Organizational Challenges in Developing One of the Nationwide Health Information Network Trial Implementation Awardees

Health care in the United States is rarely delivered in a coordinated manner. Current methods to share patient information are inefficient and may lead to medical errors, higher readmission rates, and delays in the delivery of needed health services. This qualitative study describes lessons learned concerning the early implementation of one Nationwide Health Information Network (NHIN) site in Long Beach, CA during its first year of operation. The Long Beach Network for Health (LBNH) focused on an incremental effort to exchange health information. Despite a limited concentration on emergency department care, virtually all respondents noted concerns regarding the sustainability, or business case, for the exchange of health information. Nevertheless, respondents were encouraged by progress on technological challenges and user requirements during this first year. The early gains in this process may, in turn, have laid the groundwork for future efforts to expand beyond the emergency department

Provider Stakeholders’ Perceived Benefit from a Nascent Health Information Exchange: A Qualitative Analysis

We sought to better understand the perceived costs and benefits of joining a nascent health information exchange (HIE) from the perspective of potential provider organization participants. We therefore conducted semi-structured interviews with organizational representatives. Interview transcriptions were thematically coded, and coded text was subsequently aggregated to summarize the breadth and depth of responses. Although no respondents expected HIE to result in net financial benefit to their organization, all respondents recognized some potential benefits, and some respondents expected HIE to result in overall organizational benefit. Disproportionate benefit was expected for the poorest, sickest patients. Many respondents had concerns about HIE increasing the risk of data security breaches, and these concerns were most pronounced at larger organizations. We found little evidence of organizational concern regarding loss of patients to other organizations or publication of unfavorable quality data. If HIE’s greatest benefactors are indeed the poorest, sickest patients, our current health care financing environment will make it difficult to align HIE costs with benefits. To sustain HIE, state and federal governments may need to consider ongoing subsidies. Furthermore, these governments will need to ensure that policies regulating data exchange have sufficient nationwide coordination and liability limitations that the perceived organizational risks of joining HIEs do not outweigh perceived benefits. HIE founders can address organizational concerns by attempting to coordinate HIE policies with those of their largest founding organizations, particularly for data security policies. Early HIE development and promotional efforts should not only focus on potential benefits, but should also address organizational concerns

Immigration Enforcement and Fairness to Would-Be Immigrants

This chapter argues that governments have a duty to take reasonably effective and humane steps to minimize the occurrence of unauthorized migration and stay. While the effects of unauthorized migration on a country’s citizens and institutions have been vigorously debated, the literature has largely ignored duties of fairness to would-be immigrants. It is argued here that failing to take reasonable steps to prevent unauthorized migration and stay is deeply unfair to would-be immigrants who are not in a position to bypass visa regulations. Importantly, the argument here is orthogonal to the debate as to how much and what kinds of immigration ought to be allowed

Towards a Health 4.0 Framework for the Design of Wearables: Leveraging Human-Centered and Robust Design

With the introduction of Health 4.0 we face a new era in healthcare and notice the disruption of delivery, adoption and use through newly introduced technology. Wearables have become increasingly important in the medical sector and their remote application and widespread use are significant to the development of technology in healthcare today and the future. The implementation of wearables requires regulations and clinical approval when intended to use for health tracking and monitoring. Within this process designers play a crucial role. Design methodologies are the guideline to accomplish a successful path towards the creation of a new product. In this paper the authors explore and draw from established design methodologies to support the creation of a framework for design of wearables in a health 4.0 context. Identifying the positions of design practices and analyzing the correlations in the context of Health 4.0 is therefore presented within this paper

The ethics of entrepreneurial philanthropy

A salient if under researched feature of the new age of global inequalities is the rise to prominence of entrepreneurial philanthropy, the pursuit of transformational social goals through philanthropic investment in projects animated by entrepreneurial principles. Super-wealthy entrepreneurs in this way extend their suzerainty from the domain of the economic to the domains of the social and political. We explore the ethics and ethical implications of entrepreneurialphilanthropy through systematic comparison with what we call customaryphilanthropy, which preferences support for established institutions and social practices. We analyse the ethical statements made at interview by 24 elite UK philanthropists, 12 customary and 12 entrepreneurial, to reveal the co-existence of two ethically charged narratives of elite philanthropic motivations, each instrumental in maintaining the established socio-economic order. We conclude that entrepreneurial philanthropy, as an ostensibly efficacious instrument of social justice, is ethically flawed by its unremitting impulse toward ideological purity

Language Proficiency and Migration: An Argument Against Testing

This paper aims at questioning the rationale for language testing in immigration policies. Although we consider knowledge of the host country’s language(s) useful and desirable for both the migrant and the host society, we argue that mandatory language testing cannot be justified. Our purpose is to offer justifications for rejecting language as a legitimate tool for controlling state borders and to regulate (access to) citizenship of a liberal democracy