The Failed Implementation of the Electronic Prescription in Germany - A Case Study

Many countries worldwide are striving for improving the quality of care and for reducing costs in the health care sector by establishing large IT infrastructures. In Germany, the introduction of the electronic health card and the national telematics infrastructure is lagging years behind the original schedule. In this paper, we describe and analyze a case study of one selected part of this ultra-large intervention. The selected part is the failed implementation of the electronic prescription. The related activities started in 2003 and ended in 2010 when a decision was made to abandon this part of the intervention. We present a detailed analysis of the project and identify 14 reasons in five categories for the project’s failure. Furthermore, we provide a multi-layered overview of the episodes and sub-projects

Product traceability in the pharmaceutical supply chain : an analysis of the auto-ID approach

Thesis (M. Eng. in Logistics)--Massachusetts Institute of Technology, Engineering Systems Division, 2003.Includes bibliographical references (p. 70-73).This thesis analyzes how the Auto-ID technology and information infrastructure will change the management and distribution of pharmaceutical products within the health care industry by enabling item level product traceability functionality. The complexity of the health care industry is steadily growing, due to the concurrent increase in medical knowledge, biomedical technologies, the number of medications and the age of the population. The key to ensuring the quality, integrity and availability of health care goods is the ability to track and trace individual items throughout their complete life-cycle from manufacturing to disposal. Product traceability within the Supply Chain is becoming increasingly important for pharmaceutical manufacturers because the increasing number of medications distributed worldwide has led to the proliferation of counterfeit drugs, product diversions, re-importations and grey markets. Ultimately, the increasing complexity of the pharmaceutical distribution could affect patient safety. The potential of the Auto-ID technology and information infrastructure to synchronize the information and material flow is illustrated using a case study methodology.by Attilio Bellman.M.Eng.in Logistic

Pharmacological correction of intrarenal hemodynamic disorders in acute kidney injury (part 2)

Evaluate the possibilities of individual pharmacological correction and intensive care of patients with acute kidney injury of different origin. A prospective nonrandomized study. Inclusion criteria: patients with prerenal, renal and subrenal AKI module in stage of oligoanuria and restoration of diuresis. Exclusion criteria: AKI in patients after cardiosurgery and operations on large vessels. Individual pharmacological and non-pharmacological correction (renoprotection) was performed in 250 ICU patients with prerenal (130), renal (81) and subrenal (39) AK

Analysis of the impact of the implementation of electronic health records in the hospital pharmaceutical supply chain

Health Information Technologies (HIT) play an important role in supporting decisions making, health care delivery, and management of health services. In recent years, new technologies have emerged in this field, such as ePrescribing, Computerized Physician Order Entry (CPOE), Bar Code Medication Administration (BCMA), electronic Medication Administration Record (eMAR), Automated Drug Management Systems, etc. It is said that the development of these new technologies will be catalysed by the implementation of Electronic Health Record (EHR), systems that have begun to implement in many countries, including Belgium. Once introduced into Health Information Technologies (HIT), the aim of this project is, at first, to describe Electronic Health Record (EHR) systems and study its impact on the healthcare system, as well as its maturity. The scope of our study was Belgium even though we extended our analysis to European countries as well as North America where EHR systems are mature. Secondly, the purpose is to analyse how the digitalization of information by using these new technologies could impact and improve pharmaceutical supply chain in hospitals. Finally, based on the findings from our research, a roadmap for Electronic Health Records (EHRs) implementation in a hospital is presented.Outgoin

Towards a Learning Health System: a SOA based platform for data re-use in chronic infectious diseases

Abstract Information and Communication Technology (ICT) tools can efficiently support clinical research by providing means to collect automatically huge amount of data useful for the management of clinical trials conduction. Clinical trials are indispensable tools for Evidence-Based Medicine and represent the most prevalent clinical research activity. Clinical trials cover only a restricted part of the population that respond to particular and strictly controlled requirements, offering a partial view of the overall patients\u2019 status. For instance, it is not feasible to consider patients with comorbidities employing only one kind of clinical trial. Instead, a system that have a comprehensive access to all the clinical data of a patient would have a global view of all the variables involved, reflecting real-world patients\u2019 experience. The Learning Health System is a system with a broader vision, in which data from various sources are assembled, analyzed by various means and then interpreted. The Institute of Medicine (IOM) provides this definition: \u201cIn a Learning Health System, progress in science, informatics, and care culture align to generate new knowledge as an ongoing, natural by-product of the care experience, and seamlessly refine and deliver best practices for continuous improvement in health and health care\u201d. The final goal of my project is the realization of a platform inspired by the idea of Learning Health System, which will be able to re-use data of different nature coming from widespread health facilities, providing systematic means to learn from clinicians\u2019 experience to improve both the efficiency and the quality of healthcare delivery. The first approach is the development of a SOA-based architecture to enable data collection from sparse facilities into a single repository, to allow medical institutions to share information without an increase in costs and without the direct involvement of users. Through this architecture, every single institution would potentially be able to participate and contribute to the realization of a Learning Health System, that can be seen as a closed cycle constituted by a sequential process of transforming patient-care data into knowledge and then applying this knowledge to clinical practice. Knowledge, that can be inferred by re-using the collected data to perform multi-site, practice-based clinical trials, could be concretely applied to clinical practice through Clinical Decision Support Systems (CDSS), which are instruments that aim to help physicians in making more informed decisions. With 4 this objective, the platform developed not only supports clinical trials execution, but also enables data sharing with external research databases to participate in wider clinical trials also at a national level without effort. The results of these studies, integrated with existing guidelines, can be seen as the knowledge base of a decision support system. Once designed and developed, the adoption of this system for chronical infective diseases management at a regional level helped in unifying data all over the Ligurian territory and actively monitor the situation of specific diseases (like HIV, HCV and HBV) for which the concept of retention in care assumes great importance. The use of dedicated standards is essential to grant the necessary level of interoperability among the structures involved and to allow future extensions to other fields. A sample scenario was created to support antiretroviral drugs prescription in the Ligurian HIV Network setting. It was thoroughly tested by physicians and its positive impact on clinical care was measured in terms of improvements in patients\u2019 quality of life, prescription appropriateness and therapy adherence. The benefits expected from the employment of the system developed were verified. Student\u2019s T test was used to establish if significant differences were registered between data collected before and after the introduction of the system developed. The results were really acceptable with the minimum p value in the order of 10 125 and the maximum in the order of 10 123. It is reasonable to assess that the improvements registered in the three analysis considered are ascribable to this system introduction and not to other factors, because no significant differences were found in the period before its release. Speed is a focal point in a system that provides decision support and it is highly recognized the importance of velocity optimization. Therefore, timings were monitored to evaluate the responsiveness of the system developed. Extremely acceptable results were obtained, with the waiting times of the order of 10 121 seconds. The importance of the network developed has been widely recognized by the medical staff involved, as it is also assessed by a questionnaire they compiled to evaluate their level of satisfaction

DEVELOPMENT OF A FORMAL FRAMEWORK FOR USABLE OPERATIONS SUPPORT IN E-HEALTH BASED SYSTEMS

This study uses advanced communications and computing technologies to support health care delivery and education. The automated e-Health-based system was designed to eliminate clumsy and tedious treatment procedures associated with manual treatment processes prevalent in care centres, especially in the developing countries. The operations support functionalities of the system are provided within a formal framework to eliminate system errors, improve dependability and enhance its usability. The framework presented in this thesis uses algebraic specifications in object constraint language (OCL) and Unified Modelling Language (UML) in the analysis and design of some subsystems in an e-Health based system. Wireless Markup Language (WML) and Java programming language were used to develop the operations support functionality with real-time access to medical information via hand-held devices. The application was deployed on a 3-tiered client / server architecture with hand-held devices as clients, providing mobile access to real-time information from server-based systems within a care centre. The system was evaluated empirically and analytically. The application’s usability evaluation was done using a questionnaire based on the attributes suggested by ISO, ANSI and ITU. The product was found to be usable with a mean rating above 4 on a scale of 5 for all attributes used for the measurement. The study revealed that 92% of the medical professionals who evaluated the application would like to see it deployed for use in medical centres in order to enhance health care delivery

Relatório de estágio curricular na direção de gestão do risco de medicamentos

Mestrado em Biomedicina FarmacêuticaThis report is a summary of the activities developed during 9 months of curricular training at the Directorate of Risk Management for Medicines as part of the master degree in Pharmaceutical Medicine. The internship has the purpose of complement the theoretical knowledge previously acquired and was focused on the two areas of the Directorate: Safety Monitoring and Risk Minimization. The activities of the Directorate include the collection and validation of Individual Case Safety Report received from healthcare professionals, patients and pharmaceutical companies. The activities of Risk Minimization include the implementation of safety variations, management of periodic safety update report and risk management plan, validation of the direct healthcare professional communication and the evaluation of educational materials. The Directorate is also responsible to identify and manage safety signals.Este relatório é o sumário das atividades realizadas durante 9 meses de estágio na Direção de Gestão do Risco de Medicamentos no âmbito do mestrado em Biomedicina Farmacêutica. O estágio teve o objetivo de complementar os conhecimentos teóricos adquiridos e contemplou as duas principais áreas de ação da Direção: a Monitorização de Segurança de Medicamentos de Uso Humano e a Minimização do Risco. De entre as atividades da Direção inclui-se a recolha e avaliação de notificações de reações adversas enviadas por profissionais de saúde, utentes e empresas farmacêuticas. As atividades de minimização do risco associado a medicamentos incluem atividades como as alterações de segurança, a gestão dos relatórios periódicos de segurança e dos planos de gestão do risco, a validação das comunicações dirigidas aos profissionais de saúde e a avaliação dos materiais educacionais. A Direção tem ainda a função de detetar novos sinais de segurança e fazer a sua gestão

Health Information Technology in the United States, 2008

Provides updated survey data on health information technology (HIT) and electronic health records adoption, with a focus on providers serving vulnerable populations. Examines assessments of HIT's effect on the cost and quality of care and emerging issues

International Profiles of Health Care Systems, 2015

This publication presents overviews of the health care systems of Australia, Canada, China, Denmark, England, France, Germany, India, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and 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