100,520 research outputs found

    Performance Analysis of a Medical Record Exchanges Model(SCI)

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    [[abstract]]Electronic medical record exchange among hospitals can provide more information for physician diagnosis and reduce costs from duplicate examinations. In this paper, we proposed and implemented a medical record exchange model. According to our study, exchange interface servers (EISs) are designed for hospitals to manage the information communication through the intra and interhospital networks linked with a medical records database. An index service center can be given responsibility for managing the EIS and publishing the addresses and public keys. The prototype system has been implemented to generate, parse, and transfer the health level seven query messages. Moreover, the system can encrypt and decrypt a message using the public-key encryption algorithm. The queuing theory is applied to evaluate the performance of our proposed model. We estimated the service time for each queue of the CPU, database, and network, and measured the response time and possible bottlenecks of the model. The capacity of the model is estimated to process the medical records of about 4000 patients/h in the 1-MB network backbone environments, which comprises about the 4% of the total outpatients in Taiwan. Performance Analysis of a Medical Record Exchanges Model (PDF Download Available). Available from: https://www.researchgate.net/publication/51375541_Performance_Analysis_of_a_Medical_Record_Exchanges_Model [accessed Jan 15, 2016]

    Accountable Care Organizations and Transaction Cost Economics

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    Using a Transaction Cost Economics (TCE) approach, this paper explores which organizational forms Accountable Care Organizations (ACOs) may take. A critical question about form is the amount of vertical integration that an ACO may have, a topic central to TCE. We posit that contextual factors outside and inside an ACO will produce variable transaction costs (the non-production costs of care) such that the decision to integrate vertically will derive from a comparison of these external versus internal costs, assuming reasonably rational management abilities. External costs include those arising from environmental uncertainty and complexity, small numbers bargaining, asset specificity, frequency of exchanges, and information impactedness. Internal costs include those arising from human resource activities including hiring and staffing, training, evaluating (i.e., disciplining, appraising, or promoting), and otherwise administering programs. At the extreme, these different costs may produce either total vertical integration or little to no vertical integration with most ACOs falling in between. This essay demonstrates how TCE can be applied to the ACO organization form issue, explains TCE, considers ACO activity from the TCE perspective, and reflects on research directions that may inform TCE and facilitate ACO development

    State Implementation of National Health Reform: Harnessing Federal Resources to Meet State Policy Goals

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    Discusses state options for maximizing coverage and access to care; reforming the health insurance market; holding insurers accountable for high-quality, affordable coverage; restructuring healthcare delivery and financing; and cutting budget deficits

    Privacy and Health Information Technology

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    The increased use of health information technology (health IT) is a common element of nearly every health reform proposal because it has the potential to decrease costs, improve health outcomes, coordinate care, and improve public health. However, it raises concerns about security and privacy of medical information. This paper examines some of the “gaps” in privacy protections that arise out of the current federal health privacy standard, the Health Insurance Portability and Accountability (HIPAA) Privacy Rule, the main federal law which governs the use and disclosure of health information. Additionally, it puts forth a range of possible solutions, accompanied by arguments for and against each. The solutions provide some options for strengthening the current legal framework of privacy protections in order to build public trust in health IT and facilitate its use for health reform. The American Recovery and Reinvestment Act (ARRA) enacted in February 2009 includes a number of changes to HIPAA and its regulations, and those changes are clearly noted among the list of solutions (and ARRA is indicated in the Executive Summary and paper where the Act has a relevant provision)

    Legal Solutions in Health Reform: Privacy and Health Information Technology

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    Identifies gaps in the federal health privacy standard and proposes options for strengthening the legal framework for privacy protections in order to build public trust in health information technology. Presents arguments for and against each option

    On the Road to Better Value: State Roles in Promoting Accountable Care Organizations

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    Outlines how accountable care organizations can deliver value through incentives to manage utilization, improve quality, and curb cost growth. Profiles states supporting the model with data, new payment methods, accountability measures, and other efforts

    Protecting Patient Privacy: Strategies for Regulating Electronic Health Records Exchange

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    The report offers policymakers 10 recommendations to protect patient privacy as New York state develops a centralized system for sharing electronic medical records. Those recommendations include:Require that the electronic systems employed by HIEs have the capability to sort and segregate medical information in order to comply with guaranteed privacy protections of New York and federal law. Presently, they do not.Offer patients the right to opt-out of the system altogether. Currently, people's records can be uploaded to the system without their consent.Require that patient consent forms offer clear information-sharing options. The forms should give patients three options: to opt-in and allow providers access to their electronic medical records, to opt-out except in the event of a medical emergency, or to opt-out altogether.Prohibit and sanction the misuse of medical information. New York must protect patients from potential bad actors--that small minority of providers who may abuse information out of fear, prejudice or malice.Prohibit the health information-sharing networks from selling data. The State Legislature should pass legislation prohibiting the networks from selling patients' private health information

    Innovative Medicaid Initiatives to Improve Service Delivery and Quality of Care: A Look at Five State Initiatives

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    Outlines initiatives in Alabama, Oklahoma, Oregon, Pennsylvania, and Washington to implement patient-centered medical home models designed to coordinate and improve quality of care; strategies; key lessons; and new opportunities under healthcare reform

    Delivering on the Promise: A State Guide to the Next Steps for Health Care Reform

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    Outlines recommendations and considerations for creating health insurance exchanges, lowering costs and improving quality, providing consumer protections, addressing reforms beyond the federal law, and offering state-level public options
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