in clinical clerkships, and primary-care tracks. Recruitment methods for residents include enhanced ambulatory-care training and primary-care programs. Financial-incentive programs such as loan forgiveness may encourage trainees to enter primary care. Retaining residents in primary-care careers may be encouraged via focused postgraduate fellowships or continuing medical education to prepare primary-care physicians as both teachers and practitioners in the changing environment. Finally, to prepare primary-care trainees to effectively and efficiently practice within the changing system, educators should consider shifting ambulatory training to community-based practices, encouraging resident participation in team-based care, providing interprofessional educational experiences, and involving trainees in quality-improvement initiatives. Medical educators in primary care must think innovatively and collaboratively to effectively recruit and train the future generation of primary-care physicians. © 2012 Mount Sinai School of Medicine.

  17. Delimitation of homogeneous regions in the UNIFESP/EPM healthcare center coverage area based on sociodemographic indicators

    Directory of Open Access Journals (Sweden)

    Karina Yuri Harada

    1999-01-01

    Full Text Available CONTEXT: The drawing up of adequate Public Health action planning to address the true needs of the population would increase the chances of effectiveness and decrease unnecessary expenses. OBJECTIVE: To identify homogeneous regions in the UNIFESP/EPM healthcare center (HCC coverage area based on sociodemographic indicators and to relate them to causes of deaths in 1995. DESIGN: Secondary data analysis. SETTING: HCC coverage area; primary care. SAMPLE: Sociodemographic indicators were obtained from special tabulations of the Demographic Census of 1991. MAIN MEASURES: Proportion of children and elderly in the population; family providers’ education level (maximum: >15 years, minimum: 20 minimum wages, minimum: <1 minimum wage; proportional mortality distribution. RESULTS: The maximum income permitted the construction of four homogeneous regions, according to income ranking. Although the proportion of children and of elderly did not vary significantly among the regions, minimum income and education showed a statistically significant (p<0.05 difference between the first region (least affluent and the others. A clear trend of increasing maximum education was observed across the regions. Mortality also differed in the first region, with deaths generated by possibly preventable infections. CONCLUSION: The inequalities observed may contribute to primary health prevention.

  18. Delimitation of homogeneous regions in the UNIFESP/EPM healthcare center coverage area based on sociodemographic indicators.

    Science.gov (United States)

    Harada, K Y; Silva, J G; Schenkman, S; Hayama, E T; Santos, F R; Prado, M C; Pontes, R H

    1999-01-07

    The drawing up of adequate Public Health action planning to address the true needs of the population would increase the chances of effectiveness and decrease unnecessary expenses. To identify homogeneous regions in the UNIFESP/EPM healthcare center (HCC) coverage area based on sociodemographic indicators and to relate them to causes of deaths in 1995. Secondary data analysis. HCC coverage area; primary care. Sociodemographic indicators were obtained from special tabulations of the Demographic Census of 1991. Proportion of children and elderly in the population; family providers' education level (maximum: > 15 years, minimum: 20 minimum wages, minimum: < 1 minimum wage); proportional mortality distribution The maximum income permitted the construction of four homogeneous regions, according to income ranking. Although the proportion of children and of elderly did not vary significantly among the regions, minimum income and education showed a statistically significant (p < 0.05) difference between the first region (least affluent) and the others. A clear trend of increasing maximum education was observed across the regions. Mortality also differed in the first region, with deaths generated by possibly preventable infections. The inequalities observed may contribute to primary health prevention.

  19. Using Ontologies for the E-learning System in Healthcare Human Resources Management

    Directory of Open Access Journals (Sweden)

    Lidia BAJENARU

    2015-01-01

    Full Text Available This paper provides a model for the use of ontology in e-learning systems for structuring educational content in the domain of healthcare human resources management (HHRM in Romania. In this respect we propose an effective method to improve the learning system by providing personalized learning paths created using ontology and advanced educational strategies to provide a personalized learning content for the medical staff. Personalization of e-learning process for the chosen target group will be achieved by setting up learning path for each user according to his profile. This will become possible using: domain ontology, learning objects, modeling student knowledge. Developing an ontology-based system for competence management allows complex interactions, providing intelligent interfacing. This is a new approach for the healthcare system managers in permanent training based on e-learning technologies and specific ontologies in a complex area that needs urgent modernization and efficiency to meet the public health economic, social and political context of Romania.

  20. Who pays for healthcare in Bangladesh? An analysis of progressivity in health systems financing.

    Science.gov (United States)

    Molla, Azaher Ali; Chi, Chunhuei

    2017-09-06

    The relationship between payments towards healthcare and ability to pay is a measure of financial fairness. Analysis of progressivity is important from an equity perspective as well as for macroeconomic and political analysis of healthcare systems. Bangladesh health systems financing is characterized by high out-of-pocket payments (63.3%), which is increasing. Hence, we aimed to see who pays what part of this high out-of-pocket expenditure. To our knowledge, this was the first progressivity analysis of health systems financing in Bangladesh. We used data from Bangladesh Household Income and Expenditure Survey, 2010. This was a cross sectional and nationally representative sample of 12,240 households consisting of 55,580 individuals. For quantification of progressivity, we adopted the 'ability-to-pay' principle developed by O'Donnell, van Doorslaer, Wagstaff, and Lindelow (2008). We used the Kakwani index to measure the magnitude of progressivity. Health systems financing in Bangladesh is regressive. Inequality increases due to healthcare payments. The differences between the Gini coefficient and the Kakwani index for all sources of finance are negative, which indicates regressivity, and that financing is more concentrated among the poor. Income inequality increases due to high out-of-pocket payments. The increase in income inequality caused by out-of-pocket payments is 89% due to negative vertical effect and 11% due to horizontal inequity. Our findings add substantial evidence of health systems financing impact on inequitable financial burden of healthcare and income. The heavy reliance on out-of-pocket payments may affect household living standards. If the government and people of Bangladesh are concerned about equitable financing burden, our study suggests that Bangladesh needs to reform the health systems financing scheme.

  1. Queueing for healthcare.

    Science.gov (United States)

    Palvannan, R Kannapiran; Teow, Kiok Liang

    2012-04-01

    Patient queues are prevalent in healthcare and wait time is one measure of access to care. We illustrate Queueing Theory-an analytical tool that has provided many insights to service providers when designing new service systems and managing existing ones. This established theory helps us to quantify the appropriate service capacity to meet the patient demand, balancing system utilization and the patient's wait time. It considers four key factors that affect the patient's wait time: average patient demand, average service rate and the variation in both. We illustrate four basic insights that will be useful for managers and doctors who manage healthcare delivery systems, at hospital or department level. Two examples from local hospitals are shown where we have used queueing models to estimate the service capacity and analyze the impact of capacity configurations, while considering the inherent variation in healthcare.

  2. A systematic review of human factors and ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety.

    Science.gov (United States)

    Xie, Anping; Carayon, Pascale

    2015-01-01

    Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how human factors and ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified 12 projects representing 23 studies and addressing different physical, cognitive and organisational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care.

  3. Ensuring the security and privacy of information in mobile health-care communication systems

    OpenAIRE

    Adesina, Ademola O.; Agbele, Kehinde K.; Februarie, Ronald; Abidoye, Ademola P.; Nyongesa, Henry O.

    2011-01-01

    The sensitivity of health-care information and its accessibility via the Internet and mobile technology systems is a cause for concern in these modern times. The privacy, integrity and confidentiality of a patient’s data are key factors to be considered in the transmission of medical information for use by authorised health-care personnel. Mobile communication has enabled medical consultancy, treatment, drug administration and the provision of laboratory results to take place outside the hosp...

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

    Science.gov (United States)

    Shanmugasundaram, Jothiganesh; Soulalay, Vongdeuane; Chettiyappan, Visvanathan

    2012-06-01

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

  5. An integrated healthcare system for personalized chronic disease care in home-hospital environments.

    Science.gov (United States)

    Jeong, Sangjin; Youn, Chan-Hyun; Shim, Eun Bo; Kim, Moonjung; Cho, Young Min; Peng, Limei

    2012-07-01

    Facing the increasing demands and challenges in the area of chronic disease care, various studies on the healthcare system which can, whenever and wherever, extract and process patient data have been conducted. Chronic diseases are the long-term diseases and require the processes of the real-time monitoring, multidimensional quantitative analysis, and the classification of patients' diagnostic information. A healthcare system for chronic diseases is characterized as an at-hospital and at-home service according to a targeted environment. Both services basically aim to provide patients with accurate diagnoses of disease by monitoring a variety of physical states with a number of monitoring methods, but there are differences between home and hospital environments, and the different characteristics should be considered in order to provide more accurate diagnoses for patients, especially, patients having chronic diseases. In this paper, we propose a patient status classification method for effectively identifying and classifying chronic diseases and show the validity of the proposed method. Furthermore, we present a new healthcare system architecture that integrates the at-home and at-hospital environment and discuss the applicability of the architecture using practical target services.

  6. Factors Influencing Healthcare Service Quality

    Directory of Open Access Journals (Sweden)

    Ali Mohammad Mosadeghrad

    2014-07-01

    Full Text Available Background The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality.

  7. Whole-system approaches to improving the health and wellbeing of healthcare workers: A systematic review.

    Directory of Open Access Journals (Sweden)

    Sarah L Brand

    Full Text Available Healthcare professionals throughout the developed world report higher levels of sickness absence, dissatisfaction, distress, and "burnout" at work than staff in other sectors. There is a growing call for the 'triple aim' of healthcare delivery (improving patient experience and outcomes and reducing costs; to include a fourth aim: improving healthcare staff experience of healthcare delivery. A systematic review commissioned by the United Kingdom's (UK Department of Health reviewed a large number of international healthy workplace interventions and recommended five whole-system changes to improve healthcare staff health and wellbeing: identification and response to local need, engagement of staff at all levels, and the involvement, visible leadership from, and up-skilling of, management and board-level staff.This systematic review aims to identify whole-system healthy workplace interventions in healthcare settings that incorporate (combinations of these recommendations and determine whether they improve staff health and wellbeing.A comprehensive and systematic search of medical, education, exercise science, and social science databases was undertaken. Studies were included if they reported the results of interventions that included all healthcare staff within a healthcare setting (e.g. whole hospital; whole unit, e.g. ward in collective activities to improve physical or mental health or promote healthy behaviours.Eleven studies were identified which incorporated at least one of the whole-system recommendations. Interventions that incorporated recommendations to address local need and engage the whole workforce fell in to four broad types: 1 pre-determined (one-size-fits-all and no choice of activities (two studies; or 2 pre-determined and some choice of activities (one study; 3 A wide choice of a range of activities and some adaptation to local needs (five studies; or, 3 a participatory approach to creating programmes responsive and adaptive to

  8. Approaches towards improving the quality of maternal and newborn health services in South Asia: challenges and opportunities for healthcare systems.

    Science.gov (United States)

    Mian, Naeem Uddin; Alvi, Muhammad Adeel; Malik, Mariam Zahid; Iqbal, Sarosh; Zakar, Rubeena; Zakar, Muhammad Zakria; Awan, Shehzad Hussain; Shahid, Faryal; Chaudhry, Muhammad Ashraf; Fischer, Florian

    2018-02-06

    South Asia is experiencing a dismal state of maternal and newborn health (MNH) as the region has been falling behind in reducing the levels of maternal and neonatal mortality. Most of the efforts are focused on enhancing coverage of MNH services; however, quality remains a serious concern if the region is to achieve expected outcomes in terms of standardised MNH services within healthcare delivery systems. This research consists of a review of South Asian quality improvement (QI) approaches/interventions, specifically implemented for MNH improvement. A literature review of QI approaches/interventions was conducted using the PRISMA guidelines. Online databases, including PubMed, the Cochrane Library and Google Scholar, were searched. Primary studies published between 1998 and 2013 were considered. Studies were initially screened and selected based upon the selection criteria for data extraction. A thematic synthesis/analysis was performed to organise, group and interpret the key findings according to prominent themes. Thirty studies from six South Asian countries were included in the review. Findings from these selected studies were grouped under eight broad, cross-cutting themes, which emerged from a deductive approach, representing the most commonly employed QI approaches for improving MNH services within different geographical settings. These consist of capacity building of healthcare providers on clinical quality, clinical audits and feedback, financial incentives to beneficiaries, pay-for-performance, supportive supervision, community engagement, collaborative efforts and multidimensional interventions. Employing and documenting QI approaches is essential in order to measure the potential of an intervention, considering its cost-effectiveness, feasibility and acceptability to communities. This research concluded that QI approaches are very diverse and cross-cutting, because they are subject to the varied requirements of regional health systems. This high level

  9. [Ophthalmological service quality offered to outpatients of the Public Healthcare System].

    Science.gov (United States)

    Santos Hercos, Benigno Vicente; Berezovsky, Adriana

    2006-01-01

    To identify the perception of the ophthalmic service quality provided for outpatients of the public healthcare system as well as to detect which actions should be considered necessary and priority in order to improve its quality. A quantitative descriptive study was carried out on 100 outpatients of the public healthcare system which were submitted to ophthalmic tests at Fundação Hilton Rocha--Belo Horizonte-MG, from July 1st-July 30th 2004. Individual interviews were carried out by giving the interviewees two structured questionnaires adapted from the modified SERVQUAL. This scale is in agreement with the reality of the studied institute. The adapted SERVQUAL scale was submitted to statistical validation and it showed a suitable internal consistency index. In general terms, a slight general dissatisfaction was detected regarding ophthalmological service quality. The interviewees cared more about safety and reliability. A higher degree of dissatisfaction was detected mainly concerning fulfillment of procedures at scheduled appointments related to the execution of services within due time-limits. The institute is supposed to plan as well as carry out actions which lead to a general improvement in the patient's satisfaction regarding service quality and mainly reliability. Service quality monitoring through periodic use of the SERVQUAL scale will not only make it possible to plan highly precise and effective intervention strategies in these and in other healthcare services but it will also allow monitoring the responses to these actions. All these actions will contribute to the improvement of the service in the system as a whole.

  10. Public healthcare interests require strict competition enforcement.

    Science.gov (United States)

    Loozen, Edith M H

    2015-07-01

    Several countries have introduced competition in their health systems in order to maintain the supply of high quality health care in a cost-effective manner. The introduction of competition triggers competition enforcement. Since healthcare is characterized by specific market failures, many favor healthcare-specific competition enforcement in order not only to account for the competition interest, but also for the healthcare interests. The question is whether healthcare systems based on competition can succeed when competition enforcement deviates from standard practice. This paper analyzes whether healthcare-specific competition enforcement is theoretically sound and practically effective. This is exemplified by the Dutch system that is based on regulated competition and thus crucially depends on getting competition enforcement right. Governments are responsible for correcting market failures. Markets are responsible for maximizing the public healthcare interests. By securing sufficient competitive pressure, competition enforcement makes sure they do. When interpreted according to welfare-economics, competition law takes into account both costs and benefits specific market behavior may have for healthcare. Competition agencies and judiciary are not legitimized to deviate from standard evidentiary requirements. Dutch case law shows that healthcare-specific enforcement favors the healthcare undertakings concerned, but to the detriment of public health care. Healthcare-specific competition enforcement is conceptually flawed and counterproductive. In order for healthcare systems based on competition to succeed, competition enforcement should be strict. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Darko Gvozdanovi_

    2007-09-01

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

  12. A Decade Lost: Primary Healthcare Performance Reporting across Canada under the Action Plan for Health System Renewal.

    Science.gov (United States)

    Johnston, Sharon; Hogel, Matthew

    2016-05-01

    In 2004, Canada's First Ministers committed to reforms that would shape the future of the Canadian healthcare landscape. These agreements included commitments to improved performance reporting within the primary healthcare system. The aim of this paper was to review the state of primary healthcare performance reporting after the public reporting mandate agreed to a decade ago in the Action Plan for Health System Renewal of 2003 expired. A grey literature search was performed to identify reports released by the governmental and independent reporting bodies across Canada. No province, or the federal government, met their performance reporting obligations from the 2004 accords. Although the indicators required to report on in the 2004 Accord no longer reflect the priorities of patients, policy makers and physicians, provinces are also failing to report on these priorities. Canada needs better primary healthcare performance reporting to enable accountability and improvement within and across provinces. Despite the national mandate to improve public health system reporting, an opportunity to learn from the diverse primary healthcare reforms, underway across Canada for the past decade, has already been lost. Copyright © 2016 Longwoods Publishing.

  13. Depiction of Trends in Administrative Healthcare Data from Hospital Information System.

    Science.gov (United States)

    Kalankesh, Leila R; Pourasghar, Faramarz; Jafarabadi, Mohammad Asghari; Khanehdan, Negar

    2015-06-01

    administrative healthcare data are among main components of hospital information system. Such data can be analyzed and deployed for a variety of purposes. The principal aim of this research was to depict trends of administrative healthcare data from HIS in a general hospital from March 2011 to March 2014. data set used for this research was extracted from the SQL database of the hospital information system in Razi general hospital located in Marand. The data were saved as CSV (Comma Separated Values) in order to facilitate data cleaning and analysis. The variables of data set included patient's age, gender, final diagnosis, final diagnosis code based on ICD-10 classification system, date of hospitalization, date of discharge, LOS(Length of Stay), ward, and survival status of the patient. Data were analyzed and visualized after applying appropriate cleansing and preparing techniques. morbidity showed a constant trend over three years. Pregnancy, childbirth and the puerperium were the leading category of final diagnosis (about 32.8 %). The diseases of the circulatory system were the second class accounting for 13 percent of the hospitalization cases. The diseases of the digestive system had the third rank (10%). Patients aged between 14 and 44 constituted a higher proportion of total cases. Diseases of the circulatory system was the most common class of diseases among elderly patients (age≥65). The highest rate of mortality was observed among patients with final diagnosis of the circulatory system diseases followed by those with diseases of the respiratory system, and neoplasms. Mortality rate for the ICU and the CCU patients were 62% and 33% respectively. The longest average of LOS (7.3 days) was observed among patients hospitalized in the ICU while patients in the Obstetrics and Gynecology ward had the shortest average of LOS (2.4 days). Multiple regression analysis revealed that LOS was correlated with variables of surgery, gender, and type of payment, ward, the

  14. Bottom-up and middle-out approaches to electronic patient information systems: a focus on healthcare pathways

    Directory of Open Access Journals (Sweden)

    Ken Eason

    2013-12-01

    Full Text Available Background A study is reported that examines the use of electronic health record (EHR systems in two UK local health communities.Objective These systems were developed locally and the aim of the study was to explore how well they were supporting the coordination of care along healthcare pathways that cross the organisational boundaries between the agencies delivering health care.Results The paper presents the findings for two healthcare pathways; the Stroke Pathway and a pathway for the care of the frail elderly in their own homes. All the pathways examined involved multiple agencies and many locally tailored EHR systems are in use to aid the coordination of care. However, the ability to share electronic patient information along the pathways was patchy. The development of systems that enabled effective sharing of information was characterised by sociotechnical system development, i.e. associating the technical development with process changes and organisational changes, with local development teams that drew on all the relevant agencies in the local health community and on evolutionary development, as experience grew of the benefits that EHR systems could deliver.Conclusions The study concludes that whilst there may be a role for a national IT strategy, for example, to set standards for systems procurement that facilitate data interchange, most systems development work needs to be done at a ‘middle-out’ level in the local health community, where joint planning between healthcare agencies can occur, and at the local healthcare pathway level where systems can be matched to specific needs for information sharing.

  15. Benchmarking local healthcare-associated infections: Available benchmarks and interpretation challenges

    Directory of Open Access Journals (Sweden)

    Aiman El-Saed

    2013-10-01

    Full Text Available Summary: Growing numbers of healthcare facilities are routinely collecting standardized data on healthcare-associated infection (HAI, which can be used not only to track internal performance but also to compare local data to national and international benchmarks. Benchmarking overall (crude HAI surveillance metrics without accounting or adjusting for potential confounders can result in misleading conclusions. Methods commonly used to provide risk-adjusted metrics include multivariate logistic regression analysis, stratification, indirect standardization, and restrictions. The characteristics of recognized benchmarks worldwide, including the advantages and limitations are described. The choice of the right benchmark for the data from the Gulf Cooperation Council (GCC states is challenging. The chosen benchmark should have similar data collection and presentation methods. Additionally, differences in surveillance environments including regulations should be taken into consideration when considering such a benchmark. The GCC center for infection control took some steps to unify HAI surveillance systems in the region. GCC hospitals still need to overcome legislative and logistic difficulties in sharing data to create their own benchmark. The availability of a regional GCC benchmark may better enable health care workers and researchers to obtain more accurate and realistic comparisons. Keywords: Benchmarking, Comparison, Surveillance, Healthcare-associated infections

  16. Systems Design Perspective of Healthcare Provision in Humanitarian Aid

    Directory of Open Access Journals (Sweden)

    Ana Laura Santos

    2014-12-01

    Full Text Available This study focuses on the role of Systems Design in addressing the challenges of healthcare provision by international emergency relief organizations in developing countries. More specifically the challenges related to the safety and performance of medical equipment that is transferred in the aftermath of a humanitarian crisis. The aim of this paper is to describe the transfer of medical equipment and its associated challenges from a systems perspective and to reflect on the value of Systems Design as an approach to humanitarian innovation, addressing the identified systemic challenges. The concepts of Human Factors and Ergonomics, and Product-Service Systems will be presented as valuable contributions to support designers in handling a larger degree of complexity throughout the design process and to support them to make informed choices regarding this particular context.

  17. [Interdisciplinary healthcare centres--a way of organising healthcare in the future from a health insurer's perspective].

    Science.gov (United States)

    Hecke, Torsten L; Hoyer, Jens Martin

    2009-01-01

    The German healthcare system modernization act enables healthcare providers to fund interdisciplinary healthcare centres. The Techniker Krankenkasse (TK) is a statutory health sickness fund that has contracted with some of the interdisciplinary healthcare centres named ATRIO-MED to achieve high-quality medical care and healthcare management. A range of patient-centred services is described in the cooperation agreement; in addition to central medical patient records one of the core competencies includes integrated pathways for defined diagnosis. The concept of the interdisciplinary healthcare centre is highly accepted among patients. It will serve as a platform for future TK healthcare policies.

  18. Hospital-Based Coalition to Improve Regional Surge Capacity

    Directory of Open Access Journals (Sweden)

    James M. Learning

    2012-12-01

    Full Text Available Introduction: Surge capacity for optimization of access to hospital beds is a limiting factor in response to catastrophic events. Medical facilities, communication tools, manpower, and resource reserves exist to respond to these events. However, these factors may not be optimally functioning to generate an effective and efficient surge response. The objective was to improve the function of these factors.Methods: Regional healthcare facilities and supporting local emergency response agencies developed a coalition (the Healthcare Facilities Partnership of South Central Pennsylvania; HCFP¬SCPA to increase regional surge capacity and emergency preparedness for healthcare facilities. The coalition focused on 6 objectives: (1 increase awareness of capabilities and assets, (2 develop and pilot test advanced planning and exercising of plans in the region, (3 augment written medical mutual aid agreements, (4 develop and strengthen partnership relationships, (5 ensure National Incident Management System compliance, and (6 develop and test a plan for effective utilization of volunteer healthcare professionals.Results: In comparison to baseline measurements, the coalition improved existing areas covered under all 6 objectives documented during a 24-month evaluation period. Enhanced communications between the hospital coalition, and real-time exercises, were used to provide evidence of improved preparedness for putative mass casualty incidents.Conclusion: The HCFP-SCPA successfully increased preparedness and surge capacity through a partnership of regional healthcare facilities and emergency response agencies.

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

    Science.gov (United States)

    Joyce, Phil; Green, Rosamund; Winch, Graham

    2007-01-01

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

  20. Students' perceptions of their learning experiences: A repeat regional survey of healthcare students.

    Science.gov (United States)

    Hamshire, Claire; Barrett, Neil; Langan, Mark; Harris, Edwin; Wibberley, Christopher

    2017-02-01

    Student experience is an international concern and recent research has focused on initiatives to improve students' learning experiences and ultimately reduce attrition levels. To determine similarities and differences between students' perceptions of their learning experiences between 2011 and 2015 in relation to campus-based learning, placement-based learning and personal circumstances. A repeat online survey in 2011 and 2015; using a questionnaire developed from thematic analysis of narrative interviews with a subsample of the target population. Nine universities in the North West of England. A total of 1080 students completed the survey in 2011 and 1983 students in 2015 from a target population of all students studying on commissioned pre-registration healthcare education programmes. An online survey was made available to all undergraduate students studying on Health Education funded programmes within the region and survey respondents were invited to give demographic information and rate their agreement to statements on four-point Likert-type responses. Responses to a repeat survey of healthcare studying in the North West of England in 2015 were strikingly similar overall to those of an original 2011 survey. Although the students were positive overall about their experiences, a number were dissatisfied with some aspects of their experiences - particularly in relation to initial support on campus and whilst studying on placement. Four years on from the original survey, despite a considerable investment in improving students' experiences across the region, there appears to be little change in students' perceptions of their learning experiences CONCLUSION: In the short-term monitoring of student experience needs to be continued; and links to attrition (potential or actual) noted and acted upon. However, given that attrition from these courses has been a long-term problem and the complexity of its resolution a recurrent finding in the literature; new ways of framing

  1. Investments in information systems and technology in the healthcare: Project management mediation

    Directory of Open Access Journals (Sweden)

    Jorge Gomes

    2017-03-01

    Full Text Available Healthcare organisations must improve their business practices and internal procedures in order to answer the increasing demand of health professionals and the general public for more and better information. Hospitals invest massively in information systems and technology (IS/IT in the hope that these investments will improve healthcare and meet patients’ demands. The main objective of our research is to study how organisational maturity, enhanced by investments in IS/IT, project management and best practices, leads to successful projects in public healthcare organisations. The rational of our model is that organisational maturity has a positive effect on IS/IT project success, and that this success is also positively enhanced by the use of project management practices. We emphasise that this combination of approaches can increase the effectiveness of projects. Furthermore, it can also improve the confidence that the results of investments will meet stakeholders’ expectations.

  2. Ethical issues in healthcare financing.

    Science.gov (United States)

    Maharaj, S R; Paul, T J

    2011-07-01

    The four goals of good healthcare are to relieve symptoms, cure disease, prolong life and improve quality of life. Access to healthcare has been a perpetual challenge to healthcare providers who must take into account important factors such as equity, efficiency and effectiveness in designing healthcare systems to meet the four goals of good healthcare. The underlying philosophy may designate health as being a basic human right, an investment, a commodity to be bought and sold, a political demand or an expenditure. The design, policies and operational arrangements will usually reflect which of the above philosophies underpin the healthcare system, and consequently, access. Mechanisms for funding include fee-for-service, cost sharing (insurance, either private or government sponsored) free-of-fee at point of delivery (payments being made through general taxes, health levies, etc) or cost-recovery. For each of these methods of financial access to healthcare services, there are ethical issues which can compromise the four principles of ethical practices in healthcare, viz beneficence, non-maleficence, autonomy and justice. In times of economic recession, providing adequate healthcare will require governments, with support from external agencies, to focus on poverty reduction strategies through provision of preventive services such as immunization and nutrition, delivered at primary care facilities. To maximize the effect of such policies, it will be necessary to integrate policies to fashion an intersectoral approach.

  3. Association between medication supplies and healthcare costs in older adults from an urban healthcare system.

    Science.gov (United States)

    Stroupe, K T; Murray, M D; Stump, T E; Callahan, C M

    2000-07-01

    The amount of medication dispensed to older adults for the treatment of chronic disease must be balanced carefully. Insufficient medication supplies lead to inadequate treatment of chronic disease, whereas excessive supplies represent wasted resources and the potential for toxicity. We used an electronic medical record system to determine the distribution of medications supplied to older urban adults and to examine the correlations of these distributions with healthcare costs and use. A cross-sectional study using data acquired over 3 years (1994-1996). A tax-supported urban public healthcare system consisting of a 300-bed hospital, an emergency department, and a network of community-based ambulatory care centers. Patients were >60 years of age and had at least one prescription refill and at least two ambulatory visits or one hospitalization during the 3-year period. Focusing on 12 major categories of drugs used to treat chronic diseases, we determined the amounts and direct costs of these medications dispensed to older adult patients. Amounts of medications that were needed by patients to medicate themselves adequately were compared with the medication supply actually dispensed considering all sources of care (primary, emergency, and inpatient). We calculated the excess drug costs attributable to oversupply of medication (>120% of the amount needed) and the drug cost reduction caused by undersupply of medication (120% of the supply needed. The total direct cost of targeted medications for 3 years was $1.96 million or, on average, $654,000 annually. During the 3-year period, patients receiving >120% of their needed medications had excess direct medication costs of $279,084 or $144 per patient, whereas patients receiving <80% of drugs needed had reduced medication costs of $423,438 or $634 per patient. Multivariable analyses revealed that both under- and over-supplies of medication were associated with a greater likelihood of emergency department visits and hospital

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

    Science.gov (United States)

    Bitsaki, Marina; Koutras, George; Heep, Hansjoerg; Koutras, Christos

    2017-01-01

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

  5. The Economics of Healthcare Shape the Practice of Neuropsychology in the Era of Integrated Healthcare.

    Science.gov (United States)

    Pliskin, Neil H

    2018-05-01

    The healthcare system in the United States is in the midst of a major transformation that has affected all healthcare specialties, including clinical psychology/neuropsychology. If this shift in the economics of healthcare reimbursement continues, it promises to impact clinical practice patterns for neuropsychologists far into the next decade.

  6. A comparative study of contemporary user involvement within healthcare systems across England, Poland and Slovenia.

    Science.gov (United States)

    Lichon, Mateusz; Kavcic, Matic; Masterson, Daniel

    2015-01-01

    The purpose of this paper is to explore how healthcare-users' engagement is perceived, how it occurs and how these perceptions differ between three European countries: England, Poland and Slovenia, using the concepts of voice, choice and coproduction. This comparative, qualitative study is based on a review of legal documents, academic literature and semi-structured interviews conducted in October and November 2011. A research sample consisted of 21 interviewees representing various stakeholders including healthcare-users, doctors and managers. Primary and secondary data were analysed using theoretical thematic analysis. Emerging themes were identified from the interviews and related to the indicators describing healthcare-users' involvement in the voice, choice and coproduction model. Results of the comparative qualitative research suggest that the healthcare-users' influence is strongly grounded in England where the healthcare system and professionals are prepared to include healthcare-users in the decision-making process. In Slovenia, cultural development of healthcare-users' involvement seems to proceed the institutional development. In Poland, institutions are ready to involve healthcare-users in decision-making process although the cultural desirability of involving users among doctors and patients is lacking. The notion of user involvement is increasingly gaining importance and research attention, yet there is still little known about the way cultural, political, historical differences between various European countries influence it. This paper explores this little known area using the original approach of user involvement (Dent et al., 2011) with input from various stakeholders including patients, healthcare representatives and academics.

  7. e-Healthcare in India: critical success factors for sustainable health systems.

    Science.gov (United States)

    Taneja, Udita; Sushil

    2007-01-01

    As healthcare enterprises seek to move towards an integrated, sustainable healthcare delivery model an IT-enabled or e-Healthcare strategy is being increasingly adopted. In this study we identified the critical success factors influencing the effectiveness of an e-Healthcare strategy in India. The performance assessment criteria used to measure effectiveness were increasing reach and reducing cost of healthcare delivery. A survey of healthcare providers was conducted. Analytic Hierarchy Process (AHP) and Interpretive Structural Modeling (ISM) were the analytical tools used to determine the relative importance of the critical success factors in influencing effectiveness of e-Healthcare and their interplay with each other. To succeed in e-Healthcare initiatives the critical success factors that need to be in place are appropriate government policies, literacy levels, and telecommunications and power infrastructure in the country. The focus should not be on the IT tools and biomedical engineering technologies as is most often the case. Instead the nontechnology factors such as healthcare provider and consumer mindsets should be addressed to increase acceptance of, and enhance the effectiveness of, sustainable e-Healthcare services.

  8. The making of a European healthcare union

    DEFF Research Database (Denmark)

    Vollaard, Hans; van de Bovenkamp, Hester M.; Martinsen, Dorte Sindbjerg

    2016-01-01

    that federalism offers the most fruitful way to do so because of its sensitivity to the EU’s institutional settings and to the territorial dimension of politics. The division of competences and national diversity of healthcare systems have been major obstacles for the formation of a healthcare union. However......, the EU obtained a role in healthcare through the impact of non-healthcare legislation, voluntary co-operation, court rulings, governments’ joint-decision traps, and fiscal stress of member states. The emerging European healthcare union is a system of cooperative federalism without much cost-sharing...

  9. The future of UK healthcare: problems and potential solutions to a system in crisis.

    Science.gov (United States)

    Montgomery, H E; Haines, A; Marlow, N; Pearson, G; Mythen, M G; Grocott, M P W; Swanton, C

    2017-08-01

    The UK's Health System is in crisis, central funding no longer keeping pace with demand. Traditional responses-spending more, seeking efficiency savings or invoking market forces-are not solutions. The health of our nation demands urgent delivery of a radical new model, negotiated openly between public, policymakers and healthcare professionals. Such a model could focus on disease prevention, modifying health behaviour and implementing change in public policy in fields traditionally considered unrelated to health such as transport, food and advertising. The true cost-effectiveness of healthcare interventions must be balanced against the opportunity cost of their implementation, bolstering the central role of NICE in such decisions. Without such action, the prognosis for our healthcare system-and for the health of the individuals it serves-may be poor. Here, we explore such a new prescription for our national health. © The Author 2017. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  10. Enhancing the performance of mobile healthcare systems based on task-redistribution

    NARCIS (Netherlands)

    Mei, H.; van Beijnum, Bernhard J.F.; Widya, I.A.; Jones, Valerie M.; Hermens, Hermanus J.

    2008-01-01

    Mobile healthcare (m-health) systems have attracted a great deal of attention due to their potential to improve the quality of diagnosis, reduce medical costs and help address the challenges posed by the aging society. A generic m-health service platform has been developed and specialized to deal

  11. The impact of the economic downturn on healthcare in Spain: consequences and alternatives.

    Science.gov (United States)

    Antonanzas, Fernando

    2013-08-01

    In Spain, the economic downturn has caused big changes in most of the public policies, where healthcare system is the one which is deeply affected too. The objective of the paper is to review some of the recent changes achieved in the system, and to discuss about providing some alternative ideas to the implemented policies. The existing universal coverage previous to the crisis, as acknowledged by the law, has changed last year and the new figure of 'insured person' has been introduced into the system. These persons are now the only ones eligible to receive healthcare under the public coverage. New co-payments have been introduced for drugs, and retired persons must also pay a 10% co-payment (which was 0% before) at the chemist office. Healthcare institutions have also implemented several policies to manage tough budget constraints. Some regions have privatized healthcare management of some hospitals (as Madrid) to control budget and presumably to obtain a higher efficiency. Different initiatives dealing with human resources and external purchases are also presented in this paper to mostly achieve budget control. The majority of the changes have been pure budget cuts and a reorganization of the system and institutions is still needed.

  12. LEAN thinking in Finnish healthcare.

    Science.gov (United States)

    Jorma, Tapani; Tiirinki, Hanna; Bloigu, Risto; Turkki, Leena

    2016-01-01

    Purpose - The purpose of this study is to evaluate how LEAN thinking is used as a management and development tool in the Finnish public healthcare system and what kind of outcomes have been achieved or expected by using it. The main focus is in managing and developing patient and treatment processes. Design/methodology/approach - A mixed-method approach incorporating the Webropol survey was used. Findings - LEAN is quite a new concept in Finnish public healthcare. It is mainly used as a development tool to seek financial savings and to improve the efficiency of patient processes, but has not yet been deeply implemented. However, the experiences from LEAN initiatives have been positive, and the methodology is already quite well-known. It can be concluded that, because of positive experiences from LEAN, the environment in Finnish healthcare is ready for the deeper implementation of LEAN. Originality/value - This paper evaluates the usage of LEAN thinking for the first time in the public healthcare system of Finland as a development tool and a management system. It highlights the implementation and achieved results of LEAN thinking when used in the healthcare environment. It also highlights the expectations for LEAN thinking in Finnish public healthcare.

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

    Science.gov (United States)

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

    2012-12-01

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

  14. Ontology-Driven Knowledge-Based Health-Care System, An Emerging Area - Challenges And Opportunities - Indian Scenario

    Science.gov (United States)

    Sunitha, A.; Babu, G. Suresh

    2014-11-01

    Recent studies in the decision making efforts in the area of public healthcare systems have been tremendously inspired and influenced by the entry of ontology. Ontology driven systems results in the effective implementation of healthcare strategies for the policy makers. The central source of knowledge is the ontology containing all the relevant domain concepts such as locations, diseases, environments and their domain sensitive inter-relationships which is the prime objective, concern and the motivation behind this paper. The paper further focuses on the development of a semantic knowledge-base for public healthcare system. This paper describes the approach and methodologies in bringing out a novel conceptual theme in establishing a firm linkage between three different ontologies related to diseases, places and environments in one integrated platform. This platform correlates the real-time mechanisms prevailing within the semantic knowledgebase and establishing their inter-relationships for the first time in India. This is hoped to formulate a strong foundation for establishing a much awaited basic need for a meaningful healthcare decision making system in the country. Introduction through a wide range of best practices facilitate the adoption of this approach for better appreciation, understanding and long term outcomes in the area. The methods and approach illustrated in the paper relate to health mapping methods, reusability of health applications, and interoperability issues based on mapping of the data attributes with ontology concepts in generating semantic integrated data driving an inference engine for user-interfaced semantic queries.

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

    Science.gov (United States)

    Beveridge, R N

    1997-01-01

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

  16. [Healthcare mistreatment attributed to discrimination among mapuche patients and discontinuation of diabetes care].

    Science.gov (United States)

    Ortiz, Manuel S; Baeza-Rivera, María José; Salinas-Oñate, Natalia; Flynn, Patricia; Betancourt, Héctor

    2016-10-01

    The negative impact of perceived discrimination on health outcomes is well established. However, less attention has been directed towards understanding the effect of perceived discrimination on health behaviors relevant for the treatment of diabetes in ethnic minorities. To examine the effects of healthcare mistreatment attributed to discrimination on the continuity of Type 2 Diabetes (DM2) care among mapuche patients in a southern region of Chile. A non-probabilistic sample of 85 mapuche DM2 patients were recruited from public and private health systems. Eligibility criteria included having experienced at least one incident of interpersonal healthcare mistreatment. All participants answered an instrument designed to measure healthcare mistreatment and continuity of diabetes care. Healthcare mistreatment attributed to ethnic discrimination was associated with the discontinuation of diabetes care. Healthcare mistreatment attributed to discrimination negatively impacted the continuity of diabetes care, a fact which may provide a better understanding of health disparities in ethnic minorities.

  17. Process-aware information system development for the healthcare domain : consistency, reliability and effectiveness

    NARCIS (Netherlands)

    Mans, R.S.; Aalst, van der W.M.P.; Russell, N.C.; Bakker, P.J.M.; Moleman, A.J.; Rinderle-Ma, S.; Sadiq, S.; Leymann, F.

    2010-01-01

    Optimal support for complex healthcare processes cannot be provided by a single out-of-the-box Process-Aware Information System and necessitates the construction of customized applications based on these systems. In order to allow for the seamless integration of the new technology into the existing

  18. 4th KES International Conference on Innovation in Medicine and Healthcare

    CERN Document Server

    Tanaka, Satoshi; Howlett, Robert; Jain, Lakhmi; InMed-16; Innovation in Medicine and Healthcare 2016

    2016-01-01

    This proceedings volume includes 32 papers, which present recent trends and innovations in medicine and healthcare including Innovative Technology in Mental Healthcare; Intelligent Decision Support Technologies and Systems in Healthcare; Biomedical Engineering, Trends, Research and Technologies; Advances in Data & Knowledge Management for Healthcare; Advanced ICT for Medical and Healthcare; Healthcare Support System; and Smart Medical and Healthcare System. Innovation in medicine and healthcare is an interdisciplinary research area, which combines the advanced technologies and problem solving skills with medical and biological science. A central theme of this proceedings is Smart Medical and Healthcare Systems (modern intelligent systems for medicine and healthcare), which can provide efficient and accurate solution to problems faced by healthcare and medical practitioners today by using advanced information communication techniques, computational intelligence, mathematics, robotics and other advanced tec...

  19. An Overview of Research Issues in the Modern Healthcare Monitoring System Design using Wireless Body area Network

    OpenAIRE

    D. Suresh; P. Alli

    2012-01-01

    Problem statement: Healthcare is recognized various leading edge technologies and new scientific discoveries to enable better cures for diseases and better means to enable early detection of most life threatening diseases. The modern health care focused for optimally reducing the healthcare costs. Approach: The modern healthcare system enables medical professionals to remotely perform real-time monitoring, early diagnosis and treatment for potential risky disease. A mobile patient monitoring ...

  20. Managing today's complex healthcare business enterprise: reflections on distinctive requirements of healthcare management education.

    Science.gov (United States)

    Welton, William E

    2004-01-01

    In early 2001, the community of educational programs offering master's-level education in healthcare management began an odyssey to modernize its approach to the organization and delivery of healthcare management education. The community recognized that cumulative long-term changes within healthcare management practice required a careful examination of healthcare management context and manpower requirements. This article suggests an evidence-based rationale for defining the distinctive elements of healthcare management, thus suggesting a basis for review and transformation of master's-level healthcare management curricula. It also suggests ways to modernize these curricula in a manner that recognizes the distinctiveness of the healthcare business enterprise as well as the changing management roles and careers within these complex organizations and systems. Through such efforts, the healthcare management master's-level education community would be better prepared to meet current and future challenges, to increase its relevance to the management practice community, and to allocate scarce faculty and program resources more effectively.

  1. PUBLIC FINANCING OF HEALTHCARE SERVICES

    Directory of Open Access Journals (Sweden)

    Agnieszka Bem

    2013-10-01

    Full Text Available Healthcare in Poland is mainly financed by public sector entities, among them the National Health Fund (NFZ, state budget and local government budgets. The task of the National Health Fund, as the main payer in the system, is chiefly currently financing the services. The state budget plays a complementary role in the system, and finances selected groups of services, health insurance premiums and investments in healthcare infrastructure. The basic role of the local governments is to ensure access to the services, mostly by performing ownership functions towards healthcare institutions.

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

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

    1999-01-01

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

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

    Science.gov (United States)

    Kolker, Eugene; Kolker, Evelyne

    2014-03-01

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

  5. Personalized biomedical devices & systems for healthcare applications

    Science.gov (United States)

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

    2011-03-01

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

  6. A healthcare Lean Six Sigma System for postanesthesia care unit workflow improvement.

    Science.gov (United States)

    Kuo, Alex Mu-Hsing; Borycki, Elizabeth; Kushniruk, Andre; Lee, Te-Shu

    2011-01-01

    The aim of this article is to propose a new model called Healthcare Lean Six Sigma System that integrates Lean and Six Sigma methodologies to improve workflow in a postanesthesia care unit. The methodology of the proposed model is fully described. A postanesthesia care unit case study is also used to demonstrate the benefits of using the Healthcare Lean Six Sigma System model by combining Lean and Six Sigma methodologies together. The new model bridges the service gaps between health care providers and patients, balances the requirements of health care managers, and delivers health care services to patients by taking the benefits of the Lean speed and Six Sigma high-quality principles. The full benefits of the new model will be realized when applied at both strategic and operational levels. For further research, we will examine how the proposed model is used in different real-world case studies.

  7. Perceived determinants of cardiovascular risk management in primary care: disconnections between patient behaviours, practice organisation and healthcare system.

    Science.gov (United States)

    Huntink, E; Wensing, M; Klomp, M A; van Lieshout, J

    2015-12-15

    Although conditions for high quality cardiovascular risk management in primary care in the Netherlands are favourable, there still remains a gap between practice guideline recommendations and practice. The aim of the current study was to identify determinants of cardiovascular primary care in the Netherlands. We performed a qualitative study, using semi-structured interviews with healthcare professionals and patients with established cardiovascular diseases or at high cardiovascular risk. A framework analysis was used to cluster the determinants into seven domains: 1) guideline factors, 2) individual healthcare professional factors, 3) patient factors, 4) professional interaction, 5) incentives and recourses, 6) mandate, authority and accountability, and 7) social, political and legal factors. Twelve healthcare professionals and 16 patients were interviewed. Healthcare professionals and patients mentioned a variety of factors concerning all seven domains. Determinants of practice according to the health care professionals were related to communication between healthcare professionals, patients' lack of knowledge and self-management, time management, market mechanisms in the Dutch healthcare system and motivational interviewing skills of healthcare professionals. Patients mentioned determinants related to their knowledge of risk factors for cardiovascular diseases, medication adherence and self-management as key determinants. A key finding is the mismatch between healthcare professionals' and patients' views on patient's knowledge and self-management. Perceived determinants of cardiovascular risk management were mainly related to patient behaviors and (but only for health professionals) to the healthcare system. Though health care professionals and patients agree upon the importance of patients' knowledge and self-management, their judgment of the current state of knowledge and self-management is entirely different.

  8. Infrastructuring Multicultural Healthcare Information Systems.

    Science.gov (United States)

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

    2017-01-01

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

  9. Strategic enterprise resource planning in a health-care system using a multicriteria decision-making model.

    Science.gov (United States)

    Lee, Chang Won; Kwak, N K

    2011-04-01

    This paper deals with strategic enterprise resource planning (ERP) in a health-care system using a multicriteria decision-making (MCDM) model. The model is developed and analyzed on the basis of the data obtained from a leading patient-oriented provider of health-care services in Korea. Goal criteria and priorities are identified and established via the analytic hierarchy process (AHP). Goal programming (GP) is utilized to derive satisfying solutions for designing, evaluating, and implementing an ERP. The model results are evaluated and sensitivity analyses are conducted in an effort to enhance the model applicability. The case study provides management with valuable insights for planning and controlling health-care activities and services.

  10. Wearable nanosensor systems and their applications in healthcare

    Science.gov (United States)

    Ramasamy, Mouli; Kumar, Prashanth S.; Varadan, Vijay K.

    2017-04-01

    The development of intelligent miniaturized nano-bio-and info-tech based sensors capable of wireless communication will fundamentally change the way we monitor and treat patients with chronic disease and after surgery. These new sensors will allow the monitoring of the patients as they maintain their normal daily activities, and provide warning to healthcare workers when critical events arise. This will facilitate early discharge of patients from hospitals as well as providing reassurance to patients and family that potential problems will be detected at an early stage. The use of continuous monitoring allows both transient and progressive abnormalities to be reliably detected thus avoiding the problems of conventional diagnosis and monitoring methods where by data is captured only for a brief period during hospital/clinic visits. We have been working with a printable organic semiconductor and thin film transistor, and have fabricated and tested various biosensors that can measure important physiological signs before and after surgery. Integrated into "smart" fabrics - garments with wireless technology - and independent e-bandaid sensors, nanosensors in tattoos and socks, minimally invasive implantable devices, the sensor systems will be able to monitor a patient's condition in real time and thus provide point-of-care diagnostics to health-care professionals and greater freedom for patients.

  11. Improving the cost-effectiveness of a healthcare system for depressive disorders by implementing telemedicine: a health economic modeling study.

    Science.gov (United States)

    Lokkerbol, Joran; Adema, Dirk; Cuijpers, Pim; Reynolds, Charles F; Schulz, Richard; Weehuizen, Rifka; Smit, Filip

    2014-03-01

    Depressive disorders are significant causes of disease burden and are associated with substantial economic costs. It is therefore important to design a healthcare system that can effectively manage depression at sustainable costs. This article computes the benefit-to-cost ratio of the current Dutch healthcare system for depression, and investigates whether offering more online preventive interventions improves the cost-effectiveness overall. A health economic (Markov) model was used to synthesize clinical and economic evidence and to compute population-level costs and effects of interventions. The model compared a base case scenario without preventive telemedicine and alternative scenarios with preventive telemedicine. The central outcome was the benefit-to-cost ratio, also known as return-on-investment (ROI). In terms of ROI, a healthcare system with preventive telemedicine for depressive disorders offers better value for money than a healthcare system without Internet-based prevention. Overall, the ROI increases from €1.45 ($1.72) in the base case scenario to €1.76 ($2.09) in the alternative scenario in which preventive telemedicine is offered. In a scenario in which the costs of offering preventive telemedicine are balanced by reducing the expenditures for curative interventions, ROI increases to €1.77 ($2.10), while keeping the healthcare budget constant. For a healthcare system for depressive disorders to remain economically sustainable, its cost-benefit ratio needs to be improved. Offering preventive telemedicine at a large scale is likely to introduce such an improvement. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  12. Complexity leadership: a healthcare imperative.

    Science.gov (United States)

    Weberg, Dan

    2012-01-01

    The healthcare system is plagued with increasing cost and poor quality outcomes. A major contributing factor for these issues is that outdated leadership practices, such as leader-centricity, linear thinking, and poor readiness for innovation, are being used in healthcare organizations. Complexity leadership theory provides a new framework with which healthcare leaders may practice leadership. Complexity leadership theory conceptualizes leadership as a continual process that stems from collaboration, complex systems thinking, and innovation mindsets. Compared to transactional and transformational leadership concepts, complexity leadership practices hold promise to improve cost and quality in health care. © 2012 Wiley Periodicals, Inc.

  13. Improving healthcare using Lean processes.

    Science.gov (United States)

    Baker, G Ross

    2014-01-01

    For more than a decade, healthcare organizations across Canada have been using Lean management tools to improve care processes, reduce preventable adverse events, increase patient satisfaction and create better work environments. The largest system-wide effort in Canada, and perhaps anywhere, is currently under way in Saskatchewan. The jury is still out on whether Lean efforts in that province, or elsewhere in Canada, are robust enough to transform current delivery systems and sustain new levels of performance. This issue of Healthcare Quarterly features several articles that provide a perspective on Lean methods in healthcare. Copyright © 2014 Longwoods Publishing.

  14. households' choices of healthcare services in the north west region

    African Journals Online (AJOL)

    model. Households' characteristics such as sex and age of household heads, marital status of household heads and .... Based Financing (PBF) of healthcare in the North .... return from this capital in both market and non- ... Healthy Life Style.

  15. Using hub technology to facilitate information system integration in a health-care enterprise.

    Science.gov (United States)

    Gendler, S M; Friedman, B A; Henricks, W H

    1996-04-01

    The deployment and maintenance of multiple point-to-point interfaces between a clinical information system, such as a laboratory information system, and other systems within a healthcare enterprise is expensive and time consuming. Moreover, the demand for such interfaces is increasing as hospitals consolidate and clinical laboratories participate in the development of regional laboratory networks and create host-to-host links with laboratory outreach clients. An interface engine, also called a hub, is an evolving technology that could replace multiple point-to-point interfaces from a laboratory information system with a single interface to the hub, preferably HL7 based. The hub then routes and translates laboratory information to other systems within the enterprise. Changes in application systems in an enterprise where a centralized interface engine has been implemented then amount to thorough analysis, an update of the enterprise's data dictionary, purchase of a single new vendor-supported interface, and table-based parameter changes on the hub. Two other features of an interface engine, support for structured query language and information store-and-forward, will facilitate the development of clinical data repositories and provide flexibility when interacting with other host systems. This article describes the advantages and disadvantages of an interface engine and lists some problems not solved by the technology. Finally, early developmental experience with an interface engine at the University of Michigan Medical Center and the benefits of the project on system integration efforts are described, not the least of which has been the enthusiastic adoption of the HL7 standard for all future interface projects.

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

    Science.gov (United States)

    Dignon, Andrée

    2016-08-01

    This article describes a study of attitudes to the current system of animal experimentation (for the production of health interventions) among 52 UK healthcare professionals. These healthcare professionals participated in three separate focus groups (of 18, 17 and 17 participants) and were invited to respond to the question 'what is your opinion about the current system of animal testing?' The study focused specifically on their views of the current system (rather than their views of animal testing in general). The healthcare professionals were critical of the current system, particularly with regard to regulation, secrecy, validity, unnecessary suffering and welfare. © The Author(s) 2014.

  17. How 'healthy' are healthcare organizations? Exploring employee healthcare utilization rates among Dutch healthcare organizations.

    Science.gov (United States)

    Bronkhorst, Babette

    2017-08-01

    Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole.

  18. XDS in healthcare: Could it lead to a duplication problem? Field study from GVR Sweden

    Science.gov (United States)

    Wintell, M.; Lundberg, N.; Lindsköld, L.

    2011-03-01

    Managing different registries and repositories within healthcare regions grows the risk of having almost the same information but with different status and with different content. This is due to the fact that when medical information is created it's done in a dynamical process that will lead to that information will change its contents during lifetime within the "active" healthcare phase. The information needs to be easy accessible, being the platform for making the medical decisions transparent. In the Region Västra Götaland (VGR), Sweden, data is shared from 29 X-ray departments with different Picture Archive and Communication Systems (PACS) and Radiology Information Systems (RIS) systems through the Infobroker solution, that's acts as a broker between the actors involved. Request/reports from RIS are stored as DIgital COmmunication in Medicine (DICOM)-Structured Reports (SR) objects, together with the images. Every status change within this activities are updated within the Information Infrastructure based on Integrating the Healthcare Enterprise (IHE) mission. Cross-enterprise Document Sharing for Imaging (XDS-I) were the registry and the central repository are the components used for sharing medical documentation. The VGR strategy was not to apply one regional XDS-I registry and repository, instead VGR applied an Enterprise Architecture (EA) intertwined with the Information Infrastructure for the dynamic delivery to consumers. The upcoming usage of different Regional XDS registries and repositories could lead to new ways of carrying out shared work but it can also lead into "problems". XDS and XDS-I implemented without a strategy could lead to increased numbers of status/versions but also duplication of information in the Information Infrastructure.

  19. Modelling mobile health systems: an application of augmented MDA for the extended healthcare enterprise

    NARCIS (Netherlands)

    Jones, Valerie M.; Rensink, Arend; Brinksma, Hendrik

    2005-01-01

    Mobile health systems can extend the enterprise computing system of the healthcare provider by bringing services to the patient any time and anywhere. We propose a model-driven design and development methodology for the development of the m-health components in such extended enterprise computing

  20. Wireless biopotential acquisition system for portable healthcare monitoring.

    Science.gov (United States)

    Wang, W-S; Huang, H-Y; Wu, Z-C; Chen, S-C; Wang, W-F; Wu, C-F; Luo, C-H

    2011-07-01

    A complete biopotential acquisition system with an analogue front-end (AFE) chip is proposed for portable healthcare monitoring. A graphical user interface (GUI) is also implemented to display the extracted biopotential signals in real-time on a computer for patients or in a hospital via the internet for doctors. The AFE circuit defines the quality of the acquired biosignals. Thus, an AFE chip with low power consumption and a high common-mode rejection ratio (CMRR) was implemented in the TSMC 0.18-μm CMOS process. The measurement results show that the proposed AFE, with a core area of 0.1 mm(2), has a CMRR of 90 dB, and power consumption of 21.6 μW. Biopotential signals of electroencephalogram (EEG), electrocardiogram (ECG) and electromyogram (EMG) were measured to verify the proposed system. The board size of the proposed system is 6 cm × 2.5 cm and the weight is 30 g. The total power consumption of the proposed system is 66 mW. Copyright © 2011 Informa UK, Ltd.

  1. Private investment in hospitals : A comparison of three healthcare systems and possible implications for real estate strategies

    NARCIS (Netherlands)

    van der Zwart, J.; de Jonge, H.; van der Voordt, Theo; van de Zwart, J; Jonge, H

    2009-01-01

    Subject/Research problem
    Healthcare is both important and expensive, and is likely to become even more expensive in the future. To keep healthcare affordable in the future, the Dutch government is currently in the process of changing legislation in order to move from a centrally directed system

  2. Data reliability in home healthcare services

    NARCIS (Netherlands)

    Vavilis, S.; Zannone, N.; Petkovic, M.

    2013-01-01

    Home healthcare services are emerging as a new frontier in healthcare practices. Data reliability, however, is crucial for the acceptance of these new services. This work presents a semi-automated system to evaluate the quality of medical measurements taken by patients. The system relies on data

  3. The role of private non-profit healthcare organizations in NHS systems: Implications for the Portuguese hospital devolution program.

    Science.gov (United States)

    Almeida, Álvaro S

    2017-06-01

    The national health services (NHS) of England, Portugal, Finland and other single-payer universalist systems financed by general taxation, are based on the theoretical principle of an integrated public sector payer-provider. However, in practice one can find different forms of participation of non-public healthcare providers in those NHS, including private for profit providers, but also third sector non-profit organizations (NPO). This paper reviews the role of non-public non-profit healthcare organizations in NHS systems. By crossing a literature review on privatization of national health services with a literature review on the comparative performance of non-profit and for-profit healthcare organizations, this paper assesses the impact of contracting private non-profit healthcare organizations on the efficiency, quality and responsiveness of services, in public universal health care systems. The results of the review were then compared to the existing evidence on the Portuguese hospital devolution to NPO program. The evidence in this paper suggests that NHS health system reforms that transfer some public-sector hospitals to NPO should deliver improvements to the health system with minimal downside risks. The very limited existing evidence on the Portuguese hospital devolution program suggests it improved efficiency and access, without sacrificing quality. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. PARTICIPATORY GOVERNANCE IN THE PUBLIC HEALTHCARE SYSTEMS OF THE SCANDINAVIAN AND BALTIC COUNTRIES

    Directory of Open Access Journals (Sweden)

    Stefanescu Aurelia

    2011-12-01

    Full Text Available The diminished trust of citizens in the public sector, the increased complexity of policy issues and the reforms in accordance with the new public management principles generate the need of focusing more extensively on participatory governance. Participatory governance can be defined as the genuine engagement of citizens and other organizations in the formulation of policies and strategies, in the decision-making process from the public sector and in the implementation of the decisions. The present paper's objectives are to define the concept of participatory governance, to argue in favor of implementing it in the public sector and to find to what extent public healthcare institutions from Scandinavian and Baltic countries publish information on participatory governance and how they perceive community engagement. The research findings are that the information on participatory governance disclosed on the websites of relevant institutions from within the Scandinavian and Baltic public healthcare systems is scarce. The countries with the greatest concern for community engagement are Denmark and Sweden. It is argued that there should be a shift in focus within the public sector in general and within the healthcare system in particular, so that citizens are genuinely involved in the relevant processes and their satisfaction is indeed at an adequate level.

  5. '1Care' and the Politics of Healthcare in Malaysia

    OpenAIRE

    Por Heong Hong

    2014-01-01

    In this article, we assess the current state of healthcare financing and the contestation surrounding it in Malaysia. The stakes are high because the system of healthcare financing in a country influences to a large extent issues of healthcare accessibility, equity and universal coverage. The taxation-based public healthcare system is a primary welfare source for the people of this country. Nevertheless, privatization of the healthcare sector, expansion of private hospitals, and increase in u...

  6. Health-care utilization and associated factors in Gauteng province, South Africa.

    Science.gov (United States)

    Abera Abaerei, Admas; Ncayiyana, Jabulani; Levin, Jonathan

    2017-01-01

    More than a billion people, mainly in low- and middle-income countries, are unable to access needed health-care services for a variety of reasons. Possible factors influencing health-care utilization include socio-demographic and economic factors such as age, sex, education, employment and income. However, different studies have showed mixed results. Moreover, there are limited studies on health-care utilization. This study aimed to determine health-care utilization and associated factors among all residents aged 18 or over in Gauteng province, South Africa. A cross-sectional study was conducted from data collected for a Quality of Life survey which was carried out by Gauteng City-Region Observatory in 2013. Simple random sampling was used to select participants. A total of 27,490 participants have been interviewed. Data were collected via a digital data collection instrument using an open source system called Formhub. Coarsened Exact Matching (CEM) was used to improve estimation of causal effects. Stepwise multiple logistic regression was employed to identify factors associated with health-care utilization. Around 95.7% reported usually utilizing health-care services while the other 4.3% reported not having sought health-care services of any type. Around 75% of participants reported reduced quality of public health services as a major reason not to visit them. Higher odds of reported health-care utilization were associated with being female (OR = 2.18, 95% CI: 1.88-2.53; p immigrant (OR = 0.61, 95% CI: 0.53-0.70; p < 0.001). The results indicated that there is a need to improve the quality of public health-care services and perception towards them as improved health-care quality increases the choice of health-care providers.

  7. Burden of Friedreich’s Ataxia to the Patients and Healthcare Systems in the United States and Canada

    Directory of Open Access Journals (Sweden)

    Barbara ePolek

    2013-05-01

    Full Text Available Objective: The study intended to substantiate healthcare resource utilization, costs and funding patterns of US and Canadian Friedreich's Ataxia (FRDA populations, to assess compliance with treatment guidance and to identify areas where novel healthcare measures or improved access to existing care may improve patients’ functional and social capabilities and reduce the financial impact on the healthcare systems. Methods: Healthcare resource utilization and costs were collected in a cross sectional study in the US (N=197 and Canada (N=43 and analyzed across severity of disease categories. Descriptive statistics, correlation analysis and hypothesis testing were applied.Results: In the US, healthcare costs of FRDA patients were higher than those of ‘adults with two and more chronic conditions’. Significantly higher costs were incurred in advanced stages of the disease, with paid homecare being the main driver. This pattern was also observed in Canada. Compliance with the recommended annual neurological and cardiological follow-up was high, but was low for the recommended regular speech therapy. In the US public and private funding ratios were similar for the FRDA and the general populations. In Canada the private funding ratio for FRDA was higher than average. Conclusions: The variety of healthcare measures addressing the broad range of symptoms of FRDA, and the increasing use of paid home care as disease progresses made total US healthcare costs of FRDA exceed the costs of US adults with two and more chronic conditions. Therefore, measures delaying disease progression will allow patients to maintain their independence longer and may reduce costs to the healthcare system. Novel measures to address dysarthria and to ensure access to them should be further investigated. The higher than average private funding ratio in Canada was due to the relatively high cost of the pharmacological treatment of FRDA.

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

    Science.gov (United States)

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

    2016-11-01

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

  9. Service Robotics in Healthcare: A Perspective for Information Systems Researchers?

    OpenAIRE

    Garmann-Johnsen, Niels Frederik; Mettler, Tobias; Sprenger, Michaela

    2014-01-01

    Recent advances in electronics and telecommunication have paved the way for service robots to enter the clinical world. While service robotics has long been a core research theme in computer science and other engineering-related fields, it has attracted little interest of Information Systems (IS) researchers so far. We argue that service robotics represents an interesting area of investigation, especially for healthcare, since current research lacks a thorough examination of socio-technical p...

  10. Learning to navigate the healthcare system in a new country: a qualitative study.

    Science.gov (United States)

    Straiton, Melanie L; Myhre, Sonja

    2017-12-01

    Learning to navigate a healthcare system in a new country is a barrier to health care. Understanding more about the specific navigation challenges immigrants experience may be the first step towards improving health information and thus access to care. This study considers the challenges that Thai and Filipino immigrant women encounter when learning to navigate the Norwegian primary healthcare system and the strategies they use. A qualitative interview study using thematic analysis. Norway. Fifteen Thai and 15 Filipino immigrant women over the age of 18 who had been living in Norway at least one year. The women took time to understand the role of the general practitioner and some were unaware of their right to an interpreter during consultations. In addition to reliance on family members and friends in their social networks, voluntary and cultural organisations provided valuable tips and advice on how to navigate the Norwegian health system. While some women actively engaged in learning more about the system, they noted a lack of information available in multiple languages. Informal sources play an important role in learning about the health care system. Formal information should be available in different languages in order to better empower immigrant women.

  11. Healthcare for persons with intellectual disability in the community

    Directory of Open Access Journals (Sweden)

    David Alan Ervin

    2014-07-01

    Full Text Available Introduction While there has been impressive progress in creating and improving community healthcare delivery systems that support people with intellectual and developmental disabilities (IDD, there is much more that can and should be done. Method This paper offers a review of healthcare delivery concepts on which new models are being developed, while also establishing an historical context. We review the need for creating fully integrated models of healthcare, and at the same time offer practical considerations that range from specific healthcare delivery system components to the need to expand our approach to training healthcare providers. The models and delivery systems, and the areas of needed focus in their development are reviewed to set a starting point for more and greater work going forward. Conclusions Today, we celebrate longer lifespans of people with IDD, increased attention to the benefits of healthcare that is responsive to their needs, and the development of important healthcare delivery systems that are customized to their needs. We also know that the growing body of research on health status offers incentive to continue developing healthcare structures for people with IDD by training healthcare providers about the needs of people with IDD, by establishing systems of care that integrate acute healthcare with long term services and support, by developing IDD medicine as a specialty, and by building health promotion and wellness resources to provide people with IDD a set of preventative health supports.

  12. Improved glycemic control without hypoglycemia in elderly diabetic patients using the ubiquitous healthcare service, a new medical information system.

    Science.gov (United States)

    Lim, Soo; Kang, Seon Mee; Shin, Hayley; Lee, Hak Jong; Won Yoon, Ji; Yu, Sung Hoon; Kim, So-Youn; Yoo, Soo Young; Jung, Hye Seung; Park, Kyong Soo; Ryu, Jun Oh; Jang, Hak C

    2011-02-01

    To improve quality and efficiency of care for elderly patients with type 2 diabetes, we introduced elderly-friendly strategies to the clinical decision support system (CDSS)-based ubiquitous healthcare (u-healthcare) service, which is an individualized health management system using advanced medical information technology. We conducted a 6-month randomized, controlled clinical trial involving 144 patients aged >60 years. Participants were randomly assigned to receive routine care (control, n = 48), to the self-monitored blood glucose (SMBG, n = 47) group, or to the u-healthcare group (n = 49). The primary end point was the proportion of patients achieving A1C healthcare system refers to an individualized medical service in which medical instructions are given through the patient's mobile phone. Patients receive a glucometer with a public switched telephone network-connected cradle that automatically transfers test results to a hospital-based server. Once the data are transferred to the server, an automated system, the CDSS rule engine, generates and sends patient-specific messages by mobile phone. After 6 months of follow-up, the mean A1C level was significantly decreased from 7.8 ± 1.3% to 7.4 ± 1.0% (P healthcare group and from 7.9 ± 1.0% to 7.7 ± 1.0% (P = 0.020) in the SMBG group, compared with 7.9 ± 0.8% to 7.8 ± 1.0% (P = 0.274) in the control group. The proportion of patients with A1C healthcare group, 23.4% in the SMBG group (23.4%), and 14.0% in the control group (P healthcare service achieved better glycemic control with less hypoglycemia than SMBG and routine care and may provide effective and safe diabetes management in the elderly diabetic patients.

  13. Attitudes of stakeholders and policymakers in the healthcare system towards the provision of spiritual care in Israel.

    Science.gov (United States)

    Bentur, Netta; Resnitzky, Shirli; Sterne, Abram

    2010-06-01

    Spiritual-care services and chaplaincy in the medical system are provided to people with serious illnesses, aiming to help them achieve moments of peace and acceptance while contending with illness or facing death. Chaplaincy has been available in Europe and in the U.S. for many decades, but such programs started to develop in Israel only few years ago. This paper examines the attitudes of stakeholders, directors and policymakers in the healthcare system towards the provision of spiritual care and the development of such programs. We conducted in-depth face-to-face interviews with 16 individuals in the healthcare system. All the interviews were transcribed in full and analyzed using qualitative study methods. Most of the interviewees had little knowledge of spiritual care and many mentioned barriers and challenges to its implementation in the healthcare system. These issues include: lack of knowledge and understanding about spiritual care precluding impeded their ability to evaluate its suitability for the healthcare services; confusion between spiritual care and religion; concerns about potential conflict with other professionals, especially social workers; barriers to funding of the new services; barriers to the successful integration of new ideas; and concerns about formal training and accreditation of the new profession. Spiritual care has begun to take root in Israel's health system, but it is still at an early stage of development. Implementation must continue apace and careful consideration must be given to optimizing its acceptance by the establishment. Copyright (c) 2010. Published by Elsevier Ireland Ltd.

  14. E-prescription as a tool for improving services and the financial viability of healthcare systems: the case of the Greek national e-prescription system.

    Science.gov (United States)

    Pangalos, G; Sfyroeras, V; Pagkalos, I

    2014-01-01

    E-prescription systems can help improve patient service, safety and quality of care. They can also help achieve better compliance for the patients and better alignment with the guidelines for the practitioners. The recently implemented national e-prescription system in Greece already covers approximately 85% of all prescriptions prescribed in Greece today (approximately 5.5 million per month). The system has not only contributed already in significant changes towards improving services and better monitoring and planning of public health, but also substantially helped to contain unnecessary expenditure related to medication use and improve transparency and administrative control. Such issues have gained increasing importance not only for Greece but also for many other national healthcare systems that have to cope with the continuous rise of medication expenditure. Our implementation has, therefore, shown that besides their importance for improving services, national e-prescription systems can also provide a valuable tool for better utilisation of resources and for containing unnecessary healthcare costs, thus contributing to the improvement of the financial stability and viability of the overall healthcare system.

  15. Caring for healthcare entrepreneurs - Towards successful entrepreneurial strategies for sustainable innovations in Dutch healthcare

    NARCIS (Netherlands)

    Janssen, M.; Moors, E.H.M.

    The sustainability of current healthcare systems is threatened by several societal developments, including an aging population, an increase of unmet medical needs and rising healthcare costs. A transition is needed in order to meet these threats and to achieve a proper balance between the demand for

  16. Design and development of a tele-healthcare information system based on web services and HL7 standards.

    Science.gov (United States)

    Huang, Ean-Wen; Hung, Rui-Suan; Chiou, Shwu-Fen; Liu, Fei-Ying; Liou, Der-Ming

    2011-01-01

    Information and communication technologies progress rapidly and many novel applications have been developed in many domains of human life. In recent years, the demand for healthcare services has been growing because of the increase in the elderly population. Consequently, a number of healthcare institutions have focused on creating technologies to reduce extraneous work and improve the quality of service. In this study, an information platform for tele- healthcare services was implemented. The architecture of the platform included a web-based application server and client system. The client system was able to retrieve the blood pressure and glucose levels of a patient stored in measurement instruments through Bluetooth wireless transmission. The web application server assisted the staffs and clients in analyzing the health conditions of patients. In addition, the server provided face-to-face communications and instructions through remote video devices. The platform deployed a service-oriented architecture, which consisted of HL7 standard messages and web service components. The platform could transfer health records into HL7 standard clinical document architecture for data exchange with other organizations. The prototyping system was pretested and evaluated in a homecare department of hospital and a community management center for chronic disease monitoring. Based on the results of this study, this system is expected to improve the quality of healthcare services.

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

    OpenAIRE

    Uzun, Vassilya; Bilgin, Sami

    2016-01-01

    For this study, we designed a QR Code Identity Tag system to integrate into the Turkish healthcare system. This system provides QR code-based medical identification alerts and an in-hospital patient identification system. Every member of the medical system is assigned a unique QR Code Tag; to facilitate medical identification alerts, the QR Code Identity Tag can be worn as a bracelet or necklace or carried as an ID card. Patients must always possess the QR Code Identity bracelets within hospi...

  18. An assessment of PKI and networked electronic patient record system: lessons learned from real patient data exchange at the platform of OCHIS (Osaka Community Healthcare Information System).

    Science.gov (United States)

    Takeda, Hiroshi; Matsumura, Yasushi; Kuwata, Shigeki; Nakano, Hirohiko; Shanmai, Ji; Qiyan, Zhang; Yufen, Chen; Kusuoka, Hideo; Matsuoka, Masaki

    2004-03-31

    To enhance medical cooperation between the hospitals and clinics around Osaka local area, the healthcare network system, named Osaka Community Healthcare Information System (OCHIS), was established with support of a supplementary budget from the Japanese government in fiscal year 2002. Although the system has been based on healthcare public key infrastructure (PKI), there remain security issues to be solved technically and operationally. An experimental study was conducted to elucidate the central and the local function in terms of a registration authority and a time stamp authority in contract with the Japanese Medical Information Systems Organization (MEDIS) in 2003. This paper describes the experimental design and the results of the study concerning message security.

  19. Theoretical background of healthcare management in the conditions of social and economic instability

    Directory of Open Access Journals (Sweden)

    Shuldyakov V.A.

    2015-03-01

    Full Text Available Purpose: to develop fundamental basis of science based healthcare management in social and economic instability. Public health state (1998-2008, selected region was characterized by cardiovascular health parameters (Code IX, ICD-10. Systematic review was performed according to PRISMA guidelines. Dynamic characteristics of major cardiovascular diseases in social and economic instability considered as a cause of a population system destabilization were reconstructed. Conclusion. Fundamentals of science based healthcare management in social and economic instability include long- and short-term prognosis of public health characteristics as the result of multifactor external influences on cardiovascular diseases prevalence.

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

    Directory of Open Access Journals (Sweden)

    Greenfield Geva

    2012-07-01

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

  1. Improving Transgender Healthcare in the New York City Correctional System.

    Science.gov (United States)

    Jaffer, Mohamed; Ayad, John; Tungol, Jose Gabriel; MacDonald, Ross; Dickey, Nathaniel; Venters, Homer

    2016-04-01

    Correctional settings create unique challenges for patients with special needs, including transgender patients, who have an increased rate of overall discrimination, sexual abuse, healthcare disparities, and improper housing. As part of our correctional health quality improvement process, we sought to review and evaluate the adequacy of care for transgender patients in the New York City jail system. Using correctional pharmacy records, transgender patients receiving hormonal treatment were identified. A brief in-person survey was conducted to evaluate their care in the community before incarceration, medical care in jail, and experience in the jail environment. Survey findings and analysis of transgender patient healthcare-related complaints revealed opportunities for improvements in the provision of care and staff understanding of this population. Utilizing these findings, we conducted lesbian, gay, bisexual, and transgender (LGBT) trainings in all 12 jail clinics for medical, nursing, and mental health staff. Three months after LGBT training, patient complaints dropped by over 50%. After the development and implementation of a newly revised transgender healthcare policy, complaints dropped to zero within 6 months. Our efforts to assess the quality of care provided to transgender patients revealed significant areas for improvement. Although we have made important gains in providing quality care through the implementation of policies and procedures rooted in community standards and the express wishes of our patients, we continue to engage this patient population to identify other issues that impact their health and well-being in the jail environment.

  2. Healthcare reform: the role of coordinated critical care.

    Science.gov (United States)

    Cerra, F B

    1993-03-01

    To evaluate and editorialize the evolving role of the discipline of critical care as a healthcare delivery system in the process of healthcare reform. The sources included material from the Federal Office of Management and Budget, Health Care Financing Review, President Bush's Office, Association of American Medical Colleges, and publications of the Society of Critical Care Medicine. Data were selected that the author felt was relevant to the healthcare reform process and its implications for the discipline of critical care. The data were extracted by the author to illustrate the forces behind healthcare reform, the implications for the practice of critical care, and role of critical care as a coordinated (managed) care system in the process of healthcare reform. Healthcare reform has been initiated because of a number of considerations that arise in evaluating the current healthcare delivery system: access, financing, cost, dissatisfactions with the mechanisms of delivery, and political issues. The reform process will occur with or without the involvement of critical care practitioners. Reforms may greatly alter the delivery of critical care services, education, training, and research in critical care. Critical care has evolved into a healthcare delivery system that provides services to patients who need and request them and provides these services in a coordinated (managed) care model. Critical care practitioners must become involved in the healthcare reform process, and critical care services that are effective must be preserved, as must the education, training, and research programs. Critical care as a healthcare delivery system utilizing a coordinated (managed) care model has the potential to provide services to all patients who need them and to deliver them in a manner that is cost effective and recognized as providing added value.

  3. Healthcare Industry Improvement with Business Intelligence

    Directory of Open Access Journals (Sweden)

    Mihaela-Laura IVAN

    2015-01-01

    Full Text Available The current paper highlights the advantages of big data analytics and business intelligence in the healthcare industry. In the paper are reviewed the Real-Time Healthcare Analytics Solutions for Preventative Medicine provided by SAP and the different ideas realized by possible customers for new applications in Healthcare industry in order to demonstrate that the healthcare system can and should benefit from the new opportunities provided by ITC in general and big data analytics in particular.

  4. Do senior management cultures affect performance? Evidence from Italian public healthcare organizations.

    Science.gov (United States)

    Prenestini, Anna; Lega, Federico

    2013-01-01

    Healthcare organizations are often characterized by diffuse power, ambiguous goals, and a plurality of actors. In this complex and pluralistic context, senior healthcare managers are expected to provide strategic direction and lead their organizations toward their goals and performance targets. The present work explores the relationship between senior management team culture and performance by investigating Italian public healthcare organizations in the Tuscany region. Our assessment of senior management culture was accomplished through the use of an established framework and a corresponding tool, the competing values framework, which supports the idea that specific aspects of performance are related to a dominant management culture. Organizational performance was assessed using a wide range of measures collected by a multidimensional performance evaluation system, which was developed in Tuscany to measure the performance of its 12 local health authorities (LHAs) and four teaching hospitals (THs). Usable responses were received from 80 senior managers of 11 different healthcare organizations (two THs and nine LHAs). Our findings show that Tuscan healthcare organizations are characterized by various dominant cultures: developmental, clan, rational, and hierarchical. These variations in dominant culture were associated with performance measures. The implications for management theory, professional practice, and public policy are discussed.

  5. Using Explorative Simulation to Drive User-Centered Design and IT-Development in Healthcare

    DEFF Research Database (Denmark)

    Edwards, Kasper; Thommesen, Jacob; Broberg, Ole

    2012-01-01

    We describe a method involving user-system simulation to drive rapid development and evaluation of layout, organization or information technology in healthcare. The method has been developed, tested and refined in three sub-projects in the Capital Region of Denmark. The overall goal of the project...... was to validate such a development method in a two-year project (2010-11). Explorative simulation is primarily based on approaches in design and usability engineering and simulation-based training in healthcare, and involves end-users and designers or engineers in a collaborative exploration of design solution...... can gain insight into the healthcare work practice and design applications accordingly - Theories and new ideas can be readily transformed to into the simulated world where they are explored and quickly rejected or used further - A very cost-effective approach to innovation....

  6. Business resilience: Reframing healthcare risk management.

    Science.gov (United States)

    Simeone, Cynthia L

    2015-09-01

    The responsibility of risk management in healthcare is fractured, with multiple stakeholders. Most hospitals and healthcare systems do not have a fully integrated risk management system that spans the entire organizational and operational structure for the delivery of key services. This article provides insight toward utilizing a comprehensive Business Resilience program and associated methodology to understand and manage organizational risk leading to organizational effectiveness and operational efficiencies, with the fringe benefit of realizing sustainable operational capability during adverse conditions. © 2015 American Society for Healthcare Risk Management of the American Hospital Association.

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

    Science.gov (United States)

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

    2012-04-01

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

  8. A wireless trust model for healthcare.

    Science.gov (United States)

    Wickramasinghe, Nilmini; Misra, Santosh K

    2004-01-01

    In today's context of escalating costs, managed care, regulations such as the Health Insurance Portability and Accountability Act (HIPAA) and a technology savvy patient, the healthcare industry can no longer be complacent regarding embracing technologies to enable better, more effective and efficient practice management. In such an environment, many healthcare organisations are turning to m-commerce or wireless solutions. These solutions, in particular the mobile electronic patient record, have many advantages over their wired counterparts, including significant cost advantages, higher levels of physician acceptance, more functionalities as well as enabling easy accessibility to healthcare in remote geographic regions, however, they also bring with them challenges of their own. One such major challenge is security. To date, few models exist that help establish an appropriate framework, in the context of wireless in healthcare, in which to understand and evaluate all the security issues let alone facilitate the development of systematic and robust solutions. Our paper addresses this need by outlining an appropriate mobile trust model for such a scenario in healthcare organisations.

  9. [Multidisciplinary health houses and regional development: a necessarily shared dyanamics.].

    Science.gov (United States)

    Autès, Michel; Dufay, Marie-Guite

    2009-03-29

    Many regional authorities (Conseils Régionaux) have taken up the issue of health houses by underlining their competence in dealing with regional development issues. This initiative is part of a broader process designed to ensure the continuity of healthcare at the different levels of provision as well as equal, universal access according to the specific needs of patients, from prevention to the most specialized forms of medical treatment. Health houses are one of the chief access points in this process, and are situated at the cross-roads of health and healthcare. The territorial health project must provide the fondations of the new health house model. According to the Health Committee of the Association of French Regions (Commission Santé de l'Association des Régions de France), there are three prerequisites: 1. a multidisciplinary offer of access to front-line healthcare services; 2. public healthcare activities: prevention, promotion of health...; 3. a network mode of organization with the local and regional hospital system to ensure optimum healthcare provision for patients. Yet a number of obstacles need to be overcome, particularly the risk of concentrating healthcare provision within a single center, thus depriving the surrounding area, but also the ill-adapted current framework of remuneration for independent medical practitioners. The purpose of regional authorities (i.e. Conseils Régionaux) is not to ensure the expansion of health houses, but rather to enable innovation by accompanying the different actors involved within the sector. Heeding the specific requirements of the local area and its needs, as well as the will of elected representatives and healthcare professionals, their aim is to develop a policy of exemplarity with all the actors involved in the sector and to uphold their legitimacy as agents of regional development. The ?Hospital, patients, health and territories' law (loi "Hôpital, patients, santé et territoires") may yet throw the

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

    Science.gov (United States)

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

    2011-01-01

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

  11. Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need.

    Directory of Open Access Journals (Sweden)

    Jens Detollenaere

    Full Text Available Access to healthcare is inequitably distributed across different socioeconomic groups. Several vulnerable groups experience barriers in accessing healthcare, compared to their more wealthier counterparts. In response to this, many countries use resources to strengthen their primary care (PC system, because in many European countries PC is the first entry-point to the healthcare system and plays a central role in the coordination of patients through the healthcare system. However it is unclear whether this strengthening of PC leads to less inequity in access to the whole healthcare system. This study investigates the association between strength indicators of PC and inequity in unmet need by merging data from the European Union Statistics on Income and Living Conditions database (2013 and the Primary Healthcare Activity Monitor for Europe (2010. The analyses reveal a significant association between the Gini coefficient for income inequality and inequity in unmet need. When the Gini coefficient of a country is one SD higher, the social inequity in unmet need in that particular country will be 4.960 higher. Furthermore, the accessibility and the workforce development of a country's PC system is inverse associated with the social inequity of unmet need. More specifically, when the access- and workforce development indicator of a country PC system are one standard deviation higher, the inequity in unmet healthcare needs are respectively 2.200 and 4.951 lower. Therefore, policymakers should focus on reducing income inequality to tackle inequity in access, and strengthen PC (by increasing accessibility and better-developing its workforce as this can influence inequity in unmet need.

  12. Healthcare information technology infrastructures in Turkey.

    Science.gov (United States)

    Dogac, A; Yuksel, M; Ertürkmen, G L; Kabak, Y; Namli, T; Yıldız, M H; Ay, Y; Ceyhan, B; Hülür, U; Oztürk, H; Atbakan, E

    2014-05-22

    The objective of this paper is to describe some of the major healthcare information technology (IT) infrastructures in Turkey, namely, Sağlık-Net (Turkish for "Health-Net"), the Centralized Hospital Appointment System, the Basic Health Statistics Module, the Core Resources Management System, and the e-prescription system of the Social Security Institution. International collaboration projects that are integrated with Sağlık-Net are also briefly summarized. The authors provide a survey of the some of the major healthcare IT infrastructures in Turkey. Sağlık-Net has two main components: the National Health Information System (NHIS) and the Family Medicine Information System (FMIS). The NHIS is a nation-wide infrastructure for sharing patients' Electronic Health Records (EHRs). So far, EHRs of 78.9 million people have been created in the NHIS. Similarly, family medicine is operational in the whole country via FMIS. Centralized Hospital Appointment System enables the citizens to easily make appointments in healthcare providers. Basic Health Statistics Module is used for collecting information about the health status, risks and indicators across the country. Core Resources Management System speeds up the flow of information between the headquarters and Provincial Health Directorates. The e-prescription system is linked with Sağlık-Net and seamlessly integrated with the healthcare provider information systems. Finally, Turkey is involved in several international projects for experience sharing and disseminating national developments. With the introduction of the "Health Transformation Program" in 2003, a number of successful healthcare IT infrastructures have been developed in Turkey. Currently, work is going on to enhance and further improve their functionality.

  13. SERVICE QUALITY MEASUREMENT: IMPLICATIONS FOR HEALTHCARE SECTOR IN BULGARIA

    OpenAIRE

    VASSILEVA, Bistra; BALLONI, Antonio José

    2014-01-01

    The aim of the paper is to present the service quality situation in hospitals in North-Eastern Planning Region in Bulgaria. Our intention was to assess the gap between the expected and perceived healthcare service quality in hospitals. To meet these goals we conducted a study using prospective questionnaire provided by the GESITI project (Management of System and Information Technology in Hospitals [GESITI], 2013) and SERVQUAL scale. The results helped us to summarize the challenges for Bulga...

  14. Message generation facilities for interoperability in pervasive healthcare environments

    NARCIS (Netherlands)

    Cardoso de Moraes, J.L.; Lopes de Souza, Wanderley; Ferreira Pires, Luis; do Prado, Antonio Francisco

    Novel information and communication technologies enable the construction of systems that allow the provision of new healthcare services anywhere, at any time, and to anyone. Since these healthcare systems may offer their healthcare records in different electronic formats, the openEHR foundation

  15. A Lexical-Ontological Resource for Consumer Healthcare

    Science.gov (United States)

    Cardillo, Elena; Serafini, Luciano; Tamilin, Andrei

    In Consumer Healthcare Informatics it is still difficult for laypeople to find, understand and act on health information, due to the persistent communication gap between specialized medical terminology and that used by healthcare consumers. Furthermore, existing clinically-oriented terminologies cannot provide sufficient support when integrated into consumer-oriented applications, so there is a need to create consumer-friendly terminologies reflecting the different ways healthcare consumers express and think about health topics. Following this direction, this work suggests a way to support the design of an ontology-based system that mitigates this gap, using knowledge engineering and semantic web technologies. The system is based on the development of a consumer-oriented medical terminology that will be integrated with other medical domain ontologies and terminologies into a medical ontology repository. This will support consumer-oriented healthcare systems, such as Personal Health Records, by providing many knowledge services to help users in accessing and managing their healthcare data.

  16. Initiation and continuation of long-acting reversible contraception in the United States military healthcare system.

    Science.gov (United States)

    Chiles, Daniel P; Roberts, Timothy A; Klein, David A

    2016-09-01

    Long-acting reversible contraception is more effective for pregnancy prevention than shorter-acting contraceptive methods and has the potential to reduce healthcare disparities and costs. However, long-acting reversible contraception is underused in the United States. One population of interest is beneficiaries of the United States military healthcare system who have access to universal healthcare, including no-cost, no-copay contraception with unlimited method switching, and comprise a large, actual use cohort. Efforts to increase long-acting reversible contraception initiation and continuation in this population may improve health outcomes and mitigate the profound consequences of unintended or mistimed pregnancy on readiness and cost to the military. We aimed to determine long-acting reversible contraception initiation and continuation rates among the diverse population with universal healthcare who are enrolled in the US military healthcare system. This study is a retrospective cohort of >1.7 million women, aged 14-40 years, who were enrolled in the US military healthcare system, TRICARE Prime, between October 2009 and September 2014. Individuals were assessed for long-acting reversible contraception initiation and continuation with the use of medical billing records. Method continuation and factors that were associated with early method discontinuation were evaluated with the Kaplan-Meier estimator and Cox proportional hazard models. During the study dates, 188,533 women initiated long-acting reversible contraception. Of these, 74.6% women selected intrauterine contraceptives. Method initiation rates remained relatively stable (41.7-50.1/1000 women/year) for intrauterine methods, although the rate for subdermal implants increased from 6.1-23.0/1000 women/year. In analysis of women who selected intrauterine contraceptives, 61.2% continued their method at 36 months, and 48.8% continued at 60 months. Among women who selected the implant, 32.0% continued their

  17. Location Allocation of Health Care Centers Using Geographical Information System: region 11 of Tehran

    OpenAIRE

    Mohsen Ahadnejad; Hosein Ghaderi; Mohammad Hadian; Payam Haghighatfard; Banafsheh Darvishi; Elham Haghighatfard; Bitasadat Zegordi; Arash Bordbar

    2015-01-01

     Background & Objective: Location allocation of healthcare centers facilitates the accessibility of health services and the lack of proper distribution of these centers leads to increasing problems of citizens' access to these centers. The main objective of this study was to evaluate the distribution of healthcare centers in the region of the study and to determine deprived areas from this services. Materials & Methods: This research is a case study that has b...

  18. From buzzword to business strategy: the case for information and decision support systems in e-healthcare.

    Science.gov (United States)

    Korukonda, Appa Rao; Korukonda, Saritha

    2006-01-01

    Although electronic healthcare can boast of a remarkable origin in modern-day e-commerce in the form of Electronic Data Interchange (EDI), its mission-critical nature in information-based strategising is yet to be realised. Restricting the scope of e-healthcare management to product advertisements and website management reflects an unfortunate trend of underutilisation of the scope of electronic decision support systems in pricing and other business strategies. This paper aims to illustrate how this trend can be corrected by transforming e-healthcare into a full-fledged business strategy for strategic positioning and corporate profitability. This argument is illustrated with the aid of a business example related to transfer pricing.

  19. Effective teamwork in primary healthcare through a structured patient-sorting system - a qualitative study on staff members' conceptions.

    Science.gov (United States)

    Maun, Andy; Engström, Miriam; Frantz, Anna; Brämberg, Elisabeth Björk; Thorn, Jörgen

    2014-11-28

    Primary healthcare meets increased demands from an aging population concerning quality and availability while concurrently dealing with a growing shortage of general practitioners and imperfect efficiency in healthcare processes. Reorganization and team development can improve quality and performance but projects in primary care frequently do not attain the targeted results. By developing and introducing a structured patient-sorting system a primary healthcare centre in Western Sweden increased its access rate significantly and employed its medical professionals more efficiently. The aim of this study was to explore staff members' conceptions of the structured patient-sorting system in order to gain an inside perspective on this project. In this qualitative study 16 interviews were conducted over a period of two years and data was analysed using a phenomenographic approach to identify the various conceptions of the eleven participants. Three categories of description were identified: The system was conceptualized as 1) a framework for the development of patient-centred processes that were clear and consistent, 2) a promotor of professional development and a shared ideal of cooperative practice and 3) a common denominator and catalyst in conflict management. This study demonstrates that the introduction of a structured patient-sorting system makes it possible for several important change processes to take place concurrently: improvement of healthcare processes, empowerment of professionals and team development. It therefore indicates the importance of an appropriate, contextualized framework to support multiple concomitant quality improvement processes. Knowledge from this study can be used to assist and improve future implementations in primary healthcare centres.

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

    Science.gov (United States)

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

    2015-05-01

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

  1. The Healthcare Public System – Does Standardization Withhold the Bucket from Leaking?

    Directory of Open Access Journals (Sweden)

    Biţoiu Teodora

    2017-12-01

    Full Text Available The public healthcare system is heavily influenced by the 3C trilemma - cost - coverage - choice. The paper’s argument tackles the fact that should the public decision on improving capacity be leaning towards universal coverage in would result in efficiency losses and, in an attempt to control the costs it would limit patients’ choice. Should priority be given to performance or value? The present paper deals with the compromise between the equity and efficiency, a leaky bucket that becomes more visible in the struggle to build capacity and intervene in the market by setting standards. Setting healthcare standards is a global concern, the 3rd Sustainable Development Goal is a clear proof of that the aim to emphasise and better analyse two of the most influential variables: efficiency and equity. All in all, what we argue is that the current leaky bucket is a trade-off between choice, coverage, and cost. For a complex public service like healthcare, targeting a full coverage and multiple choice would incur huge costs and, cutting costs considerably restricts both the choice and coverage. The cost is influenced by the production capacity use when the activity has large fixed costs.

  2. Quality use of medicine in a developing economy: Measures to overcome challenges in the Malaysian healthcare system

    Directory of Open Access Journals (Sweden)

    Nurul-Ain Mohd-Tahir

    2015-07-01

    Full Text Available Malaysia inherits a highly subsidized tax-based public healthcare system complemented by a fee-for-service private sector. Population health in Malaysia has considerably improved since independence using a relatively small amount of gross domestic product (~4%. Brain drain of highly specialized personnel, growth in healthcare spending, demographic and disease pattern changes and increase in patients’ demands and expectations towards better medical care are exerting pressure on the sustainability of the system to continuously provide efficient and effective services at relatively low cost. Malaysia has adopted and implemented some of the quality use of medicine concepts such as National Essential Medicine List, health technology assessment and promotion of generic medicines in their health policy, but so far the results may not be optimal. Activities to further promote these strategies are needed for successful implementation to achieve more positive and sustained beneficial outcomes. Better strategic planning, management and collaboration between various stakeholders, considering the needs and barriers of the strategies, are important to ensure effective implementation of the strategies. More emphasis should be placed upon more equitable and rational distribution of healthcare resources to cater for rapid urbanization. Additionally, a sustainable health financing structure that is more progressive and does not encourage moral hazard should be established. In conclusion, Malaysia has achieved good outcomes in population health with relatively low financial inputs since independence. However, changes in the overall environment have created issues which would threaten the long-term viability of the healthcare system if not tackled properly. The numbers of internationally trialled strategies could be used to deal with these challenges. In addition, coordinated implementation of these strategies and effective engagement and communication between

  3. Quality use of medicine in a developing economy: Measures to overcome challenges in the Malaysian healthcare system.

    Science.gov (United States)

    Mohd-Tahir, Nurul-Ain; Paraidathathu, Thomas; Li, Shu-Chuen

    2015-01-01

    Malaysia inherits a highly subsidized tax-based public healthcare system complemented by a fee-for-service private sector. Population health in Malaysia has considerably improved since independence using a relatively small amount of gross domestic product (~4%). Brain drain of highly specialized personnel, growth in healthcare spending, demographic and disease pattern changes and increase in patients' demands and expectations towards better medical care are exerting pressure on the sustainability of the system to continuously provide efficient and effective services at relatively low cost. Malaysia has adopted and implemented some of the quality use of medicine concepts such as National Essential Medicine List, health technology assessment and promotion of generic medicines in their health policy, but so far the results may not be optimal. Activities to further promote these strategies are needed for successful implementation to achieve more positive and sustained beneficial outcomes. Better strategic planning, management and collaboration between various stakeholders, considering the needs and barriers of the strategies, are important to ensure effective implementation of the strategies. More emphasis should be placed upon more equitable and rational distribution of healthcare resources to cater for rapid urbanization. Additionally, a sustainable health financing structure that is more progressive and does not encourage moral hazard should be established. In conclusion, Malaysia has achieved good outcomes in population health with relatively low financial inputs since independence. However, changes in the overall environment have created issues which would threaten the long-term viability of the healthcare system if not tackled properly. The numbers of internationally trialled strategies could be used to deal with these challenges. In addition, coordinated implementation of these strategies and effective engagement and communication between various stakeholders

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

    Science.gov (United States)

    Gabriele, Edward F.

    2011-01-01

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

  5. GE Healthcare | College of Engineering & Applied Science

    Science.gov (United States)

    Olympiad Girls Who Code Club FIRST Tech Challenge NSF I-Corps Site of Southeastern Wisconsin UW-Milwaukee ; Talent GE Healthcare is the founding partner of the Center for Advanced Embedded Systems (CAES), formerly GE Healthcare's needs for talent. Business Corporate Partners ANSYS Institute GE Healthcare Catalyst

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

    Science.gov (United States)

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

    2016-05-27

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

  7. Shifting subjects of health-care: placing "medical tourism" in the context of Malaysian domestic health-care reform.

    Science.gov (United States)

    Ormond, Meghann

    2011-01-01

    "Medical tourism" has frequently been held to unsettle naturalised relationships between the state and its citizenry. Yet in casting "medical tourism" as either an outside "innovation" or "invasion," scholars have often ignored the role that the neoliberal retrenchment of social welfare structures has played in shaping the domestic health-care systems of the "developing" countries recognised as international medical travel destinations. While there is little doubt that "medical tourism" impacts destinations' health-care systems, it remains essential to contextualise them. This paper offers a reading of the emergence of "medical tourism" from within the context of ongoing health-care privatisation reform in one of today's most prominent destinations: Malaysia. It argues that "medical tourism" to Malaysia has been mobilised politically both to advance domestic health-care reform and to cast off the country's "underdeveloped" image not only among foreign patient-consumers but also among its own nationals, who are themselves increasingly envisioned by the Malaysian state as prospective health-care consumers.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  10. Learning to navigate the healthcare system in a new country: a qualitative study

    Science.gov (United States)

    Straiton, Melanie L.; Myhre, Sonja

    2017-01-01

    Objective Learning to navigate a healthcare system in a new country is a barrier to health care. Understanding more about the specific navigation challenges immigrants experience may be the first step towards improving health information and thus access to care. This study considers the challenges that Thai and Filipino immigrant women encounter when learning to navigate the Norwegian primary healthcare system and the strategies they use. Design A qualitative interview study using thematic analysis. Setting Norway. Participants Fifteen Thai and 15 Filipino immigrant women over the age of 18 who had been living in Norway at least one year. Results The women took time to understand the role of the general practitioner and some were unaware of their right to an interpreter during consultations. In addition to reliance on family members and friends in their social networks, voluntary and cultural organisations provided valuable tips and advice on how to navigate the Norwegian health system. While some women actively engaged in learning more about the system, they noted a lack of information available in multiple languages. Conclusions Informal sources play an important role in learning about the health care system. Formal information should be available in different languages in order to better empower immigrant women. PMID:29087232

  11. The national response for preventing healthcare-associated infections: infrastructure development.

    Science.gov (United States)

    Mendel, Peter; Siegel, Sari; Leuschner, Kristin J; Gall, Elizabeth M; Weinberg, Daniel A; Kahn, Katherine L

    2014-02-01

    In 2009, the US Department of Health and Human Services (HHS) launched the Action Plan to Prevent Healthcare-associated Infections (HAIs). The Action Plan adopted national targets for reduction of specific infections, making HHS accountable for change across the healthcare system over which federal agencies have limited control. This article examines the unique infrastructure developed through the Action Plan to support adoption of HAI prevention practices. Interviews of federal (n=32) and other stakeholders (n=38), reviews of agency documents and journal articles (n=260), and observations of interagency meetings (n=17) and multistakeholder conferences (n=17) over a 3-year evaluation period. We extract key progress and challenges in the development of national HAI prevention infrastructure--1 of the 4 system functions in our evaluation framework encompassing regulation, payment systems, safety culture, and dissemination and technical assistance. We then identify system properties--for example, coordination and alignment, accountability and incentives, etc.--that enabled or hindered progress within each key development. The Action Plan has developed a model of interagency coordination (including a dedicated "home" and culture of cooperation) at the federal level and infrastructure for stimulating change through the wider healthcare system (including transparency and financial incentives, support of state and regional HAI prevention capacity, changes in safety culture, and mechanisms for stakeholder engagement). Significant challenges to infrastructure development included many related to the same areas of progress. The Action Plan has built a foundation of infrastructure to expand prevention of HAIs and presents useful lessons for other large-scale improvement initiatives.

  12. Finnish perspectives of wireless in healthcare.

    Science.gov (United States)

    Alasaarela, Esko

    2009-01-01

    Wireless solutions are a good choice for healthcare development in Finland. A survey of 135 experts in Finland show that (1) the competences needed for developing wireless solutions exist (2) the Finnish healthcare system is integrated enough and (3) the technology industry in this area is too weak for global marketing. The following recommendations can be concluded: (1) Cooperate internationally (2) Develop integrated solutions and health managing concepts for the important health problems (such as diabetes), (3) Harness the healthcare system to act as a test bed for new solutions and (4) Help companies to grow and take global roles.

  13. A cloud-based X73 ubiquitous mobile healthcare system: design and implementation.

    Science.gov (United States)

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

    2014-01-01

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

  14. The Puerto Rico Healthcare Crisis.

    Science.gov (United States)

    Roman, Jesse

    2015-12-01

    The Commonwealth of Puerto Rico is an organized nonincorporated territory of the United States with a population of more than 3.5 million U.S. citizens. The island has been the focus of much recent attention due to the recent default on its debt (estimated at more than $70 billion), high poverty rates, and increasing unemployment. Less attention, however, has been given to the island's healthcare system, which many believe is on the verge of collapsing. Healthcare makes up 20% of the Puerto Rican economy, and this crisis affects reimbursement rates for physicians while promoting the disintegration of the island's healthcare infrastructure. A major contributor relates to a disparity in federal funding provided to support the island's healthcare system when compared with that provided to the states in the mainland and Hawaii. Puerto Rico receives less federal funding for healthcare than the other 50 states and the District of Columbia even though it pays its share of social security and Medicare taxes. To make matters worse, the U.S. Center for Medicaid and Medicare Services is planning soon to implement another 11% cut in Medical Advantage reimbursements. This disparity in support for healthcare is considered responsible for ∼$25 billion of Puerto Rico's total debt. The impact of these events on the health of Puerto Ricans in the island cannot be entirely predicted, but the loss of healthcare providers and diminished access to care are a certainty, and quality care will suffer, leading to serious implications for those with chronic medical disorders including respiratory disease.

  15. E-commerce in healthcare: changing the traditional landscape.

    Science.gov (United States)

    Aggarwal, A K; Travers, S

    2001-01-01

    The healthcare industry, with more than one trillion dollars in revenue, accounts for about one-seventh of the U.S. economy. A significant portion of this revenue is lost to escalating healthcare system costs. This article examines the shortcomings of the traditional healthcare delivery system in terms of information flow, communication standards, case collections, and IT spending. It makes the case that e-commerce has the ability to transact some healthcare business more efficiently and cost-effectively. With the Internet as a delivery platform, several models offer improvement over the status quo.

  16. Improvement and modification of the routing system for the health-care waste collection and transportation in Istanbul

    International Nuclear Information System (INIS)

    Alagoez, Aylin Zeren; Kocasoy, Guenay

    2008-01-01

    Handling of health-care wastes is among the most important environmental problems in Turkey as it is in the whole world. Approximately 25-30 tons of health-care wastes, in addition to the domestic and recyclable wastes, are generated from hospitals, clinics and other small health-care institutions daily on the European and the Asian sides of Istanbul [Kocasoy, G., Topkaya, B., Zeren, B.A., Kilic, M., et al., 2004. Integrated Health-care Waste Management in Istanbul, Final Report of the LIFE00 TCY/TR/054 Project, Turkish National Committee on Solid Wastes, Istanbul, Turkey; Zeren, B.A., 2004. The Health-care Waste Management of the Hospitals in the European Side of Istanbul, M.S. Thesis, Bogazici University, Istanbul, Turkey; Kilic, M., 2004. Determination of the Health-care Waste Handling and Final Disposal of the Infected Waste of Hospital-Medical Centers in the Anatolian Side of Istanbul. M.S. Thesis, Bogazici University, Istanbul, Turkey]. Unfortunately, these wastes are not handled, collected or temporarily stored at the institutions properly according to the published Turkish Medical Waste Control Regulation [Ministry of Environment and Forestry, 2005. Medical Waste Control Regulation. Official Gazette No. 25883, Ankara, Turkey]. Besides the inappropriate handling at the institutions, there is no systematic program for the transportation of the health-care wastes to the final disposal sites. The transportation of these wastes is realized by the vehicles of the municipalities in an uncontrolled, very primitive way. As a consequence, these improperly managed health-care wastes cause many risks to the public health and people who handle them. This study has been conducted to develop a health-care waste collection and transportation system for the city of Istanbul, Turkey. Within the scope of the study, the collection of health-care wastes from the temporary storage rooms of the health-care institutions, transportation of these wastes to the final disposal areas

  17. An Efficient Network Coding-Based Fault-Tolerant Mechanism in WBAN for Smart Healthcare Monitoring Systems

    Directory of Open Access Journals (Sweden)

    Yuhuai Peng

    2017-08-01

    Full Text Available As a key technology in smart healthcare monitoring systems, wireless body area networks (WBANs can pre-embed sensors and sinks on body surface or inside bodies for collecting different vital signs parameters, such as human Electrocardiograph (ECG, Electroencephalograph (EEG, Electromyogram (EMG, body temperature, blood pressure, blood sugar, blood oxygen, etc. Using real-time online healthcare, patients can be tracked and monitored in normal or emergency conditions at their homes, hospital rooms, and in Intensive Care Units (ICUs. In particular, the reliability and effectiveness of the packets transmission will be directly related to the timely rescue of critically ill patients with life-threatening injuries. However, traditional fault-tolerant schemes either have the deficiency of underutilised resources or react too slowly to failures. In future healthcare systems, the medical Internet of Things (IoT for real-time monitoring can integrate sensor networks, cloud computing, and big data techniques to address these problems. It can collect and send patient’s vital parameter signal and safety monitoring information to intelligent terminals and enhance transmission reliability and efficiency. Therefore, this paper presents a design in healthcare monitoring systems for a proactive reliable data transmission mechanism with resilience requirements in a many-to-one stream model. This Network Coding-based Fault-tolerant Mechanism (NCFM first proposes a greedy grouping algorithm to divide the topology into small logical units; it then constructs a spanning tree based on random linear network coding to generate linearly independent coding combinations. Numerical results indicate that this transmission scheme works better than traditional methods in reducing the probability of packet loss, the resource redundant rate, and average delay, and can increase the effective throughput rate.

  18. [Regional health and autonomy conferences (CRSAs): the implications for medical democracy at a regional level].

    Science.gov (United States)

    Devictor, Bernadette

    2010-01-01

    The HPST law seeks to reorganize the governance of healthcare at a regional level and to maintain the existence of regional health conferences, now known as regional health and autonomy conferences (CRSAs). The purpose of this article is to examine the new duties attributed to the CRSAs and to consider the various issues raised by their practice. The article also provides an analysis of the preconditions required for the successful implementation of medical democracy at a regional level, ie.: the involvement of the CRSAs in the assessment of regional healthcare policies, the mobilization of funds, the composition of the CRSAs (including the full range of healthcare areas), the importance of providing adequate support for territorial conferences, and the elaboration of a communicative space for fostering exchanges between CRSAs.

  19. Complexity science and leadership in healthcare.

    Science.gov (United States)

    Burns, J P

    2001-10-01

    The emerging field of complexity science offers an alternative leadership strategy for the chaotic, complex healthcare environment. A survey revealed that healthcare leaders intuitively support principles of complexity science. Leadership that uses complexity principles offers opportunities in the chaotic healthcare environment to focus less on prediction and control and more on fostering relationships and creating conditions in which complex adaptive systems can evolve to produce creative outcomes.

  20. To serve or to leave: a question faced by public sector healthcare providers in Pakistan.

    Science.gov (United States)

    Mir, Ali Mohammad; Shaikh, Muhammad Saleem; Rashida, Gul; Mankani, Neha

    2015-11-25

    The availability of properly trained and motivated providers is a prerequisite for provision of easily accessible healthcare. Pakistan has been listed by the World Health Organization in its World Health Report 2006 as one of 57 countries with a critical health workforce deficiency. This study examines the factors associated with the willingness of public sector healthcare providers to leave government service and recommends measures that can be adopted to attract and retain staff in the country's public healthcare system. A stratified, random sampling methodology was adopted to recruit a nationally representative sample of 1,296 public sector healthcare providers, including paramedics, medical doctors, and specialists. A semi-structured questionnaire was used to interview these providers. Logistic regressions measured the association with determinants of their willingness to leave the public health sector for better prospects elsewhere. A third of all healthcare providers who were interviewed were of the view that, provided the opportunity, they would leave government service. The odds of willingness to leave service were highest among providers from the region of Azad Jammu and Kashmir (adjusted odds ratio [AOR] = 4.33; 95% CI, 2.49-7.54) followed by the province of Balochistan (AOR = 4.21; 95% CI, 2.41-7.33), and the region of Gilgit Baltistan (AOR = 3.34; 95% CI, 1.67-6.67). Providers who expressed dissatisfaction in the manner their performance was evaluated and those who were dissatisfied with the current salary, each had higher odds of considering leaving government service (AOR = 1.67; 95% CI, 1.18-2.40 and AOR = 2.03; 95% CI, 1.47-2.81, respectively). Providers who reported experiencing interference in their work by influential politicians of the area were more inclined to leave (AOR = 1.44; 95% CI, 1.05-1.98). This study clearly highlights the need to implement more focused strategies in the public healthcare system in Pakistan in

  1. An advanced rehabilitation robotic system for augmenting healthcare.

    Science.gov (United States)

    Hu, John; Lim, Yi-Je; Ding, Ye; Paluska, Daniel; Solochek, Aaron; Laffery, David; Bonato, Paolo; Marchessault, Ronald

    2011-01-01

    Emerging technologies such as rehabilitation robots (RehaBot) for retraining upper and lower limb functions have shown to carry tremendous potential to improve rehabilitation outcomes. Hstar Technologies is developing a revolutionary rehabilitation robot system enhancing healthcare quality for patients with neurological and muscular injuries or functional impairments. The design of RehaBot is a safe and robust system that can be run at a rehabilitation hospital under the direct monitoring and interactive supervision control and at a remote site via telepresence operation control. RehaBot has a wearable robotic structure design like exoskeleton, which employs a unique robotic actuation--Series Elastic Actuator. These electric actuators provide robotic structural compliance, safety, flexibility, and required strength for upper extremity dexterous manipulation rehabilitation training. RehaBot also features a novel non-treadmill paddle platform capable of haptics feedback locomotion rehabilitation training. In this paper, we concern mainly about the motor incomplete patient and rehabilitation applications.

  2. Individual responsibility for what? : A conceptual framework for exploring the suitability of private financing in a publicly funded health-care system

    OpenAIRE

    Tinghög, Gustav; Carlsson, Per; Lyttkens, Carl H.

    2010-01-01

    Policymakers in publicly funded health-care systems are frequently required to make intricate decisions on which health-care services to include or exclude from the basic health-care package. Although it seems likely that the concept of individual responsibility is an essential feature of such decisions, it is rarely explicitly articulated or evaluated in health policy. This paper presents a tentative conceptual framwork for exploring when health-care services contain characteristics that fac...

  3. Minority mothers' healthcare beliefs, commonly used alternative healthcare practices, and potential complications for infants and children.

    Science.gov (United States)

    Hannan, Jean

    2015-06-01

    Complementary and alternative healthcare practices have increased substantially in the United States especially with low-income ethnic minority mothers. These mothers often have provider mistrust, language barriers, differing health belief systems, and as a result are less likely to seek preventive health screening, access healthcare services, and use alternative remedies for their infants and children that are potentially harmful or lethal. Therefore, the purpose of this article is to examine healthcare beliefs, commonly used alternative healthcare practices, and their potential complications for infants and children. A search of CINAHL and PubMed (1980-2012) was conducted using the following terms: alternative healthcare practice, mothers' health beliefs, cultural health beliefs, folk remedies, and infant health practices. Given the changing U.S. population and an increasing immigrant population, examining alternative healthcare practices mothers use for their infants and children is especially important for providers in addressing healthcare for this group. The use of alternative healthcare practices is rarely discussed by parents with healthcare providers for fear of disapproval. When interviewing ethnic minority mothers and caregivers questions should include the use of alternative healthcare practices for infants and children and information regarding the potential dangers should be provided to them. ©2014 American Association of Nurse Practitioners.

  4. Application of simplified Complexity Theory concepts for healthcare social systems to explain the implementation of evidence into practice.

    Science.gov (United States)

    Chandler, Jacqueline; Rycroft-Malone, Jo; Hawkes, Claire; Noyes, Jane

    2016-02-01

    To examine the application of core concepts from Complexity Theory to explain the findings from a process evaluation undertaken in a trial evaluating implementation strategies for recommendations about reducing surgical fasting times. The proliferation of evidence-based guidance requires a greater focus on its implementation. Theory is required to explain the complex processes across the multiple healthcare organizational levels. This social healthcare context involves the interaction between professionals, patients and the organizational systems in care delivery. Complexity Theory may provide an explanatory framework to explain the complexities inherent in implementation in social healthcare contexts. A secondary thematic analysis of qualitative process evaluation data informed by Complexity Theory. Seminal texts applying Complexity Theory to the social context were annotated, key concepts extracted and core Complexity Theory concepts identified. These core concepts were applied as a theoretical lens to provide an explanation of themes from a process evaluation of a trial evaluating the implementation of strategies to reduce surgical fasting times. Sampled substantive texts provided a representative spread of theoretical development and application of Complexity Theory from late 1990's-2013 in social science, healthcare, management and philosophy. Five Complexity Theory core concepts extracted were 'self-organization', 'interaction', 'emergence', 'system history' and 'temporality'. Application of these concepts suggests routine surgical fasting practice is habituated in the social healthcare system and therefore it cannot easily be reversed. A reduction to fasting times requires an incentivised new approach to emerge in the surgical system's priority of completing the operating list. The application of Complexity Theory provides a useful explanation for resistance to change fasting practice. Its utility in implementation research warrants further attention and

  5. Performance management in healthcare: a critical analysis.

    Science.gov (United States)

    Hewko, Sarah J; Cummings, Greta G

    2016-01-01

    Purpose - The purpose of this paper is to explore the underlying theoretical assumptions and implications of current micro-level performance management and evaluation (PME) practices, specifically within health-care organizations. PME encompasses all activities that are designed and conducted to align employee outputs with organizational goals. Design/methodology/approach - PME, in the context of healthcare, is analyzed through the lens of critical theory. Specifically, Habermas' theory of communicative action is used to highlight some of the questions that arise in looking critically at PME. To provide a richer definition of key theoretical concepts, the authors conducted a preliminary, exploratory hermeneutic semantic analysis of the key words "performance" and "management" and of the term "performance management". Findings - Analysis reveals that existing micro-level PME systems in health-care organizations have the potential to create a workforce that is compliant, dependent, technically oriented and passive, and to support health-care systems in which inequalities and power imbalances are perpetually reinforced. Practical implications - At a time when the health-care system is under increasing pressure to provide high-quality, affordable services with fewer resources, it may be wise to investigate new sector-specific ways of evaluating and managing performance. Originality/value - In this paper, written for health-care leaders and health human resource specialists, the theoretical assumptions and implications of current PME practices within health-care organizations are explored. It is hoped that readers will be inspired to support innovative PME practices within their organizations that encourage peak performance among health-care professionals.

  6. Building Healthcare Capacity in Pediatric Neurosurgery and Psychiatry in a Post-Soviet System: Ukraine.

    Science.gov (United States)

    Romach, Myroslava K; Rutka, James T

    2018-03-01

    Many academic centers in North America are initiating global partnerships to build physician capacity in resource-poor countries. An opportunity arose to develop a pediatric program (Ukraine Paediatric Fellowship Program, UPFP) in Ukraine, a large European country in transition from a Soviet/communist political and social system. This entailed dealing with a centralized and rigid healthcare system based on the Semashko model of the former Soviet Union. Our capacity-building model has several key features: endowed philanthropic funding for sustainability, bilateral exchange of knowledge, a focus primarily on pediatric brain disorders, and team building. Centers for partnering are selected on the basis of need, receptivity to change, and participants' fluency in English. Ukrainian physicians attend month-long observerships in Toronto, and biannual teaching visits are conducted by Canadian clinicians. Over 5 years, 7 teaching visits have taken place, and 20 physicians have trained at SickKids Hospital in Toronto. Six Ukrainian children's hospitals are now collaborating with UPFP. New surgical procedures have been introduced, such as endoscopic ventriculostomy and corpus callosotomy. Patient referrals to regional institutions have increased, and new projects that affect fetal and infant neurodevelopment have been initiated (e.g., treatment of perinatal maternal depression and folic acid fortification of flour). Ukrainian participants rate the program highly in their evaluations. In a short time, UPFP has had considerable success in increasing physician capacity for improved pediatric care in regions of Ukraine. The keys to success have included focusing locally, selecting trustable partners, building incrementally, and creating interspecialty synergies. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. IoT Contextual Factors on Healthcare.

    Science.gov (United States)

    Michalakis, Konstantinos; Caridakis, George

    2017-01-01

    With the emergence of the Internet of Things, new services in healthcare will be available and existing systems will be integrated in the IoT framework, providing automated medical supervision and efficient medical treatment. Context awareness plays a critical role in realizing the vision of the IoT, providing rich contextual information that can help the system act more efficiently. Since context in healthcare has its unique characteristics, it is necessary to define an appropriate context aware framework for healthcare IoT applications. We identify this context as perceived in healthcare applications and describe the context aware procedures. We also present an architecture that connects the sensors that measure biometric data with the sensory networks of the environment and the various IoT middleware that reside in the geographical area. Finally, we discuss the challenges for the realization of this vision.

  8. A multinational study to develop universal standardization of whole-body bone density and composition using GE Healthcare Lunar and Hologic DXA systems.

    Science.gov (United States)

    Shepherd, John A; Fan, Bo; Lu, Ying; Wu, Xiao P; Wacker, Wynn K; Ergun, David L; Levine, Michael A

    2012-10-01

    Dual-energy x-ray absorptiometry (DXA) is used to assess bone mineral density (BMD) and body composition, but measurements vary among instruments from different manufacturers. We sought to develop cross-calibration equations for whole-body bone density and composition derived using GE Healthcare Lunar and Hologic DXA systems. This multinational study recruited 199 adult and pediatric participants from a site in the US (n = 40, ages 6 through 16 years) and one in China (n = 159, ages 5 through 81 years). The mean age of the participants was 44.2 years. Each participant was scanned on both GE Healthcare Lunar and Hologic Discovery or Delphi DXA systems on the same day (US) or within 1 week (China) and all scans were centrally analyzed by a single technologist using GE Healthcare Lunar Encore version 14.0 and Hologic Apex version 3.0. Paired t-tests were used to test the results differences between the systems. Multiple regression and Deming regressions were used to derive the cross-conversion equations between the GE Healthcare Lunar and Hologic whole-body scans. Bone and soft tissue measures were highly correlated between the GE Healthcare Lunar and Hologic and systems, with r ranging from 0.96 percent fat [PFAT] to 0.98 (BMC). Significant differences were found between the two systems, with average absolute differences for PFAT, BMC, and BMD of 1.4%, 176.8 g and 0.013 g/cm(2) , respectively. After cross-calibration, no significant differences remained between GE Healthcare Lunar measured results and the results converted from Hologic. The equations we derived reduce differences between BMD and body composition as determined by GE Healthcare Lunar and Hologic systems and will facilitate combining study results in clinical or epidemiological studies. Copyright © 2012 American Society for Bone and Mineral Research.

  9. Deaf women: experiences and perceptions of healthcare system access.

    Science.gov (United States)

    Steinberg, Annie G; Wiggins, Erin A; Barmada, Carlin Henry; Sullivan, Vicki Joy

    2002-10-01

    The authors investigated the knowledge, attitudes, and healthcare experiences of Deaf women. Interviews with 45 deaf women who participated in focus groups in American Sign Language were translated, transcribed, and analyzed. Deaf women's understanding of women's health issues, knowledge of health vocabulary in both English and American Sign Language, common health concerns among Deaf women, and issues of access to information, including pathways and barriers, were examined. As a qualitative study, the results of this investigation are limited and should be viewed as exploratory. A lack of health knowledge was evident, including little understanding of the meaning or value of cancer screening, mammography, or Pap smears; purposes of prescribed medications, such as hormone replacement therapy (HRT); or necessity for other medical or surgical interventions. Negative experiences and avoidance or nonuse of health services were reported, largely due to the lack of a common language with healthcare providers. Insensitive behaviors were also described. Positive experiences and increased access to health information were reported with practitioners who used qualified interpreters. Providers who demonstrated minimal signing skills, a willingness to use paper and pen, and sensitivity to improving communication were appreciated. Deaf women have unique cultural and linguistic issues that affect healthcare experiences. Improved access to health information may be achieved with specialized resource materials, improved prevention and targeted intervention strategies, and self-advocacy skills development. Healthcare providers must be trained to become more effective communicators with Deaf patients and to use qualified interpreters to assure access to healthcare for Deaf women.

  10. Cadeia de valor da saúde: um modelo para o sistema de saúde brasileiro Healthcare value chain: a model for the Brazilian healthcare system

    Directory of Open Access Journals (Sweden)

    Marcelo Caldeira Pedroso

    2012-10-01

    Full Text Available Este artigo apresenta um modelo de cadeia de valor da saúde que representa, de maneira esquemática, o sistema de saúde do Brasil. O modelo proposto tem como intuito apresentar uma adequação à realidade brasileira, bem como abrangência e flexibilidade para utilização em atividades acadêmicas e análises do setor de saúde do Brasil. O modelo coloca ênfase em três componentes: principais atividades dessa cadeia, agrupadas em elos verticais e horizontais; missão de cada um desses elos; e principais fluxos da cadeia. A cadeia proposta é formada por seis elos verticais e três horizontais, perfazendo um total de nove: desenvolvimento de conhecimento em saúde; fornecimento de produtos e tecnologias; serviços de saúde; intermediação financeira; financiamento da saúde; consumo de saúde; regulação; distribuição de produtos de saúde; e serviços de apoio e complementares. A análise da cadeia proposta pode ser realizada por meio de quatro fluxos: inovação e conhecimento; produtos e serviços; financeiro; e de informação.This article presents a model of the healthcare value chain which consists of a schematic representation of the Brazilian healthcare system. The proposed model is adapted for the Brazilian reality and has the scope and flexibility for use in academic activities and analysis of the healthcare sector in Brazil. It places emphasis on three components: the main activities of the value chain, grouped in vertical and horizontal links; the mission of each link and the main value chain flows. The proposed model consists of six vertical and three horizontal links, amounting to nine. These are: knowledge development; supply of products and technologies; healthcare services; financial intermediation; healthcare financing; healthcare consumption; regulation; distribution of healthcare products; and complementary and support services. Four flows can be used to analyze the value chain: knowledge and innovation; products and

  11. Nonattendance to medical specialists’ appointments and its relation to regional environmental and socioeconomic indicators in the Chilean public health system

    Directory of Open Access Journals (Sweden)

    Elizabeth Angélica Salinas Rebolledo

    2014-10-01

    Full Text Available INTRODUCTION Medical care provided by medical specialists is one of the scarcest resources in the public system. It is costly and difficult to access for the general population. Availability and accessibility of specialized care is related to economic, social and cultural aspects that vary among geographical areas. An aggravating factor for this situation is patients’ failure to appear on the date of their appointment, which is defined as the nonattendance of patients to medical specialist appointments without notice. OBJECTIVES To measure and analyze the phenomenon of nonattendance of patients to medical appointments with specialists in the public healthcare system of Chile and its relationship with environmental and socioeconomic regional indicators. METHODS Ecological design study, using medical care records in the public system and environmental and socioeconomic regional indicators potentially related to the absence of patients, between the years 2005-2010. Poisson regression models with random components were used for assessing associations. RESULTS There is 16.5% of nonattendance of patients, with a range between regions from 8.8 to 20.2%. Nonattendance is higher in the specialties of dermatology, geriatrics and nutrition (20.0%, in children (3.1% more than in adults, in areas with highest indigenous population (RR=1.3, in areas with low diversity of specialties (RR=1.1 and in the months of February, July, November and December (RR>1.1. CONCLUSIONS In Chile, socioeconomic factors and the management of healthcare resources have greater influence on the nonattendance of patients to medical specialists’ appointments than environmental factors; therefore, this phenomenon may be avoidable.

  12. Healthcare provider education: from institutional boxes to dynamic networks.

    Science.gov (United States)

    Eisler, George

    2009-01-01

    The world recognizes the need for close collaboration in planning between the healthcare system and the post-secondary education system; this has also been advocated in the lead article. Forums and mechanisms to facilitate this collaboration are being implemented from local to global environments. Beyond the focus on competency gaps, there are important functional co-dependencies between healthcare and post-secondary education, including the need for a more formalized continuous quality improvement approach at the inter-organizational system level. The case for this close and continuous collaborative relationship is based on the following: (1) a close functional relationship, (2) joint responsibility for healthcare provider education, (3) the urgent need to address the workforce and education strategies for almost all healthcare services areas and (4) the factors that characterize successful and sustained quality improvement in complex adaptive systems. A go-forward vision consisting of an integrated web of academic health networks is proposed, each with its particular shared vision and aligned with an overall vision for healthcare in each provincial jurisdiction, as well as with national and global healthcare objectives.

  13. Robustness in practice--the regional planning of health services.

    Science.gov (United States)

    Best, G; Parston, G; Rosenhead, J

    1986-05-01

    Earlier work has criticized the dominant tendencies in operational research contributions to health services planning as characterized by optimization, implausible demands for data, depoliticization, hierarchy and inflexibility. This paper describes an effort which avoids at least some of these pitfalls. The project was to construct a planning system for a regional health council in Ontario, Canada, which would take account of the possible alternative future states of the health-care system's environment and would aim to keep options for future development open. The planning system devised is described in the paper. It is based on robustness analysis, which evaluates alternative initial action sets in terms of the useful flexibility they preserve. Other features include the explicit incorporation of pressures for change generated outside the health-care system, and a satisficing approach to the identification of both initial action sets and alternative future configurations of the health-care system. It was found possible to borrow and radically 're-use' techniques or formulations from the mainstream of O.R. contributions. Thus the 'reference projection' method was used to identify inadequacies in performance which future health-care system configurations must repair. And Delphi analysis, normally a method for generating consensus, was used in conjunction with cluster analysis of responses to generate meaningfully different alternative futures.

  14. Board Governance: Transformational Approaches Under Healthcare Reform.

    Science.gov (United States)

    Zastocki, Deborah K

    2015-01-01

    Previous successes of healthcare organizations and effective governance practices in the pre-reform environment are not predictive of future success. Healthcare has been through numerous phases of growth and development using tried-and-true strategies. The challenge is that our toolbox does not contain what is needed to build the future healthcare delivery systems required in the post-reform world. Healthcare has had a parochial focus at the local level, with some broadening of horizons at the state and national levels. But healthcare delivery is now a global issue that requires a totally different perspective, and many countries are confronting similar issues. US healthcare reform initiatives have far-reaching implications. Compounding the reform dynamics are the simultaneously occurring, gamechanging accelerants such as enabling information technologies and mobile health, new providers of healthcare, increased consumer demands, and limited healthcare dollars, to name a few. Operating in this turbulent environment requires transformational board, executive, and physician leadership because traditional ways of planning for incremental change and attempting to time those adjustments can prove disastrous. Creating the legacy healthcare system for tomorrow requires governing boards and executive leadership to act today as they would in the desired future system. Boards need to create a culture that fosters.innovation with a tolerance for risk and some failure. To provide effective governance, boards must essentially develop new skills, expertise, and ways of thinking. The rapid rate of change requires board members to possess certain capabilities, including the ability to deal with ambiguity and uncertainty while demonstrating flexibility and adaptability, all with a driving commitment to metrics and results. This requires development plans for both individual members and the overall board. In short, the board needs to function differently, particularly regarding the

  15. Use of healthcare resources and costs of acute cardioembolic stroke management in the Region of Madrid: The CODICE Study.

    Science.gov (United States)

    de Andrés-Nogales, F; Vivancos Mora, J; Barriga Hernández, F J; Díaz Otero, F; Izquierdo Esteban, L; Ortega-Casarrubios, M Á; Castillo Moreno, L; Ximénez-Carrillo Rico, Á; Martín Torres, M P; Gómez-Escalonilla Escobar, C I; Torres González, C; de Salas-Cansado, M; Casado Gómez, M Á; Soto Álvarez, J; Gil-Núñez, A

    2015-01-01

    Stroke is the main cause of admission to Neurology departments and cardioembolic stroke (CS) is one of the most common subtypes of stroke. A multicentre prospective observational study was performed in 5 Neurology departments in public hospitals in the Region of Madrid (Spain). The objective was to estimate the use of healthcare resources and costs of acute CS management. Patients with acute CS at<48h from onset were recruited. Patients' socio-demographic, clinical, and healthcare resource use data were collected during hospitalisation and at discharge up to 30 days after admission, including data for rehabilitation treatment after discharge. During an 8-month recruitment period, 128 patients were recruited: mean age, 75.3±11.25; 46.9% women; mortality rate, 4.7%. All patients met the CS diagnostic criteria established by GEENCV-SEN, based on medical history or diagnostic tests. Fifty per cent of the patients had a history of atrial fibrillation and 18.8% presented other major cardioembolic sources. Non-valvular atrial fibrillation was the most frequent cause of CS (33.6%). Data for healthcare resource use, given a mean total hospital stay of 10.3±9.3 days, are as follows: rehabilitation therapy during hospital stay (46.9%, mean 4.5 days) and after discharge (56.3%, mean 26.8 days), complications (32%), specific interventions (19.5%), and laboratory and diagnostic tests (100%). Head CT (98.4%), duplex ultrasound of supra-aortic trunks (87.5%), and electrocardiogram (85.9%) were the most frequently performed diagnostic procedures. Average total cost per patient during acute-phase management and rehabilitation was €13,139. Hospital stay (45.0%) and rehabilitation at discharge (29.2%) accounted for the largest part of resources used. Acute CS management in the Region of Madrid resulted consumes large amounts of resources (€13,139), mainly due to hospital stays and rehabilitation. Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier Espa

  16. The eICU research institute - a collaboration between industry, health-care providers, and academia.

    Science.gov (United States)

    McShea, Michael; Holl, Randy; Badawi, Omar; Riker, Richard R; Silfen, Eric

    2010-01-01

    As the volume of data that is electronically available promliferates, the health-care industry is identifying better ways to use this data for patient care. Ideally, these data are collected in real time, can support point-of-care clinical decisions, and, by providing instantaneous quality metrics, can create the opportunities to improve clinical practice as the patient is being cared for. The business-world technology supporting these activities is referred to as business intelligence, which offers competitive advantage, increased quality, and operational efficiencies. The health-care industry is plagued by many challenges that have made it a latecomer to business intelligence and data-mining technology, including delayed adoption of electronic medical records, poor integration between information systems, a lack of uniform technical standards, poor interoperability between complex devices, and the mandate to rigorously protect patient privacy. Efforts at developing a health care equivalent of business intelligence (which we will refer to as clinical intelligence) remains in its infancy. Until basic technology infrastructure and mature clinical applications are developed and implemented throughout the health-care system, data aggregation and interpretation cannot effectively progress. The need for this approach in health care is undisputed. As regional and national health information networks emerge, we need to develop cost-effective systems that reduce time and effort spent documenting health-care data while increasing the application of knowledge derived from that data.

  17. [Geographical coverage of the Mexican Healthcare System and a spatial analysis of utilization of its General Hospitals in 1998].

    Science.gov (United States)

    Hernández-Avila, Juan E; Rodríguez, Mario H; Rodríguez, Norma E; Santos, René; Morales, Evangelina; Cruz, Carlos; Sepúlveda-Amor, Jaime

    2002-01-01

    To describe the geographical coverage of the Mexican Healthcare System (MHS) services and to assess the utilization of its General Hospitals. A Geographic Information System (GIS) was used to include sociodemographic data by locality, the geographical location of all MHS healthcare services, and data on hospital discharge records. A maximum likelihood estimation model was developed to assess the utilization levels of 217 MHS General Hospitals. The model included data on human resources, additional infrastructure, and the population within a 25 km radius. In 1998, 10,806 localities with 72 million inhabitants had at least one public healthcare unit, and 97.2% of the population lived within 50 km of a healthcare unit; however, over 18 million people lived in rural localities without a healthcare unit. The mean annual hospital occupation rate was 48.5 +/- 28.5 per 100 bed/years, with high variability within and between states. Hospital occupation was significantly associated with the number of physicians in the unit, and in the Mexican Institute of Social Security units utilization was associated with additional health infrastructure, and with the population's poverty index. GIS analysis allows improved estimation of the coverage and utilization of MHS hospitals.

  18. Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa.

    Science.gov (United States)

    Claassens, Mareli M; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J; Enarson, Donald A; Beyers, Nulda; Borgdorff, Martien W

    2013-01-01

    Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB.

  19. Tuberculosis in Healthcare Workers and Infection Control Measures at Primary Healthcare Facilities in South Africa

    Science.gov (United States)

    Claassens, Mareli M.; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J.; Enarson, Donald A.; Beyers, Nulda; Borgdorff, Martien W.

    2013-01-01

    Background Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. Methods One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. Results The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). Conclusion The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB. PMID:24098461

  20. Mindful Application of Aviation Practices in Healthcare.

    Science.gov (United States)

    Powell-Dunford, Nicole; Brennan, Peter A; Peerally, Mohammad Farhad; Kapur, Narinder; Hynes, Jonny M; Hodkinson, Peter D

    2017-12-01

    Evidence supports the efficacy of incorporating select recognized aviation practices and procedures into healthcare. Incident analysis, debrief, safety brief, and crew resource management (CRM) have all been assessed for implementation within the UK healthcare system, a world leader in aviation-based patient safety initiatives. Mindful application, in which aviation practices are specifically tailored to the unique healthcare setting, show promise in terms of acceptance and long-term sustainment. In order to establish British healthcare applications of aviation practices, a PubMed search of UK authored manuscripts published between 2005-2016 was undertaken using search terms 'aviation,' 'healthcare,' 'checklist,' and 'CRM.' A convenience sample of UK-authored aviation medical conference presentations and UK-authored patient safety manuscripts were also reviewed. A total of 11 of 94 papers with UK academic affiliations published between 2005-2016 and relevant to aviation modeled healthcare delivery were found. The debrief process, incident analysis, and CRM are the primary practices incorporated into UK healthcare, with success dependent on cultural acceptance and mindful application. CRM training has gained significant acceptance in UK healthcare environments. Aviation modeled incident analysis, debrief, safety brief, and CRM training are increasingly undertaken within the UK healthcare system. Nuanced application, in which the unique aspects of the healthcare setting are addressed as part of a comprehensive safety approach, shows promise for long-term success. The patient safety brief and aviation modeled incident analysis are in earlier phases of implementation, and warrant further analysis.Powell-Dunford N, Brennan PA, Peerally MF, Kapur N, Hynes JM, Hodkinson PD. Mindful application of aviation practices in healthcare. Aerosp Med Hum Perform. 2017; 88(12):1107-1116.

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

    Science.gov (United States)

    Yahav, Inbal

    2010-01-01

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

  2. Perpetual transitions in Romanian healthcare.

    Science.gov (United States)

    Spiru, Luiza; Traşcu, Răzvan Ioan; Turcu, Ileana; Mărzan, Mircea

    2011-12-01

    Although Romania has a long-lasting tradition in organized medical healthcare, in the last two decades the Romanian healthcare system has been undergoing a perpetual transition with negative effects on all parties involved. The lack of long-term strategic vision, the implementation of initiatives without any impact studies, hence the constant short-term approach from the policy makers, combined with the "inherited" low allocation from GDP to the healthcare system have contributed significantly to its current evolution. Currently, most measures taken are of the "fire-fighting" type, rather than looking to the broader, long time perspective. There should be no wonder then, that predictive and preventive services do not get the proper attention and support. Patient and physicians should step in and take action in regulating a system that was originally designed for them. But until this happens, the organizations with leadership skills and vision need to take action-and this has already started.

  3. [IHE (Integrating the Healthcare Enterprise): a new approach for the improvement of digital communication in healthcare].

    Science.gov (United States)

    Wein, B B

    2003-02-01

    Parallel to the introduction of diagnosis related groups (DRGs) for the reimbursement of hospitals, a marked reduction of financial means within the healthcare system is taking place. Healthcare enterprise information systems will play an increasing role to accommodate the new working conditions by developing reliable and efficient workflow solutions. Interfacing the systems currently in use can meet considerable obstacles. By offering high connectivity, IHE (Integrating the Healthcare Enterprise), which was initiated by concerted actions of users and vendors, ensures improved health care delivery and, furthermore, assists in acquiring new information systems in the future. IHE is not a standard but makes extensive use of existing international standards, such as HL7 and DICOM. National IHE demonstrations confirmed the power of this approach and presented its mission to large groups of users and vendors. The concept continues to grow and for the first time provides groups of various interests cooperative solutions to the problems encountered in collecting and distributing information.

  4. IHE (Integrating the Healthcare Enterprise): A new approach for the improvement of digital communication in healthcare

    International Nuclear Information System (INIS)

    Wein, B.B.

    2003-01-01

    Parallel to the introduction of diagnosis related groups (DRGs) for the reimbursement of hospitals, a marked reduction of financial means within the healthcare system is taking place. Healthcare enterprise information systems will play an increasing role to accommodate the new working conditions by developing reliable and efficient workflow solutions. Interfacing the systems currently in use can meet considerable obstacles. By offering high connectivity, IHE (Integrating the Healthcare Enterprise), which was initiated by concerted actions of users and vendors, ensures improved health care delivery and, furthermore, assists in acquiring new information systems in the future. IHE is not a standard but makes extensive use of existing international standards, such as HL7 and DICOM. National IHE demonstrations confirmed the power of this approach and presented its mission to large groups of users and vendors. The concept continues to grow and for the first time provides groups of various interests cooperative solutions to the problems encountered in collecting and distributing information. (orig.) [de

  5. LEAN THINKING IN HEALTHCARE: REVIEW OF IMPLEMENTATION RESULTS

    Directory of Open Access Journals (Sweden)

    Marija Kovacevic

    2016-03-01

    Full Text Available For over decade, automotive industry originated lean concept has been successfully implemented in healthcare systems as a management method and philosophy with main focus on elimination of all types of wastes and looses in all tasks and processes so that time, materials, resources and medical procedures could be realized as effectively as it is possible. As main result lean concept implementation ensured to healthcare organizations to focus on their main core function and dedicate more time and efforts to patients without additional costs for them or healthcare system. However, lean implementation in healthcare could be much more difficult than in standard industrial environment and there are significant number of examples of lean in healthcare projects that failed to gain any measurable results and sustainable benefits from it. This paper presents review of some of the most successful implementations of lean tools and principles in healthcare organizations.

  6. Leveraging Health Information Technology to Improve Quality in Federal Healthcare.

    Science.gov (United States)

    Weigel, Fred K; Switaj, Timothy L; Hamilton, Jessica

    2015-01-01

    Healthcare delivery in America is extremely complex because it is comprised of a fragmented and nonsystematic mix of stakeholders, components, and processes. Within the US healthcare structure, the federal healthcare system is poised to lead American medicine in leveraging health information technology to improve the quality of healthcare. We posit that through developing, adopting, and refining health information technology, the federal healthcare system has the potential to transform federal healthcare quality by managing the complexities associated with healthcare delivery. Although federal mandates have spurred the widespread use of electronic health records, other beneficial technologies have yet to be adopted in federal healthcare settings. The use of health information technology is fundamental in providing the highest quality, safest healthcare possible. In addition, health information technology is valuable in achieving the Agency for Healthcare Research and Quality's implementation goals. We conducted a comprehensive literature search using the Google Scholar, PubMed, and Cochrane databases to identify an initial list of articles. Through a thorough review of the titles and abstracts, we identified 42 articles as having relevance to health information technology and quality. Through our exclusion criteria of currency of the article, citation frequency, applicability to the federal health system, and quality of research supporting conclusions, we refined the list to 11 references from which we performed our analysis. The literature shows that the use of computerized physician order entry has significantly increased accurate medication dosage and decreased medication errors. The use of clinical decision support systems have significantly increased physician adherence to guidelines, although there is little evidence that indicates any significant correlation to patient outcomes. Research shows that interoperability and usability are continuing challenges for

  7. Healthcare Policy Statement on the Utility of Coronary Computed Tomography for Evaluation of Cardiovascular Conditions and Preventive Healthcare: From the Health Policy Working Group of the Society of Cardiovascular Computed Tomography.

    Science.gov (United States)

    Slim, Ahmad M; Jerome, Scott; Blankstein, Ron; Weigold, Wm Guy; Patel, Amit R; Kalra, Dinesh K; Miller, Ryan; Branch, Kelley; Rabbat, Mark G; Hecht, Harvey; Nicol, Edward D; Villines, Todd C; Shaw, Leslee J

    The rising cost of healthcare is prompting numerous policy and advocacy discussions regarding strategies for constraining growth and creating a more efficient and effective healthcare system. Cardiovascular imaging is central to the care of patients at risk of, and living with, heart disease. Estimates are that utilization of cardiovascular imaging exceeds 20 million studies per year. The Society of Cardiovascular CT (SCCT), alongside Rush University Medical Center, and in collaboration with government agencies, regional payers, and industry healthcare experts met in November 2016 in Chicago, IL to evaluate obstacles and hurdles facing the cardiovascular imaging community and how they can contribute to efficacy while maintaining or even improving outcomes and quality. The summit incorporated inputs from payers, providers, and patients' perspectives, providing a platform for all voices to be heard, allowing for a constructive dialogue with potential solutions moving forward. This article outlines the proceedings from the summit, with a detailed review of past hurdles, current status, and potential solutions as we move forward in an ever-changing healthcare landscape. Copyright © 2017 Society of Cardiovascular Computed Tomography. All rights reserved.

  8. Fully integrated biochip platforms for advanced healthcare.

    Science.gov (United States)

    Carrara, Sandro; Ghoreishizadeh, Sara; Olivo, Jacopo; Taurino, Irene; Baj-Rossi, Camilla; Cavallini, Andrea; de Beeck, Maaike Op; Dehollain, Catherine; Burleson, Wayne; Moussy, Francis Gabriel; Guiseppi-Elie, Anthony; De Micheli, Giovanni

    2012-01-01

    Recent advances in microelectronics and biosensors are enabling developments of innovative biochips for advanced healthcare by providing fully integrated platforms for continuous monitoring of a large set of human disease biomarkers. Continuous monitoring of several human metabolites can be addressed by using fully integrated and minimally invasive devices located in the sub-cutis, typically in the peritoneal region. This extends the techniques of continuous monitoring of glucose currently being pursued with diabetic patients. However, several issues have to be considered in order to succeed in developing fully integrated and minimally invasive implantable devices. These innovative devices require a high-degree of integration, minimal invasive surgery, long-term biocompatibility, security and privacy in data transmission, high reliability, high reproducibility, high specificity, low detection limit and high sensitivity. Recent advances in the field have already proposed possible solutions for several of these issues. The aim of the present paper is to present a broad spectrum of recent results and to propose future directions of development in order to obtain fully implantable systems for the continuous monitoring of the human metabolism in advanced healthcare applications.

  9. Business process modeling in healthcare.

    Science.gov (United States)

    Ruiz, Francisco; Garcia, Felix; Calahorra, Luis; Llorente, César; Gonçalves, Luis; Daniel, Christel; Blobel, Bernd

    2012-01-01

    The importance of the process point of view is not restricted to a specific enterprise sector. In the field of health, as a result of the nature of the service offered, health institutions' processes are also the basis for decision making which is focused on achieving their objective of providing quality medical assistance. In this chapter the application of business process modelling - using the Business Process Modelling Notation (BPMN) standard is described. Main challenges of business process modelling in healthcare are the definition of healthcare processes, the multi-disciplinary nature of healthcare, the flexibility and variability of the activities involved in health care processes, the need of interoperability between multiple information systems, and the continuous updating of scientific knowledge in healthcare.

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

    Science.gov (United States)

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

    2016-01-01

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

  11. [Local and citizen participation and representation strategies in Healthcare Administration].

    Science.gov (United States)

    Sancho Serena, Francesc; Grané Alsina, Montserrat; Olivet, Miquel

    2015-11-01

    The public as a whole are the rightful owners and beneficiaries of the public healthcare system in our country. As such, they collaborate in its maintenance and upkeep through payment of taxes. The government is accountable to the public as to how the ever-scarce resources are allocated. When it comes to the area of healthcare, this represents an added factor of complexity and specificity which makes the issue a particularly sensitive one. In the field of healthcare, both the General Health Law and the Law of Catalan Healthcare Code define the actors responsible for the public representation of its citizens. Nevertheless, their inclusion does not necessarily guarantee the perception of participation by its citizens or that of a greater democratic quality. The model must be understood as the intermediary link between a legally regulated framework and the actual debate, which in a globalized world with such an immense volume of information available to citizens and with the current online social networking sites, occurs at the heart of society in general, even though government has no such incorporation channel. The system will need to be developed as new technologies enable this, towards a more direct and more global models for participation. Participation is a flexible concept which, as far as possible, needs to adapt to the different problems as well as the different regions. Legislative regulation must therefore provide the mechanisms and stable frameworks for participation. In turn however, it must also establish dynamic systems capable of adapting to and incorporating the varying demands and methods of participation coming from the public in response to disparate processes. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

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

    Energy Technology Data Exchange (ETDEWEB)

    Boyd, Brian K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Parker, Graham B. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Petersen, Joseph M. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Sullivan, Greg [Efficiency Solutions, LLC (United States); Goetzler, W. [Navigant Consulting, Inc. (United States); Sutherland, T. A. [Navigant Consulting, Inc. (United States); Foley, K. J. [Navigant Consulting, Inc. (United States)

    2014-08-14

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

  13. Big Data, Big Problems: A Healthcare Perspective.

    Science.gov (United States)

    Househ, Mowafa S; Aldosari, Bakheet; Alanazi, Abdullah; Kushniruk, Andre W; Borycki, Elizabeth M

    2017-01-01

    Much has been written on the benefits of big data for healthcare such as improving patient outcomes, public health surveillance, and healthcare policy decisions. Over the past five years, Big Data, and the data sciences field in general, has been hyped as the "Holy Grail" for the healthcare industry promising a more efficient healthcare system with the promise of improved healthcare outcomes. However, more recently, healthcare researchers are exposing the potential and harmful effects Big Data can have on patient care associating it with increased medical costs, patient mortality, and misguided decision making by clinicians and healthcare policy makers. In this paper, we review the current Big Data trends with a specific focus on the inadvertent negative impacts that Big Data could have on healthcare, in general, and specifically, as it relates to patient and clinical care. Our study results show that although Big Data is built up to be as a the "Holy Grail" for healthcare, small data techniques using traditional statistical methods are, in many cases, more accurate and can lead to more improved healthcare outcomes than Big Data methods. In sum, Big Data for healthcare may cause more problems for the healthcare industry than solutions, and in short, when it comes to the use of data in healthcare, "size isn't everything."

  14. Costing Practices in Healthcare

    DEFF Research Database (Denmark)

    Chapman, Christopher; Kern, Anja; Laguecir, Aziza

    2014-01-01

    .e., Diagnosis Related Group (DRG) systems, and costing practices. DRG-based payment systems strongly influence costing practices in multiple ways. In particular, setting DRG tariffs requires highly standardized costing practices linked with specific skill sets from management accountants and brings other...... jurisdictions (e.g., clinical coding) to bear on costing practice. These factors contribute to the fragmentation of the jurisdiction of management accounting.......The rising cost of healthcare is a globally pressing concern. This makes detailed attention to the way in which costing is carried out of central importance. This article offers a framework for considering the interdependencies between a dominant element of the contemporary healthcare context, i...

  15. Language awareness in the bilingual healthcare setting: a national survey.

    Science.gov (United States)

    Roberts, Gwerfyl Wyn; Irvine, Fiona Elizabeth; Jones, Peter Reece; Spencer, Llinos Haf; Baker, Colin Ronald; Williams, Cen

    2007-09-01

    The significance of effective interpersonal communication in healthcare is well established, as is the importance of overcoming language barriers. This has a particular bearing for minority language speakers, where denying language choice can compromise the quality of healthcare provision. Nevertheless, there is limited empirical research exploring language awareness in healthcare and the factors that influence language choice for minority language speakers. This paper reports on the nurses, midwives and health visitors (NMHV) data set of the first phase of a large-scale national study, commissioned by the Welsh Assembly Government, to examine the nature and extent of Welsh language awareness amongst healthcare professionals in Wales, UK. The study involved a questionnaire survey of healthcare professionals working in the public, private and voluntary sectors of healthcare. A stratified random sample of 3358 healthcare professionals was surveyed, of which 1842 (55%) were nurses, midwives and health visitors. The researcher-designed self-administered questionnaire was distributed by post to participants between July and September 2003. A total of 1042 (57%) NMHV returned their questionnaires for analysis. A strong positive correlation is identified between the NMHV use of the Welsh language in practice and their Welsh language proficiency (planguage attitudes (planguage region (planguage attitude scores are more positive than expected, particularly amongst those with limited Welsh language proficiency and those working in regions with the lowest proportions of Welsh speakers. In view of the universal drive for culturally and linguistically appropriate healthcare practice, the findings have important implications for bilingual and multilingual healthcare settings worldwide. The evidence emerging from this survey confirms that cross-cultural communication is enhanced by NMHV language attitudes as well as their proficiency levels. Language awareness training is

  16. Dynamic analysis of interhospital collaboration and competition: empirical evidence from an Italian regional health system.

    Science.gov (United States)

    Mascia, Daniele; Di Vincenzo, Fausto; Cicchetti, Americo

    2012-05-01

    Policymakers stimulate competition in universalistic health-care systems while encouraging the formation of service provision networks among hospital organizations. This article addresses a gap in the extant literature by empirically analyzing simultaneous collaboration and competition between hospitals within the Italian National Health Service, where important procompetition reforms have been implemented. To explore how rising competition between hospitals relates to their propensity to collaborate with other local providers. Longitudinal data on interhospital collaboration and competition collected in an Italian region from 2003 to 2007 are analyzed. Social network analysis techniques are applied to study the structure and dynamics of interhospital collaboration. Negative binomial regressions are employed to explore how interhospital competition relates to the collaborative network over time. Competition among providers does not hinder interhospital collaboration. Collaboration is primarily local, with resource complementarity and differentials in the volume of activity and hospital performance explaining the propensity to collaborate. Formation of collaborative networks among hospitals is not hampered by reforms aimed at fostering market forces. Because procompetition reforms elicit peculiar forms of managed competition in universalistic health systems, studies are needed to clarify whether the positive association between interhospital competition and collaboration can be generalized to other health-care settings. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  17. The Systemic Products as a Source of Competitive Advantage on Healthcare Sector Example. Part II

    Directory of Open Access Journals (Sweden)

    Izabela SZTANGRET

    2015-12-01

    Full Text Available In the healthcare sector, different healthcare providers, such as home care, primary care, pharmacies and hospital clinics but also a financial institution, collaborate in order to increase values for patients, such as better health state, more complex services, high quality of services, and increased feeling of safety. By creating a value, flexible networks health care providers and additional actors create value through collaboration. The purpose of this article is to identify the specific character of systemic healthcare product, created in synergy relations of medical enntities in the area of new way of meeting customers’ needs. Critical analysis of literature in the field of studied category is conducted in the article; furthermore qualitative method of empirical studies (case study and quantitative (online questionnaire is applied for practical illustration of described processes and phenomena. The article is a second part of the stud.

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

    Science.gov (United States)

    McKay, Kathy; Shand, Fiona

    2016-01-01

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

  19. STRATEGIC ANALYSIS OF THE STATE-PRIVATE PARTNERSHIP INSTITUTE IN THE HEALTHCARE

    Directory of Open Access Journals (Sweden)

    V. L. Adzhienko

    2017-01-01

    Full Text Available Management decisions, both at the enterprise level and at the industry level as a whole, is impossible without carrying out a strategic analysis, which is regarded as the performance of a corresponding management function that is perspective-oriented and has a high level of uncertainty. Strategic analysis involves researching the system of factors that determine the future state of the public-private partnership (PPP in the development of health care. The strategic analysis of PPP in the healthcare sector as a complex study of positive and negative factors that may affect the efficiency of the development of the PPP institution in the development of the healthcare is under consideration in the article. A number of new components complementing the system of strategic analysis of PPPs in the healthcare were proposed, and generalizations and conclusions were made.The aim of the research is to study the impact of the strategic analysis of PPPs in the sphere of healthcare on the formation of strategic directions for increasing the efficiency of using the PPP institution in healthcare.Materials and methods. In the process of achieving the research goal, methods of strategic and integrated economic analysis were used.Results and discussion. In our strategic analysis of PPP in the healthcare, it was revealed that under the conditions of underfunding national economy, medical institutions based on PPPs are being established in order to modernize and improve the quality of public services. PPP is an effective mechanism for attracting long-term investments aimed at the development of the health sector. The results of our analysis of PPP in the sphere of Russian healthcare made it possible to reveal that at present there are more than 70 projects in the process of implementation, 61 projects are already under construction and operation. Within the framework of the PPP-implemented healthcare projects, it is planned to attract investments of 61 billion rubles

  20. Healthcare Lean.

    Science.gov (United States)

    Long, John C

    2003-01-01

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

  1. A Way Forward for Healthcare in Madagascar?

    Science.gov (United States)

    Marks, Florian; Rabehanta, Nathalie; Baker, Stephen; Panzner, Ursula; Park, Se Eun; Fobil, Julius N; Meyer, Christian G; Rakotozandrindrainy, Raphaël

    2016-03-15

    A healthcare utilization survey was conducted as a component of the Typhoid Fever Surveillance in Africa Program (TSAP). The findings of this survey in Madagascar contrasted with those in other sites of the program; namely, only 30% of the population sought healthcare at the government-provided healthcare facilities for fever. These findings promoted us to determine the drivers and barriers in accessing and utilizing healthcare in Madagascar. Here we review the results of the TSAP healthcare utilization initiative and place them in the context of the current organization of the Madagascan healthcare system. Our work highlights the demands of the population for access to appropriate healthcare and the need for novel solutions that can quickly provide an affordable and sustainable basic healthcare infrastructure until a government-funded scheme is in place. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  2. Cultural diversity training for UK healthcare professionals: a comprehensive nationwide cross-sectional survey.

    Science.gov (United States)

    Bentley, Paul; Jovanovic, Ana; Sharma, Pankaj

    2008-10-01

    Healthcare inequalities within the UK based on patients' ethnicity have been found over the last five years in a large number of medical specialties. One possible explanation for this lies in ignorance of ethnic minority healthcare needs among professionals. Cultural diversity programmes have been shown to improve patient outcomes including compliance, yet these are not as yet requirements for any UK healthcare professionals with the exception of psychiatrists. This paper documents the frequency, regional variation, characteristics and motivations for cultural diversity training through a questionnaire survey of the educational leads of every UK medical school, postgraduate deanery and schools of nursing, physiotherapy, occupational therapy, speech and language therapy, and pharmacy. The results showed a wide variation in teaching practices between healthcare professions and geographical regions. This study provides evidence for the need for national guidelines to incorporate cultural competency training by all UK healthcare professional training bodies.

  3. Data warehousing as a healthcare business solution.

    Science.gov (United States)

    Scheese, R

    1998-02-01

    Because of the trend toward consolidation in the healthcare field, many organizations have massive amounts of data stored in various information systems organizationwide, but access to the data by end users may be difficult. Healthcare organizations are being pressured to provide managers easy access to the data needed for critical decision making. One solution many organizations are turning to is implementing decision-support data warehouses. A data warehouse instantly delivers information directly to end users, freeing healthcare information systems staff for strategic operations. If designed appropriately, data warehouses can be a cost-effective tool for business analysis and decision support.

  4. Healthcare costs for new technologies

    International Nuclear Information System (INIS)

    Goyen, Mathias; Debatin, Joerg F.

    2009-01-01

    Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. Avoidable healthcare cost drivers are identified and related policy issues are discussed. (orig.)

  5. Healthcare costs for new technologies

    Energy Technology Data Exchange (ETDEWEB)

    Goyen, Mathias; Debatin, Joerg F. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany)

    2009-03-15

    Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. Avoidable healthcare cost drivers are identified and related policy issues are discussed. (orig.)

  6. Health sector reforms for 21 st century healthcare

    Directory of Open Access Journals (Sweden)

    Darshan Shankar

    2015-01-01

    Full Text Available The form of the public health system in India is a three tiered pyramid-like structure consisting primary, secondary, and tertiary healthcare services. The content of India′s health system is mono-cultural and based on western bio-medicine. Authors discuss need for health sector reforms in the wake of the fact that despite huge investment, the public health system is not delivering. Today, 70% of the population pays out of pocket for even primary healthcare. Innovation is the need of the hour. The Indian government has recognized eight systems of healthcare viz., Allopathy, Ayurveda, Siddha, Swa-rigpa, Unani, Naturopathy, Homeopathy, and Yoga. Allopathy receives 97% of the national health budget, and 3% is divided amongst the remaining seven systems. At present, skewed funding and poor integration denies the public of advantage of synergy and innovations arising out of the richness of India′s Medical Heritage. Health seeking behavior studies reveal that 40-70% of the population exercise pluralistic choices and seek health services for different needs, from different systems. For emergency and surgery, Allopathy is the first choice but for chronic and common ailments and for prevention and wellness help from the other seven systems is sought. Integrative healthcare appears to be the future framework for healthcare in the 21 st century. A long-term strategy involving radical changes in medical education, research, clinical practice, public health and the legal and regulatory framework is needed, to innovate India′s public health system and make it both integrative and participatory. India can be a world leader in the new emerging field of "integrative healthcare" because we have over the last century or so assimilated and achieved a reasonable degree of competence in bio-medical and life sciences and we possess an incredibly rich and varied medical heritage of our own.

  7. Health sector reforms for 21(st) century healthcare.

    Science.gov (United States)

    Shankar, Darshan

    2015-01-01

    The form of the public health system in India is a three tiered pyramid-like structure consisting primary, secondary, and tertiary healthcare services. The content of India's health system is mono-cultural and based on western bio-medicine. Authors discuss need for health sector reforms in the wake of the fact that despite huge investment, the public health system is not delivering. Today, 70% of the population pays out of pocket for even primary healthcare. Innovation is the need of the hour. The Indian government has recognized eight systems of healthcare viz., Allopathy, Ayurveda, Siddha, Swa-rigpa, Unani, Naturopathy, Homeopathy, and Yoga. Allopathy receives 97% of the national health budget, and 3% is divided amongst the remaining seven systems. At present, skewed funding and poor integration denies the public of advantage of synergy and innovations arising out of the richness of India's Medical Heritage. Health seeking behavior studies reveal that 40-70% of the population exercise pluralistic choices and seek health services for different needs, from different systems. For emergency and surgery, Allopathy is the first choice but for chronic and common ailments and for prevention and wellness help from the other seven systems is sought. Integrative healthcare appears to be the future framework for healthcare in the 21(st) century. A long-term strategy involving radical changes in medical education, research, clinical practice, public health and the legal and regulatory framework is needed, to innovate India's public health system and make it both integrative and participatory. India can be a world leader in the new emerging field of "integrative healthcare" because we have over the last century or so assimilated and achieved a reasonable degree of competence in bio-medical and life sciences and we possess an incredibly rich and varied medical heritage of our own.

  8. Healthcare public key infrastructure (HPKI) and non-profit organization (NPO): essentials for healthcare data exchange.

    Science.gov (United States)

    Takeda, Hiroshi; Matsumura, Yasushi; Nakagawa, Katsuhiko; Teratani, Tadamasa; Qiyan, Zhang; Kusuoka, Hideo; Matsuoka, Masami

    2004-01-01

    To share healthcare information and to promote cooperation among healthcare providers and customers (patients) under computerized network environment, a non-profit organization (NPO), named as OCHIS, was established at Osaka, Japan in 2003. Since security and confidentiality issues on the Internet have been major concerns in the OCHIS, the system has been based on healthcare public key infrastructure (HPKI), and found that there remained problems to be solved technically and operationally. An experimental study was conducted to elucidate the central and the local function in terms of a registration authority and a time stamp authority by contracting with the Ministry of Economics and Trading Industries in 2003. This paper describes the experimental design with NPO and the results of the study concerning message security and HPKI. The developed system has been operated practically in Osaka urban area.

  9. Review Clostridium difficile: A healthcare-associated infection of ...

    African Journals Online (AJOL)

    populations.19-22. While CDI has been extensively researched in well-resourced health systems, there are few published studies about CDI in sub-Saharan Africa. Healthcare-associated infections cause a greater disease burden in healthcare systems with fewer resources.23 Furthermore, in sub-Saharan Africa there is.

  10. Developing a Security Metrics Scorecard for Healthcare Organizations.

    Science.gov (United States)

    Elrefaey, Heba; Borycki, Elizabeth; Kushniruk, Andrea

    2015-01-01

    In healthcare, information security is a key aspect of protecting a patient's privacy and ensuring systems availability to support patient care. Security managers need to measure the performance of security systems and this can be achieved by using evidence-based metrics. In this paper, we describe the development of an evidence-based security metrics scorecard specific to healthcare organizations. Study participants were asked to comment on the usability and usefulness of a prototype of a security metrics scorecard that was developed based on current research in the area of general security metrics. Study findings revealed that scorecards need to be customized for the healthcare setting in order for the security information to be useful and usable in healthcare organizations. The study findings resulted in the development of a security metrics scorecard that matches the healthcare security experts' information requirements.

  11. Selecting healthcare information systems provided by third-party vendors: a mind map beyond the manuals.

    Science.gov (United States)

    Gortzis, Lefteris G

    2010-01-01

    The selection of a new healthcare information system (HIS) has always been a daunting process for clinicians, health care providers and policy makers. The objective of this study is to present the lessons learned and the main findings from several relevant case studies to support this process. Data were collected by retrospectively reviewing the summative results of three well-established systems, acquiring feedback from two E.U. projects, and conducting semi-structured interviews with a number of collaborators involved in electronic healthcare interventions. Selection issues were identified and classified into the following five categories: (i) data creation, (ii) data management, (iii) data sharing, (iv) data presentation and (v) modules management. A mind map was also structured to provide a more manageable list of issues concerning the most common electronic clinical technologies (e-CT). The vendor manual is intended as an overview of the merchandise e-CT and therefore has limited potential in supporting effectively the selection process of a new HIS. The present classification and the mind map - based on lessons learned - provide a ready-to-use toolkit for supporting the HIS selection process when healthcare organisations are unable to employ research development groups to lay the groundwork for building a new HIS from scratch.

  12. Priming the Pump for Big Data at Sentara Healthcare.

    Science.gov (United States)

    Kern, Howard P; Reagin, Michael J; Reese, Bertram S

    2016-01-01

    Today's healthcare organizations are facing significant demands with respect to managing population health, demonstrating value, and accepting risk for clinical outcomes across the continuum of care. The patient's environment outside the walls of the hospital and physician's office-and outside the electronic health record (EHR)-has a substantial impact on clinical care outcomes. The use of big data is key to understanding factors that affect the patient's health status and enhancing clinicians' ability to anticipate how the patient will respond to various therapies. Big data is essential to delivering sustainable, highquality, value-based healthcare, as well as to the success of new models of care such as clinically integrated networks (CINs) and accountable care organizations.Sentara Healthcare, based in Norfolk, Virginia, has been an early adopter of the technologies that have readied us for our big data journey: EHRs, telehealth-supported electronic intensive care units, and telehealth primary care support through MDLIVE. Although we would not say Sentara is at the cutting edge of the big data trend, it certainly is among the fast followers. Use of big data in healthcare is still at an early stage compared with other industries. Tools for data analytics are maturing, but traditional challenges such as heightened data security and limited human resources remain the primary focus for regional health systems to improve care and reduce costs. Sentara primarily makes actionable use of big data in our CIN, Sentara Quality Care Network, and at our health plan, Optima Health. Big data projects can be expensive, and justifying the expense organizationally has often been easier in times of crisis. We have developed an analytics strategic plan separate from but aligned with corporate system goals to ensure optimal investment and management of this essential asset.

  13. Sensors for everyday life healthcare settings

    CERN Document Server

    Mukhopadhyay, Subhas; Jayasundera, Krishanthi; Swain, Akshya

    2017-01-01

    Sensors were developed to detect and quantify structures and functions of human body as well as to gather information from the environment in order to optimize the efficiency, cost-effectiveness and quality of healthcare services as well as to improve health and quality of life. This book offers an up-to-date overview of the concepts, modeling, technical and technological details and practical applications of different types of sensors. It also discusses the trends for the next generation of sensors and systems for healthcare settings. It is aimed at researchers and graduate students in the field of healthcare technologies, as well as academics and industry professionals involved in developing sensing systems for human body structures and functions, and for monitoring activities and health.

  14. Shifting to triple value healthcare: Reflections from England.

    Science.gov (United States)

    Jani, Anant; Jungmann, Sven; Gray, Muir

    2018-02-01

    Increasing need and demand because of growing and aging populations combined with stagnant or decreasing resources being invested into healthcare globally mean that a radical shift is needed to ensure that healthcare systems can meet current and future challenges. Quality-, safety- and efficiency-improvement approaches have been used as means to address many problems in healthcare and while they are essential and necessary, they are not sufficient to meet our current challenges. To build resilient and sustainable healthcare systems, we need a shift to focus on triple value healthcare, which will help healthcare professionals improve outcomes at the process, patient and population levels while also optimising resource utilisation. Here we present a brief history of the Quality and Evidence-based Healthcare model and then describe how value emerged as a predominant theme in England. We then highlight the four solutions that we, as part of the RightCare programme, designed and refined in the English NHS to turn theory into practice: We end with a description of how triple value is being introduced into Germany and steps that can be taken to facilitate its adoption. Copyright © 2018. Published by Elsevier GmbH.

  15. The Hazards of Data Mining in Healthcare.

    Science.gov (United States)

    Househ, Mowafa; Aldosari, Bakheet

    2017-01-01

    From the mid-1990s, data mining methods have been used to explore and find patterns and relationships in healthcare data. During the 1990s and early 2000's, data mining was a topic of great interest to healthcare researchers, as data mining showed some promise in the use of its predictive techniques to help model the healthcare system and improve the delivery of healthcare services. However, it was soon discovered that mining healthcare data had many challenges relating to the veracity of healthcare data and limitations around predictive modelling leading to failures of data mining projects. As the Big Data movement has gained momentum over the past few years, there has been a reemergence of interest in the use of data mining techniques and methods to analyze healthcare generated Big Data. Much has been written on the positive impacts of data mining on healthcare practice relating to issues of best practice, fraud detection, chronic disease management, and general healthcare decision making. Little has been written about the limitations and challenges of data mining use in healthcare. In this review paper, we explore some of the limitations and challenges in the use of data mining techniques in healthcare. Our results show that the limitations of data mining in healthcare include reliability of medical data, data sharing between healthcare organizations, inappropriate modelling leading to inaccurate predictions. We conclude that there are many pitfalls in the use of data mining in healthcare and more work is needed to show evidence of its utility in facilitating healthcare decision-making for healthcare providers, managers, and policy makers and more evidence is needed on data mining's overall impact on healthcare services and patient care.

  16. [Determinants of the use of different healthcare levels in the General System of Social Security in Health in Colombia and the Unified Health System in Brazil].

    Science.gov (United States)

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

    2014-01-01

    To compare the use of different healthcare levels, and its determinants, in two different health systems, the General System of Social Security in Health (GSSSH) and the Unified Health System (UHS) in municipalities in Colombia and Brazil. A cross-sectional study was carried out, based on a population survey in two municipalities in Colombia (n=2163) and two in Brazil (n=2155). Outcome variables consisted of the use of primary care services, outpatient secondary care services, and emergency care in the previous 3 months. Explanatory variables were need and predisposing and enabling factors. Bivariate and multivariate logistic regression analyses were performed by healthcare level and country. The determinants of use differed by healthcare level and country: having a chronic disease was associated with a greater use of primary and outpatient secondary care in Colombia, and was also associated with the use of emergency care in Brazil. In Colombia, persons enrolled in the contributory scheme more frequently used the services of the GSSSH than persons enrolled with subsidized contributions in primary and outpatient secondary care and more than persons without insurance in any healthcare level. In Brazil, the low-income population and those without private insurance more frequently used the UHS at any level. In both countries, the use of primary care was increased when persons knew the healthcare center to which they were assigned and if they had a regular source of care. Knowledge of the referral hospital increased the use of outpatient secondary care and emergency care. In both countries, the influence of the determinants of use differed according to the level of care used, emphasizing the need to analyze healthcare use by disaggregating it by level of care. Copyright © 2014. Published by Elsevier Espana.

  17. State of science: human factors and ergonomics in healthcare.

    Science.gov (United States)

    Hignett, Sue; Carayon, Pascale; Buckle, Peter; Catchpole, Ken

    2013-01-01

    The past decade has seen an increase in the application of human factors and ergonomics (HFE) techniques to healthcare delivery in a broad range of contexts (domains, locations and environments). This paper provides a state of science commentary using four examples of HFE in healthcare to review and discuss analytical and implementation challenges and to identify future issues for HFE. The examples include two domain areas (occupational ergonomics and surgical safety) to illustrate a traditional application of HFE and the area that has probably received the most research attention. The other two examples show how systems and design have been addressed in healthcare with theoretical approaches for organisational and socio-technical systems and design for patient safety. Future opportunities are identified to develop and embed HFE systems thinking in healthcare including new theoretical models and long-term collaborative partnerships. HFE can contribute to systems and design initiatives for both patients and clinicians to improve everyday performance and safety, and help to reduce and control spiralling healthcare costs. There has been an increase in the application of HFE techniques to healthcare delivery in the past 10 years. This paper provides a state of science commentary using four illustrative examples (occupational ergonomics, design for patient safety, surgical safety and organisational and socio-technical systems) to review and discuss analytical and implementation challenges and identify future issues for HFE.

  18. The interdependent roles of patients, families and professionals in cystic fibrosis: a system for the coproduction of healthcare and its improvement.

    Science.gov (United States)

    Sabadosa, Kathryn A; Batalden, Paul B

    2014-04-01

    A quality healthcare system is coproduced by patients, families and healthcare professionals working interdependently to cocreate and codeliver care. Cystic fibrosis (CF) patients and families rely on healthcare professionals to provide the best possible care and timely, accurate information. They know that the care at home and in clinical settings needs to be seamless, using shared information and decisions. A parent's journey of better care begins with her son's diagnosis and moves to her involvement to improve the systems and processes of care for others. She reflects on this work and identifies five elements that contributed to the coproduction of improved care: (1) mental and emotional readiness to engage; (2) curiosity and the search for insight; (3) reframe challenges into opportunities for improvement; (4) listen and learn from everyone, bringing home what is relevant; and (5) personal participation. Joined with the reflections of an improvement scientist, they note that chronic care relies on informed, activated patients and prepared, proactive healthcare professionals working together and that it is more than 'patient-centric'. They propose a model for the coimprovement of systems of care.

  19. Healthcare waste management status in Lagos State, Nigeria: a case study from selected healthcare facilities in Ikorodu and Lagos metropolis.

    Science.gov (United States)

    Longe, Ezechiel O

    2012-06-01

    A survey of healthcare waste management practices and their implications for health and the environment was carried out. The study assessed waste management practices in 20 healthcare facilities ranging in capacity from 40 to 600 beds in Ikorodu and metropolitan Lagos, Lagos State, Nigeria. The prevailing healthcare waste management status was analysed. Management issues on quantities and proportion of different constituents of waste, segregation, collection, handling, transportation, treatment and disposal methods were assessed. The waste generation averaged 0.631 kg bed(-1) day(-1) over the survey area. The waste stream from the healthcare facilities consisted of general waste (59.0%), infectious waste (29.7%), sharps and pathological (8.9%), chemical (1.45%) and others (0.95%). Sharps/pathological waste includes disposable syringes. In general, the waste materials were collected in a mixed form, transported and disposed of along with municipal solid waste with attendant risks to health and safety. Most facilities lacked appropriate treatment systems for a variety of reasons that included inadequate funding and little or no priority for healthcare waste management as well as a lack of professionally competent waste managers among healthcare providers. Hazards associated with healthcare waste management and shortcomings in the existing system were identified.

  20. Assessment of healthcare waste generation rate and its ...

    African Journals Online (AJOL)

    Assessment of healthcare waste generation rate and its management system in health centers of Bench Maji Zone. ... Background: It is known that the basic role of healthcare system is to preserve the health of patients and protect the public from diseases. However, in the process of performing these activities, health ...

  1. Sensing behaviour in healthcare design

    DEFF Research Database (Denmark)

    Thorpe, Julia Rosemary; Hysse Forchhammer, Birgitte; Maier, Anja

    2017-01-01

    We are entering an era of distributed healthcare that should fit and respond to individual needs, behaviour and lifestyles. Designing such systems is a challenging task that requires continuous information about human behaviour on a large scale, for which pervasive sensing (e.g. using smartphones...... specifically on activity and location data that can easily be obtained from smartphones or wearables. We further demonstrate how these are applied in healthcare design using an example from dementia care. Comparing a current and proposed scenario exemplifies how integrating sensor-derived information about...... user behaviour can support the healthcare design goals of personalisation, adaptability and scalability, while emphasising patient quality of life....

  2. “Take in two parks and call me in the morning” – Perception of parks as an essential component of our healthcare system

    Directory of Open Access Journals (Sweden)

    A.J. Mowen

    2017-06-01

    Full Text Available As a feature of the built neighborhood environment, parks have been associated with a range of positive health outcomes. Recognition of these contributions has prompted advocates to suggest parks are a part of our healthcare system. Despite these developments, park investments have declined over the past decade nationally, lagging behind expenditures on other community services such as health. Perhaps the idea of parks as a solution to the nation's health concerns has not diffused across the population. To date, however, public perception of parks' role in healthcare has not been documented. This study responds to this gap by assessing whether parks are perceived as an essential part of the healthcare system. Self-administered surveys were completed by a statewide sample of Pennsylvania adults (2014 and by a sample of primary care clinic visitors in Hershey, Pennsylvania (2015. Participants from both studies were asked the extent they agreed with the following statement: Parks, trails, and open space are an essential component of our healthcare system. Response was also compared across demographic characteristics to assess whether this belief was universally held. Findings indicate 73% of the statewide sample and 68% of the clinical sample agreed parks, trails, and open space are an essential element of the healthcare system. Males, those with lower levels of educational attainment, and rural residents were statistically less likely to agree with this statement. Results indicate widespread belief in parks as an essential part of the healthcare system, suggesting consideration of health-sector investments in these settings.

  3. The joint use of resilience engineering and lean production for work system design: A study in healthcare.

    Science.gov (United States)

    Rosso, Caroline Brum; Saurin, Tarcisio Abreu

    2018-09-01

    Although lean production (LP) has been increasingly adopted in healthcare systems, its benefits often fall short of expectations. This might be partially due to the failure of lean to account for the complexity of healthcare. This paper discusses the joint use of principles of LP and resilience engineering (RE), which is an approach for system design inspired by complexity science. Thus, a framework for supporting the design of socio-technical systems, which combines insights from LP and RE, was developed and tested in a system involving a patient flow from an emergency department to an intensive care unit. Based on this empirical study, as well as on extant theory, eight design propositions that support the framework application were developed. Both the framework and its corresponding propositions can contribute to the design of socio-technical systems that are at the same time safe and efficient. Copyright © 2018 Elsevier Ltd. All rights reserved.

  4. Assessing the evolution of primary healthcare organizations and their performance (2005-2010 in two regions of Québec province: Montréal and Montérégie

    Directory of Open Access Journals (Sweden)

    Provost Sylvie

    2010-12-01

    Full Text Available Abstract Background The Canadian healthcare system is currently experiencing important organizational transformations through the reform of primary healthcare (PHC. These reforms vary in scope but share a common feature of proposing the transformation of PHC organizations by implementing new models of PHC organization. These models vary in their performance with respect to client affiliation, utilization of services, experience of care and perceived outcomes of care. Objectives In early 2005 we conducted a study in the two most populous regions of Quebec province (Montreal and Montérégie which assessed the association between prevailing models of primary healthcare (PHC and population-level experience of care. The goal of the present research project is to track the evolution of PHC organizational models and their relative performance through the reform process (from 2005 until 2010 and to assess factors at the organizational and contextual levels that are associated with the transformation of PHC organizations and their performance. Methods/Design This study will consist of three interrelated surveys, hierarchically nested. The first survey is a population-based survey of randomly-selected adults from two populous regions in the province of Quebec. This survey will assess the current affiliation of people with PHC organizations, their level of utilization of healthcare services, attributes of their experience of care, reception of preventive and curative services and perception of unmet needs for care. The second survey is an organizational survey of PHC organizations assessing aspects related to their vision, organizational structure, level of resources, and clinical practice characteristics. This information will serve to develop a taxonomy of organizations using a mixed methods approach of factorial analysis and principal component analysis. The third survey is an assessment of the organizational context in which PHC organizations are

  5. Assessing the evolution of primary healthcare organizations and their performance (2005-2010) in two regions of Québec province: Montréal and Montérégie.

    Science.gov (United States)

    Levesque, Jean-Frédéric; Pineault, Raynald; Provost, Sylvie; Tousignant, Pierre; Couture, Audrey; Da Silva, Roxane Borgès; Breton, Mylaine

    2010-12-01

    The Canadian healthcare system is currently experiencing important organizational transformations through the reform of primary healthcare (PHC). These reforms vary in scope but share a common feature of proposing the transformation of PHC organizations by implementing new models of PHC organization. These models vary in their performance with respect to client affiliation, utilization of services, experience of care and perceived outcomes of care. In early 2005 we conducted a study in the two most populous regions of Quebec province (Montreal and Montérégie) which assessed the association between prevailing models of primary healthcare (PHC) and population-level experience of care. The goal of the present research project is to track the evolution of PHC organizational models and their relative performance through the reform process (from 2005 until 2010) and to assess factors at the organizational and contextual levels that are associated with the transformation of PHC organizations and their performance. This study will consist of three interrelated surveys, hierarchically nested. The first survey is a population-based survey of randomly-selected adults from two populous regions in the province of Quebec. This survey will assess the current affiliation of people with PHC organizations, their level of utilization of healthcare services, attributes of their experience of care, reception of preventive and curative services and perception of unmet needs for care. The second survey is an organizational survey of PHC organizations assessing aspects related to their vision, organizational structure, level of resources, and clinical practice characteristics. This information will serve to develop a taxonomy of organizations using a mixed methods approach of factorial analysis and principal component analysis. The third survey is an assessment of the organizational context in which PHC organizations are evolving. The five year prospective period will serve as a natural

  6. Steering healthcare service delivery: a regulatory perspective.

    Science.gov (United States)

    Prakash, Gyan

    2015-01-01

    The purpose of this paper is to explore regulation in India's healthcare sector and makes recommendations needed for enhancing the healthcare service. The literature was reviewed to understand healthcare's regulatory context. To understand the current healthcare system, qualitative data were collected from state-level officials, public and private hospital staff. A patient survey was performed to assess service quality (QoS). Regulation plays a central role in driving healthcare QoS. India needs to strengthen market and institutional co-production based approaches for steering its healthcare in which delivery processes are complex and pose different challenges. This study assesses current healthcare regulation in an Indian state and presents a framework for studying and strengthening regulation. Agile regulation should be based on service delivery issues (pull approach) rather than monitoring and sanctions based regulatory environment (push approach). Healthcare pitfalls across the world seem to follow similar follies. India's complexity and experience is useful for emerging and developed economies. The author reviewed around 70 publications and synthesised them in healthcare regulatory contexts. Patient's perception of private providers could be a key input towards steering regulation. Identifying gaps across QoS dimensions would be useful in taking corrective measures.

  7. Comparing Relational and Ontological Triple Stores in Healthcare Domain

    Directory of Open Access Journals (Sweden)

    Ozgu Can

    2017-01-01

    Full Text Available Today’s technological improvements have made ubiquitous healthcare systems that converge into smart healthcare applications in order to solve patients’ problems, to communicate effectively with patients, and to improve healthcare service quality. The first step of building a smart healthcare information system is representing the healthcare data as connected, reachable, and sharable. In order to achieve this representation, ontologies are used to describe the healthcare data. Combining ontological healthcare data with the used and obtained data can be maintained by storing the entire health domain data inside big data stores that support both relational and graph-based ontological data. There are several big data stores and different types of big data sets in the healthcare domain. The goal of this paper is to determine the most applicable ontology data store for storing the big healthcare data. For this purpose, AllegroGraph and Oracle 12c data stores are compared based on their infrastructural capacity, loading time, and query response times. Hence, healthcare ontologies (GENE Ontology, Gene Expression Ontology (GEXO, Regulation of Transcription Ontology (RETO, Regulation of Gene Expression Ontology (REXO are used to measure the ontology loading time. Thereafter, various queries are constructed and executed for GENE ontology in order to measure the capacity and query response times for the performance comparison between AllegroGraph and Oracle 12c triple stores.

  8. Acceptability of picture archiving and communication system (PACS) among hospital healthcare personnel based on a unified theory of acceptance and use of technology.

    Science.gov (United States)

    Ahmadi, Maryam; Mehrabi, Nahid; Sheikhtaheri, Abbas; Sadeghi, Mojtaba

    2017-09-01

    The picture archiving and communication system (PACS) is a healthcare system technology which manages medical images and integrates equipment through a network. There are some theories about the use and acceptance of technology by people to describe the behavior and attitudes of end users towards information technologies. We investigated the influential factors on users' acceptance of PACS in the military hospitals of Tehran. In this applied analytical and cross-sectional study, 151 healthcare employees of military hospitals who had experience in using the PACS system were investigated. Participants were selected by census. The following variables were considered: performance expectancy, efforts expectancy, social influence, facilitating conditions and behavioral intention. Data were gathered using a questionnaire. Its validity and reliability were approved by a panel of experts and was piloted with 30 hospital healthcare staff (Cronbach's alpha =0.91). Spearman correlation coefficient and multiple linear regression analysis were used in analyzing the data. Expected performance, efforts expectancy, social impact and facilitating conditions had a significant relationship with behavioral intention. The multiple regression analysis indicated that only performance expectancy can predict the user's behavioral intentions to use PACS technology. Performance and effort expectancies are quite influential in accepting the use of PACS in hospitals. All healthcare personnel should become aware that using such technology is necessary in a hospital. Knowing the influencing factors that affect the acceptance of using new technology can help in improving its use, especially in a healthcare system. This can improve the offered healthcare services' quality.

  9. Coproduction of healthcare service.

    Science.gov (United States)

    Batalden, Maren; Batalden, Paul; Margolis, Peter; Seid, Michael; Armstrong, Gail; Opipari-Arrigan, Lisa; Hartung, Hans

    2016-07-01

    Efforts to ensure effective participation of patients in healthcare are called by many names-patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always 'coproduced'. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. Forecasting the regional distribution and sufficiency of physicians in Japan with a coupled system dynamics-geographic information system model.

    Science.gov (United States)

    Ishikawa, Tomoki; Fujiwara, Kensuke; Ohba, Hisateru; Suzuki, Teppei; Ogasawara, Katsuhiko

    2017-09-12

    In Japan, the shortage of physicians has been recognized as a major medical issue. In our previous study, we reported that the absolute shortage will be resolved in the long term, but maldistribution among specialties will persist. To address regional shortage, several Japanese medical schools increased existing quota and established "regional quotas." This study aims to assist policy makers in designing effective policies; we built a model for forecasting physician numbers by region to evaluate future physician supply-demand balances. For our case study, we selected Hokkaido Prefecture in Japan, a region displaying disparities in healthcare services availability between urban and rural areas. We combined a system dynamics (SD) model with geographic information system (GIS) technology to analyze the dynamic change in spatial distribution of indicators. For Hokkaido overall and for each secondary medical service area (SMSA) within the prefecture, we analyzed the total number of practicing physicians. For evaluating absolute shortage and maldistribution, we calculated sufficiency levels and Gini coefficient. Our study covered the period 2010-2030 in 5-year increments. According to our forecast, physician shortage in Hokkaido Prefecture will largely be resolved by 2020. Based on current policies, we forecast that four SMSAs in Hokkaido will continue to experience physician shortages past that date, but only one SMSA would still be understaffed in 2030. The results show the possibility that diminishing imbalances between SMSAs would not necessarily mean that regional maldistribution would be eliminated, as seen from the sufficiency levels of the various SMSAs. Urgent steps should be taken to place doctors in areas where our forecasting model predicts that physician shortages could occur in the future.

  11. The perils of healthcare workforce forecasting: a case study of the Philadelphia metropolitan area.

    Science.gov (United States)

    Smith, David Barton; Aaronson, William

    2003-01-01

    In 1996, a widely circulated and influential forecast for the Philadelphia Metropolitan Area stated that a decline in hospital and healthcare employment in the region would occur over the next five years. It also suggested that this decline would exacerbate the problem of an oversupply of nurses seeking hospital employment. The forecast reflected a regional leadership and expert consensus on the impact of the managed care transformation on workforce needs and was supported by short-term statistical trends in regional utilization and employment. Confounding these predictions was the fact that hospital and healthcare employment actually grew. By the end of 2001, hospitals in the region were experiencing problems in recruiting sufficient numbers of nurses, pharmacists, and technicians. The forecast failed to anticipate the impact of a strong regional economy on supply and underestimated the resilience of underlying forces that have driven the long-term growth in healthcare workforce demand. More effective ongoing monitoring can help moderate the fluctuation of workforce shortages and surpluses.

  12. An Interoperable Security Framework for Connected Healthcare

    NARCIS (Netherlands)

    Asim, M.; Petkovic, M.; Qu, M.; Wang, C.

    2011-01-01

    Connected and interoperable healthcare system promises to reduce thecost of the healthcare delivery, increase its efficiency and enableconsumers to better engage with clinicians and manage their care. However at the same time it introduces new risks towards security andprivacy of personal health

  13. The US healthcare workforce and the labor market effect on healthcare spending and health outcomes.

    Science.gov (United States)

    Pellegrini, Lawrence C; Rodriguez-Monguio, Rosa; Qian, Jing

    2014-06-01

    The healthcare sector was one of the few sectors of the US economy that created new positions in spite of the recent economic downturn. Economic contractions are associated with worsening morbidity and mortality, declining private health insurance coverage, and budgetary pressure on public health programs. This study examines the causes of healthcare employment growth and workforce composition in the US and evaluates the labor market's impact on healthcare spending and health outcomes. Data are collected for 50 states and the District of Columbia from 1999-2009. Labor market and healthcare workforce data are obtained from the Bureau of Labor Statistics. Mortality and health status data are collected from the Centers for Disease Control and Prevention's Vital Statistics program and Behavioral Risk Factor Surveillance System. Healthcare spending data are derived from the Centers for Medicare and Medicaid Services. Dynamic panel data regression models, with instrumental variables, are used to examine the effect of the labor market on healthcare spending, morbidity, and mortality. Regression analysis is also performed to model the effects of healthcare spending on the healthcare workforce composition. All statistical tests are based on a two-sided [Formula: see text] significance of [Formula: see text] .05. Analyses are performed with STATA and SAS. The labor force participation rate shows a more robust effect on healthcare spending, morbidity, and mortality than the unemployment rate. Study results also show that declining labor force participation negatively impacts overall health status ([Formula: see text] .01), and mortality for males ([Formula: see text] .05) and females ([Formula: see text] .001), aged 16-64. Further, the Medicaid and Medicare spending share increases as labor force participation declines ([Formula: see text] .001); whereas, the private healthcare spending share decreases ([Formula: see text] .001). Public and private healthcare spending also

  14. How can healthcare standards be standardised?

    Science.gov (United States)

    Shaw, Charles D

    2015-10-01

    International travel, medical tourism and trade have created a demand for reliable assessment of healthcare provision across borders, and for information which is accessible to patients, insurers and referring institutions. External assessment schemes for healthcare providers may be clustered into three types: statutory regulation and institutional licensing, International Standardization Organisation certification, and voluntary systems such as peer review and healthcare accreditation. Increasing complexity of healthcare provision, pressures for public accountability and expectations of professional self-governance place a burden on the inspectors and the inspected. If only to contain costs of external assessment and to increase access to reliable information for patients and insurers, the three approaches must work together rather than compete. This paper summarises the origins, aims, authority and methods of the three general models, describing current pressures and opportunities for convergence (between systems and across borders) in the UK and in Europe. 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.

  15. [Prevalence of oral anticoagulation and quality of its management in primary healthcare: A study by the Health Sentinel Network of the Region of Valencia (Spain)].

    Science.gov (United States)

    Boned-Ombuena, Ana; Pérez-Panadés, Jordi; López-Maside, Aurora; Miralles-Espí, Maite; Guardiola Vilarroig, Sandra; Adam Ruiz, Desamparados; Zurriaga, Oscar

    2017-11-01

    To estimate the prevalence of patients with oral anticoagulant therapy (OAT) in the Region of Valencia and to evaluate the quality of management of OAT with vitaminK antagonists (VKA) carried out in primary healthcare. Observational cross-sectional study conducted through the Health Sentinel Network of the Region of Valencia, which includes a survey and the retrospective analysis of OAT monitoring. Primary healthcare, Region of Valencia, Spain. All patients aged 18years or older on OAT who consulted during the year 2014. The population covered by the 59 doctors of the Health Sentinel Network constitutes 2.2% of the adult population of the Region of Valencia, and it is representative of it. Demographic, socioeconomic and health data as well as information concerning OAT. Quality of OAT management with VKA was assessed by means of the percentage of time in therapeutic range (TTR), computed using the Rosendaal method. A total of 1,144 patients were recorded (mean age 74.5±11 years; 49.7% women). Prevalence of OAT in the Region of Valencia is 1.3 cases per 100 population. The characteristic profile of these patients is an old person, with several comorbidities and a low level of education, who lives accompanied. Atrial fibrillation is the most common indication. 82.8% of patients on OAT with VKA were monitored in primary healthcare. The average TTR was 65.0%, and 53.9% of patients had a TTR ≥65%. Among inadequately controlled patients, 74.4% were perceived as well-controlled by their primary care doctor. Prevalence of OAT is high, and it is expected to increase. The degree of control achieved meets the generally accepted quality standard (mean TTR ≥65%), and it is comparable to that observed in other national and international studies. However, there is wide scope for improvement. It is crucial to optimize the management of this therapy in the most effective and cost-effective way. Among other measures, access of physicians to their patients' clinical information

  16. Sharing Elderly Healthcare information on Cloud Computing

    OpenAIRE

    Lu, Fangjie; Khan, Israr

    2012-01-01

    Context: Due to rapid increase in the population of elderly people, sharing healthcare information has become an essential requirement for the development of e-health system. By conducting a research in e-health and cloud computing we have explored the advantages and disadvantages of sharing healthcare information for elderly people through cloud computing. Objectives: The main purpose of this research is to investigate the suitability of cloud computing to share healthcare information. The s...

  17. Internet of Things Healthcare Market Research Report

    OpenAIRE

    Vijay

    2018-01-01

    The global IoT in healthcare market is growing at a significant rate, due to increasing demand for advanced healthcare information system, and growing prevalence of chronic and lifestyle associated diseases. In addition, the growing need for remote patient monitoring services, increasing demand of mHealth technologies, and increasing support from government organizations are also driving the growth of the global IoT in healthcare market. Explore Report with Detailed TOC at: https://www.ps...

  18. Effects of the per diem prospective payment system with DRG-like grouping system (DPC/PDPS) on resource usage and healthcare quality in Japan.

    Science.gov (United States)

    Hamada, Hironori; Sekimoto, Miho; Imanaka, Yuichi

    2012-10-01

    In 2003, Japan introduced the prospective payment system (PPS) with diagnosis-related groups (DRG) rearranged grouping system called the diagnostic procedure combination/per-diem payment system (DPC/PDPS). Even after eight years, little is known about the effects of DPC/PDPS. The purpose of this study was to examine the effects of DPC/PDPS on resource usage and healthcare quality. Using 2001-2009 (fiscal year) administrative data of acute myocardial infarction patients, four indices, including inpatient total accumulated medical charges, length of stay (LOS), mortality rate, and readmission rate, were compared between patients reimbursed by DPC/PDPS or by fee-for-service. DPC/PDPS significantly reduced total accumulated medical charges by $1061 (95% confidence interval [CI], -2007, -116) and LOS by 2.29 days (95% CI, -3.71, -0.88) after risk adjustment. However, mortality rate (Odds ratio [OR], 0.94; 95% CI, 0.73, 1.21) was unchanged. Furthermore, DPC/PDPS increased the readmission rate (OR, 1.37; 95% CI, 1.03, 1.82). This study showed that DPC/PDPS was associated with reduced resource usage, but not improved healthcare quality, as with DRG/PPSs in other countries. To achieve successful healthcare reform, further discussion on additional motives will be required. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  19. Performance of healthcare organizations: contributing variables to efficiency and quality

    OpenAIRE

    Albuquerque, Isabel Garcia da Fonseca e Faro de

    2018-01-01

    The transition from volume-based healthcare to value-based healthcare has been the major challenge of National Health Systems. Nevertheless, some variables that might contribute to bring together healthcare professionals and healthcare challenges have been overlooked. Study A, the first of three studies, conducted in a primary healthcare setting, revealed that perceived and objective organizational performance is predicted by sense of community, which simultaneously mediates the relationship ...

  20. Something is amiss in Denmark: A comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente

    DEFF Research Database (Denmark)

    Schiøtz, Michaela Louise; Price, Mary; Frølich, Anne

    2011-01-01

    As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas for improvement. Prior work indicates that chronic care coordination is poor in the DHS, especially in comparison...