Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review

Background: Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned. <br><br> Purpose: This paper explores the extent to which integrated primary health care (PHC) is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. <br><br> Methods: A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care. <br><br> Results: Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care. <br><br> Conclusion: Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development

Sound Foundations: Leveraging International Standards for Australia\u27s National Ehealth System

Background: Australia is currently in the process of deploying a national personally controlled electronic health record (PCEHR). This is being built using a combination of international standards and profiles as well as Australian Standards and with specifications developed by the National eHealth Transition Authority (NeHTA). Objective: There exists a poor appreciation of how the complex construction of the overall system is supported and protected by multiple international standards. These fundamental underpinnings have been sourced from international standards groups such as Health Level Seven (HL7) and Integrating the Health Enterprise (IHE) as well as developed locally. In addition, other services underlie this infrastructure such as secure messaging, the national Health Identification Service and the National Authentication Service for Health (NASH). Methods: An analysis of the national e-health system demonstrates how this model of standards and service integration results in a complex service oriented architecture. Results: The expected benefits from the integrated yet highly dependent nature of the national ehealth system are improved patient outcomes and significant cost savings. These are grounded and balanced by the current and future challenges that include incorporating the PCEHR into clincial workflows and ensuring relevant, timely, detailed clinical data as well as consistent security policy issues and unquantified security threats. Conclusions: Ultimately, Australia has designed an ambitious yet diverse and integrated architecture. What remains to be seen is if the challenges that the medical software industry and clinical community face in leveraging the political process in order to encourage provider and public participation in ehealth, can be achieved despite the sound underpinnings of international standards

Application of Lifetime Electronic Health Records: Are we ready yet?

Integrated care concepts can help to diminish demographic challenges. Therefore, the use of eHealth solutions is recognised as an efficient approach. Lifetime electronic health records (LEHRs) are expected to increase continuity, effectiveness, efficiency and thus quality of the care process. With respect to these benefits, an overarching implementation of LEHRs is desirable but non-existent. Hence, the aim of the article is to analyse the current LEHR implementation readiness of EU member states to derive implications for further LEHR research and development. Therefore, a case study on Denmark, Germany and Italy was conducted. The analysis shows that all countries fulfil the technical requirements but Denmark has great experiences and willingness to implement advanced eHealth measures like LEHRs. First Italian pilot projects are quite promising as well. The article paves the way for LEHR implementation and there with for integrated care

Developing a European grid infrastructure for cancer research: vision, architecture and services

Life sciences are currently at the centre of an information revolution. The nature and amount of information now available opens up areas of research that were once in the realm of science fiction. During this information revolution, the data-gathering capabilities have greatly surpassed the data-analysis techniques. Data integration across heterogeneous data sources and data aggregation across different aspects of the biomedical spectrum, therefore, is at the centre of current biomedical and pharmaceutical R&D

Framing the Implementation and Adoption of Innovation in the NHS: An Interactive Multi-User Perspective

The UK National Health Service (NHS) has been slow at adopting seemingly well-evidenced innovation. A great deal of energy and resources have gone into understanding the issues behind the failure to adopt innovation in the NHS. In recent times Accelerated Access Review (AAR) identified new barriers to innovation and put forward solutions at both local and national levels (Department of Health and Department for Business, Energy and Industrial Strategy, 2017). Scholars and policy-makers have investigated the majority of the obstacles to adopting innovation in the NHS and results have appeared in multiple outlets over the last twenty years. Innovation within the NHS have mostly been judged on a least-cost basis or presumed to yield a positive return in the very first year. Some scholars also point to the fact that most perspectives on innovation deem it as a luxury rather than a routine part of the operational management. The failure to successfully adopt innovations is costing taxpayers and despite so many obstacles well documented, the NHS is still struggling to overcome the scale of innovation. To this concern, my research is an attempt to better understand the process of innovation adoption in healthcare. Using a year-long field study at one of the largest UK-based University Hospitals, I have explored the process of adoption of electronic medicine chart (EMEDs) designed to replace traditional paper-based systems. Based on three groups of non-clinical and clinical stakeholders, I have developed a multi-view perspective of the adoption process. Exploring the perspectives of both the clinical users (doctors, nurses, and pharmacists) and technology (clinical and non-clinical) implementer groups, I have developed a multi-view perspective of the adoption process. To address the struggles and complexity of the adoption process underpinning the implementation of innovation in hospitals, my research has advanced a socio-cognitive perspective through examining the groups of technology implementers and technology users. Currently, a body of research exists which has examined the adoption of innovation underpinning implementation in firms. The literature has tended to provide economic-based theories of rational action by focussing on channels through which technical or economic benefits are communicated as a means to propagate its adoption. An alternative to economic-based explanations, the institutional theory perspectives have identified forces triggering adoption, irrespective of the innovation’s technical, work-related, or economic benefits to the adopter. Contributing to the growing interest in socio-cognitive perspective, my research through interactive framing has examined the groups of technology implementers and technology users. This has been done to develop an understanding of how actors ‘make sense’ of the process unfolding through them (the implementers and users). Having used Gioia methodology, I have utilised data collected through rich in-depth interviews of the actors during the process of implementation and adoption. The data collected have been used to build a data structure leading onto an interactive grounded theory model of EMEDs adoption. The model is built on three core dynamic framing activities – intrinsic, frictional and transitioning. Collectively they represent a cognitive transformation of all the actors involved and offer insight into the negotiated state and challenges of adoption process faced by both users and implementers in a complex organisation

Uma rede telemática para a prestação regional de cuidados de saúde

Doutoramento em Engenharia InformáticaAs tecnologias de informação e comunicação na área da saúde não são só um instrumento para a boa gestão de informação, mas antes um fator estratégico para uma prestação de cuidados mais eficiente e segura. As tecnologias de informação são um pilar para que os sistemas de saúde evoluam em direção a um modelo centrado no cidadão, no qual um conjunto abrangente de informação do doente deve estar automaticamente disponível para as equipas que lhe prestam cuidados, independentemente de onde foi gerada (local geográfico ou sistema). Este tipo de utilização segura e agregada da informação clínica é posta em causa pela fragmentação generalizada das implementações de sistemas de informação em saúde. Várias aproximações têm sido propostas para colmatar as limitações decorrentes das chamadas “ilhas de informação” na saúde, desde a centralização total (um sistema único), à utilização de redes descentralizadas de troca de mensagens clínicas. Neste trabalho, propomos a utilização de uma camada de unificação baseada em serviços, através da federação de fontes de informação heterogéneas. Este agregador de informação clínica fornece a base necessária para desenvolver aplicações com uma lógica regional, que demostrámos com a implementação de um sistema de registo de saúde eletrónico virtual. Ao contrário dos métodos baseados em mensagens clínicas ponto-a-ponto, populares na integração de sistemas em saúde, desenvolvemos um middleware segundo os padrões de arquitetura J2EE, no qual a informação federada é expressa como um modelo de objetos, acessível através de interfaces de programação. A arquitetura proposta foi instanciada na Rede Telemática de Saúde, uma plataforma instalada na região de Aveiro que liga oito instituições parceiras (dois hospitais e seis centros de saúde), cobrindo ~350.000 cidadãos, utilizada por ~350 profissionais registados e que permite acesso a mais de 19.000.000 de episódios. Para além da plataforma colaborativa regional para a saúde (RTSys), introduzimos uma segunda linha de investigação, procurando fazer a ponte entre as redes para a prestação de cuidados e as redes para a computação científica. Neste segundo cenário, propomos a utilização dos modelos de computação Grid para viabilizar a utilização e integração massiva de informação biomédica. A arquitetura proposta (não implementada) permite o acesso a infraestruturas de e-Ciência existentes para criar repositórios de informação clínica para aplicações em saúde.Modern health information technology is not just a supporting instrument to good information management but a strategic requirement to provide more efficient and safer health care. Health information technology is a cornerstone to build the future patient-centric health care systems in which a comprehensive set of patient data will be available to the relevant care teams, in spite of where (system or service point) it was generated. Such secure and efficient use of clinical data is challenged by the existing fragmentation of health information systems implementation. Several approaches have been proposed to address the limitations of the so called “information silos” in healthcare, ranging from full centralization (a single system) to full-decentralized clinical message exchange networks. In this work we advocate the use of a service-based unification layer, by federating distributed heterogeneous information sources. This clinical information hub provides the basis to build regional-level applications, which we have demonstrated by implementing a virtual Electronic Health Record system. Unlike the message-driven, point-to-point approaches popular in health care systems integration, we developed a middleware layer, using J2EE architectural patterns, in which the common information is represented as an object model, accessible through programming interfaces. The proposed architecture was instantiated in the Rede Telemática da Saúde network, a platform deployed in the region of Aveiro connecting eight partner institutions (two hospitals and six primary care units), covering ~ 350,000 citizens, indexing information on more than 19,000,000 episodes of care and used by ~350 registered professionals. In addition to the regional health information collaborative platform (RTSys), we introduce a second line of research towards bridging the care networks and the science networks. In the later scenario, we propose the use of Grid computing to enable the massive use and integration of biomedical information. The proposed architecture (not implemented) enables to access existing e-Science infrastructures to create clinical information repositories for health applications