Alcuni abstract di articoli che trattano argomenti relativi all'eHealth

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International Profiles of Health Care Systems, 2011

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

Identifying Health Facilities outside the Enterprise: Challenges and Strategies for Supporting Health Reform and Meaningful Use

Objective: To support collation of data for disability determination, we sought to accurately identify facilities where care was delivered across multiple, independent hospitals and clinics. Methods: Data from various institutions' electronic health records were merged and delivered as continuity of care documents to the United States Social Security Administration (SSA). Results: Electronic records for nearly 8000 disability claimants were exchanged with SSA. Due to the lack of standard nomenclature for identifying the facilities in which patients received the care documented in the electronic records, SSA could not match the information received with information provided by disability claimants. Facility identifiers were generated arbitrarily by health care systems and therefore could not be mapped to the existing international standards. Discussion: We propose strategies for improving facility identification in electronic health records to support improved tracking of a patient's care between providers to better serve clinical care delivery, disability determination, health reform and meaningful use. Conclusion: Accurately identifying the facilities where health care is delivered to patients is important to a number of major health reform and improvement efforts underway in many nations. A standardized nomenclature for identifying health care facilities is needed to improve tracking of care and linking of electronic health records

International Profiles of Health Care Systems, 2012

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, care coordination, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

An Exploration in Accountable Care Organization Structure, Contingency and Performance, 2015-2017

The Patient Protection and Affordable Care Act of 2010 enacted one of the most significant reforms seen in the United States healthcare landscape. The Center for Medicare and Medicaid (CMS) led transformation efforts in regulatory reform and coverage expansion across the U.S. population. Since 2010, care delivery systems have been shifting from episodic, decentralized and fee-for-service models to value-based population health models, like accountable care organizations (ACO). ACOs have been specifically primed for local response to improve the health of their communities. ACO research has traditionally focused on performance measures like mortality, readmissions, quality outcomes and savings. ACO organizational characteristics analyzed in the literature have focused on provider composition, health information technology, leadership structures and provider access. According to CMS, readmissions account for one of the greatest contributors in healthcare spend, and studies by The Commonwealth Fund detail the top percentile of the population as high need, high cost (HNHC) patients who further contribute to the majority of healthcare spend. Opportunity exists to explore the diversity among ACO structures, their relationship to local environments and influence on top contributors to healthcare spend, like readmissions and high need, high cost populations. The objectives of this study are to better understand existing ACO structures, explore relationships among ACO organizational structures, their local environment in which they operate and directional impact on performance, with emphasis on at risk patients like high need, high cost populations. Theoretically, this study applies Structural Contingency Theory (SCT) for its empirical analyses, specifically a multiple contingency approach. In the extant literature, SCT has not been commonly applied due to its longitudinal nature and limited public access to ACO organizational data. The study sample consists of 45 ACOs that entered into the Medicare Shared Savings Program under Track 1 for the entire term from 2015 to 2017. ACO performance is represented by total shared savings, change in rate of readmissions and change in rate of inpatient psychiatric admissions. Four contingency-structure relationships are analyzed from the National Survey of Accountable Care Organizations and CMS Public Use Files, 1) ACO governance structure and strategy alignment, 2) Interdependency from complex coordination and formalized provider agreement types, 3) interdependency from complex coordination and formalized relationships with mental and behavioral health specialists, and 4) complex coordination and health IT integration and interoperability. Regression analyses were used to analyzed potential misfit and directional impact on performance and the contingency-structure pairs. Results indicate that wide variety exists among ACO structures, that conventional investments in provider agreements and fully integrated health IT do not clearly present positive performance effect. Future research opportunities exist to further examine the impact ACO programs have on meeting community needs and populations. This study offers the theoretical application of a multiple contingency approach from Structural Contingency Theory and a practical exploration of ACO structure, its contextual operations and performance on high need, high cost populations

FROM IMPROVISATION TO STANDARDIZATION FOR ACHIEVING A BETTER QUALITY OF CARE: A COUNTERINTUITIVE INTERPRETATION OF DISEASE MANAGEMENT AND ITS IMPLICATION ON HELTHCARE INFORMATION SYSTEMS

In this paper the main assumption and components of the Disease Management approach and programmes are discussed and interpreted on the basis on the classical theory of J.D. Thompson. Such interpretation would allow to highlight a counter-intuitive aspect of the approach: in a sector usually considered as the prototype of the intensive technology, the DM promises to shift to mediating technologies introducing a tighter, standard regulation allowing not only cost-cuttings, but also higher quality perceived by patients. These considerations will be instrumental to discuss the implication of Disease Management strategies in action in respect with the functional aspects of Healthcare Information Systems. Adopting the classification of the core capabilities of an EHR-S provided by Tang, the specific features of DM-S, suitable to properly exploit the ICT to support DM programs, will be highlighted. Some consideration on the current stage of the IGEA project, i.e. the sole nationwide Disease Management program being conducting in Italy, will conclude the paper

How Labor-Management Partnerships Improve Patient Care, Cost Control, and Labor Relations: Case Studies of Fletcher Allen Health Care, Kaiser Permanente, and Montefiore Medical Center’s Care Management Corporation

[Excerpt] This paper explores the ways in which healthcare unions and their members are strategically engaging with management through partnership to control costs and improve the patient experience, clinical outcomes, workplace environment, and labor relations. These initiatives depend on making use of the knowledge of front-line healthcare workers, improving communication between all staff members, and increasing transparency. In turn, these initiatives can also lead to more robust and dynamic local unions. Through participating in joint work activities, many union members note feeling more respected in their workplace and more connected to their union. Unions can benefit from these activities by offering their members the ability to inform decisions about how work gets done

Creating Community Environments That Promote Comprehensive Health and Wellness

Describes the impact of Hurricanes Katrina and Rita on the health of the residents of Arkansas, Louisiana, and Mississippi. Outlines strategies to identify effective programs designed to reduce health disparities and improve health status in the region

Investigation of the viability of an integrated cloud-based electronic medical record for health clinics in Free State, South Africa

Thesis (Master of Information Technology) -- Central University of Technology, Free State, 2019The use of paper-based medical records leads to gaps in patient healthcare. Paper-based records are prone to challenges such as lack of real-time access to patient data, and inability to share and exchange medical data among different health institutions. A solution to address most of the challenges associated with paper-based medical records is to have an information system, such as an Electronic Medical Record (EMR) system. EMRs have proven to be more complete and quicker to access as opposed to paper records. Although EMRs may help resolve some of the problems with paper-based medical records, if the EMR systems are not linked or integrated, the problem of real-time accessibility and exchange of patient data remains unresolved. This leads to challenges in monitoring a patient’s health progress and providing continuity of care. The emerging cloud-computing model, which leverages the Internet to allow the sharing of IT resources as online services, may offer a cost-effective solution of integrating diverse EMR systems. It can serve as an electronic medical record storage centre which simplifies the complexities with EMR exchange methods between different systems and saves the equipment setup expenses for smaller healthcare facilities. In addition, cloud computing may improve healthcare services and benefit medical research. Despite the benefits offered by cloud computing, the adoption of cloud computing in the healthcare industry is the slowest compared to other industries. Further, adopting cloud computing involves many factors which require rigorous evaluation prior to introducing the new computing model to an organization. Very few empirical studies have focused on exploring factors influencing the adoption of cloud computing, especially in the public health sector. This study aimed to investigate the viability of an integrated cloud-based EMR system by exploring factors which influence the intent to adopt cloud computing at public healthcare facilities in the Free State province, South Africa. Through a review of literature on existing studies on the adoption of cloud computing and the Technology-Organization-Environment (TOE) framework, TOE factors were identified and adopted to suit the study’s context. The study carried out a quantitative cross-sectional research by collecting data using a questionnaire which was surveyed to a sample of five principal network controllers from all districts of the Free State and 31 public healthcare facilities in the Free State (FS), South Africa. The data collected was analyzed using SPSS version 19. The study’s hypotheses were tested by conducting a Spearman’s Coefficient Correlation. Results of the study revealed that most of the public healthcare facilities are using paper-based medical records with some form of IT to record basic patient information. Further, results of the study showed that some of the Health Information Systems (HIS) utilized at these healthcare facilities in the FS include Meditech, PADS, PharmAssist, Tier.net, HPRS, Rx Solutions, RDM, ETR and DHIS. According to this study, investments into IT infrastructure need to be considered by these health facilities as the current internet facilities will not be able to accommodate the use of cloud computing and only some facilities have internet facilities in place. Despite these challenges, these healthcare facilities are willing to adopt a cloud-based EMR system. Lastly, results of the study revealed that the factors associated with the intent to adopt cloud computing included relative advantage, security concern, organization readiness and top management support

Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations