Audit-based Compliance Control (AC2) for EHR Systems

Traditionally, medical data is stored and processed using paper-based files. Recently, medical facilities have started to store, access and exchange medical data in digital form. The drivers for this change are mainly demands for cost reduction, and higher quality of health care. The main concerns when dealing with medical data are availability and confidentiality. Unavailability (even temporary) of medical data is expensive. Physicians may not be able to diagnose patients correctly, or they may have to repeat exams, adding to the overall costs of health care. In extreme cases availability of medical data can even be a matter of life or death. On the other hand, confidentiality of medical data is also important. Legislation requires medical facilities to observe the privacy of the patients, and states that patients have a final say on whether or not their medical data can be processed or not. Moreover, if physicians, or their EHR systems, are not trusted by the patients, for instance because of frequent privacy breaches, then patients may refuse to submit (correct) information, complicating the work of the physicians greatly. \ud \ud In traditional data protection systems, confidentiality and availability are conflicting requirements. The more data protection methods are applied to shield data from outsiders the more likely it becomes that authorized persons will not get access to the data in time. Consider for example, a password verification service that is temporarily not available, an access pass that someone forgot to bring, and so on. In this report we discuss a novel approach to data protection, Audit-based Compliance Control (AC2), and we argue that it is particularly suited for application in EHR systems. In AC2, a-priori access control is minimized to the mere authentication of users and objects, and their basic authorizations. More complex security procedures, such as checking user compliance to policies, are performed a-posteriori by using a formal and automated auditing mechanism. To support our claim we discuss legislation concerning the processing of health records, and we formalize a scenario involving medical personnel and a basic EHR system to show how AC2 can be used in practice. \ud \ud This report is based on previous work (Dekker & Etalle 2006) where we assessed the applicability of a-posteriori access control in a health care scenario. A more technically detailed article about AC2 recently appeared in the IJIS journal, where we focussed however on collaborative work environments (Cederquist, Corin, Dekker, Etalle, & Hartog, 2007). In this report we first provide background and related work before explaining the principal components of the AC2 framework. Moreover we model a detailed EHR case study to show its operation in practice. We conclude by discussing how this framework meets current trends in healthcare and by highlighting the main advantages and drawbacks of using an a-posteriori access control mechanism as opposed to more traditional access control mechanisms

Understanding the Workforce Needs of New Jersey's Public Health and Other Disaster Management Employers

This report explores the priority workforce needs of New Jersey's public disaster management system. An advisory group of disaster management-related employers from law enforcement and state and local public health systems and educational institutions was convened in the spring of 2006 to identify priority workforce skill needs. Researchers also conducted interviews with state officials, domestic security, public health, and disaster planning experts, as well as reviews of labor market information, state and national websites, and industry and scholarly literature

The Changing Demographic Profile of the United States

[Excerpt] The United States, the third most populous country globally, accounts for about 4.5% of the world’s population. The U.S. population—currently estimated at 308.7 million persons—has more than doubled since its 1950 level of 152.3 million. More than just being double in size, the population has become qualitatively different from what it was in 1950. As noted by the Population Reference Bureau, “The U.S. is getting bigger, older, and more diverse.” The objective of this report is to highlight some of the demographic changes that have already occurred since 1950 and to illustrate how these and future trends will reshape the nation in the decades to come (through 2050). The United States Is Getting Bigger. U.S. population growth is due to the trends over time in the interplay of increased births, decreased deaths, and increased net immigration. The United States Is Getting Older. Aside from the total size, one of the most important demographic characteristics of a population for public policy is its age and sex structure. This report illustrates how the United States has been in the midst of a profound demographic change: the rapid aging of its population, as reflected by an increasing proportion of persons aged 65 and older, and an increasing median age in the population. The United States Is Becoming More Racially and Ethnically Diverse, reflecting the major influence that immigration has had on both the size and the age structure of the U.S. population. This section considers the changing profile of the five major racial groups in the United States. In addition, trends in the changing ethnic composition of the Hispanic or Latino Origin population are discussed. Although this report will not specifically discuss policy options to address the changing demographic profile, it is important to recognize that the inexorable demographic momentum will have important implications for the economic and social forces that will shape future societal well-being. There is ample reason to believe that the United States will be able to cope with the current and projected demographic changes if policymakers accelerate efforts to address and adapt to the changing population profile as it relates to a number of essential domains, such as work, retirement, and pensions; private wealth and income security; the federal budget and intergenerational equity; health, healthcare, and health spending; and the health and well-being of the aging population. These topics, among others, are discussed briefly in the final section of this report. This report will be updated as needed

How 5G wireless (and concomitant technologies) will revolutionize healthcare?

The need to have equitable access to quality healthcare is enshrined in the United Nations (UN) Sustainable Development Goals (SDGs), which defines the developmental agenda of the UN for the next 15 years. In particular, the third SDG focuses on the need to “ensure healthy lives and promote well-being for all at all ages”. In this paper, we build the case that 5G wireless technology, along with concomitant emerging technologies (such as IoT, big data, artificial intelligence and machine learning), will transform global healthcare systems in the near future. Our optimism around 5G-enabled healthcare stems from a confluence of significant technical pushes that are already at play: apart from the availability of high-throughput low-latency wireless connectivity, other significant factors include the democratization of computing through cloud computing; the democratization of Artificial Intelligence (AI) and cognitive computing (e.g., IBM Watson); and the commoditization of data through crowdsourcing and digital exhaust. These technologies together can finally crack a dysfunctional healthcare system that has largely been impervious to technological innovations. We highlight the persistent deficiencies of the current healthcare system and then demonstrate how the 5G-enabled healthcare revolution can fix these deficiencies. We also highlight open technical research challenges, and potential pitfalls, that may hinder the development of such a 5G-enabled health revolution

Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China.

Universal health coverage (UHC) has been identified as a priority for the global health agenda. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, aiming to provide universal coverage of basic healthcare by the end of 2020. We conducted a secondary data analysis and combined it with a literature review, analysing the overview of UHC in China with regard to financial protection, coverage of health services and the reported coverage of the WHO and the World Bank UHC indicators. The results include the following: out-of-pocket expenditures as a percentage of current health expenditures in China have dropped dramatically from 60.13% in 2000 to 35.91% in 2016; the health insurance coverage of the total population jumped from 22.1% in 2003 to 95.1% in 2013; the average life expectancy increased from 72.0 to 76.4, maternal mortality dropped from 59 to 29 per 100 000 live births, the under-5 mortality rate dropped from 36.8 to 9.3 per 1000 live births, and neonatal mortality dropped from 21.4 to 4.7 per 1000 live births between 2000 and 2017; and so on. Our findings show that while China appears to be well on the path to UHC, there are identifiable gaps in service quality and a requirement for ongoing strengthening of financial protections. Some of the key challenges remain to be faced, such as the fragmented and inequitable health delivery system, and the increasing demand for high-quality and value-based service delivery. Given that China has committed to achieving UHC and 'Healthy China 2030', the evidence from this study can be suggestive of furthering on in the UHC journey and taking the policy steps necessary to secure change

Equity in the Digital Age: How Health Information Technology Can Reduce Disparities

While enormous medical and technological advancements have been made over the last century, it is only very recently that there have been similar rates of development in the field of health information technology (HIT).This report examines some of the advancements in HIT and its potential to shape the future health care experiences of consumers. Combined with better data collection, HIT offers signi?cant opportunities to improve access to care, enhance health care quality, and create targeted strategies that help promote health equity. We must also keep in mind that technology gaps exist, particularly among communities of color, immigrants, and people who do not speak English well. HIT implementation must be done in a manner that responds to the needs of all populations to make sure that it enhances access, facilitates enrollment, and improves quality in a way that does not exacerbate existing health disparities for the most marginalized and underserved

Alcuni abstract di articoli che trattano argomenti relativi all'eHealth

Non utile per esam

Evaluating the Provision of Botnet Defences using Translational Research Concepts.

Botnet research frequently draws on concepts from other fields. An example is the use of epidemiological models when studying botnet propagation, which facilitate an understanding of bot spread dynamics and the exploration of behavioural theory. Whilst the literature is rich with these models, it is lacking in work aimed at connecting the insights of theoretical research with day-to-day practice. To address this, we look at botnets through the lens of implementation science, a discipline from the field of translational research in health care, which is designed to evaluate the implementation process. In this paper, we explore key concepts of implementation science, and propose a framework-based approach to improve the provision of security measures to network entities. We demonstrate the approach using existing propagation models, and discuss the role of implementation science in malware defence

Living Longer on Less

Economic security for seniors was built on the three-legged stool of retirement (Social Security, pensions, and savings) at the core of the social contract that rewards a lifetime of productivity. Economic security of seniors, however, is being challenged by two simultaneously occurring trends: a weakening of the three legs of retirement security income and dramatically increasing expenses, such as for healthcare and housing. This report examines the long-term economic security of seniors, depicts current trends and suggests policies promoting the enduring well-being of seniors. Particular areas of vulnerability include: Housing45% of senior households spend nearly a third of their income on housing. 31% either rent or have no home equity to draw on in tough times; Healthcare40% of senior households spend more than 15% of their income on healthcare;Budgets1 in 3 senior households has no money whatsoever left over after meeting essential expenses;AssetsMore than half of all senior households (54 percent) do not have sufficient financial resources to meet median projected expenses based on their current financial net worth, projected Social Security, and pension incomes