Do electronic patient information systems improve efficiency and quality of care? An evaluation of utilisation of the Discovery HealthID application

Background. Electronic health records (EHRs) appear to offer a number of potential benefits, but practitioners are often hesitant to make the transition to using them.Objectives. To determine whether the use of one such system, designed and offered by a health insurer (HealthID; Discovery Health), makes a difference to the efficiency and quality of doctor-patient consultations.Methods. A descriptive study using mixed methods was designed. A qualitative phase of individual interviews of purposefully sampled respondents was followed by a quantitative survey of a random sample of general practitioners and specialists who were registered users of the system.Results. In the qualitative findings, 18 respondents reported their perceptions of the ease of use of the application, their motivation for using it, its functions and benefits, the impact on efficiency and quality of care, and the challenges they experienced. In addition, they reported on the details of the challenges of using the system, and made suggestions for improvements, particularly with regard to the need for training and IT support. The quantitative results from the majority of 93 respondents confirmed that while the use of the app improved patient care through positive effects on specific functions such as access to accurate patient records and easier Chronic Illness Benefit applications, they felt that it had an equivocal impact in other areas, such as maintaining patient confidentiality and enhancing teamwork and efficiency. The financial incentives offered by Discovery Health, as well as possibly the training and support provided, appear to be more influential for high-frequency than for low-frequency users. The majority said that it did not help with referrals or script writing, or with access to International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) codes.Conclusions. EHR systems like Discovery Health’s HealthID could improve the efficiency of medical consultations by increasing access to stored health information without requiring data entry by clinicians, and thereby have the potential to indirectly improve the quality of care, provided that certain conditions are met.

Final Technical Report - Open Architectures, Standards and Information Systems (OASIS II) – Developing Capacity, Sharing Knowledge and Good Principles across eHealth in Africa

The OASIS II project aimed to build on aspects of the Open Architectures, Standards and Information Systems for Healthcare in Africa (OASIS) project, previously funded by IDRC through the South African Medical Research Council. The objectives of the project included over-arching, network-wide objectives and individual project objectives. In addition, OASIS II aimed to investigate a shared research purpose and combine existing methods between one existing and four new projects and partners to: 1) elaborate a network-wide OASIS II research methodology, 2) establish an open enterprise architectural framework for eHealth in developing countries and 3) create a collaborative framework for sharing new evidence regarding the impact of eHealth solutions in resource-poor settings

Circulating biomarkers of immune activation distinguish viral suppression from nonsuppression in HAART-treated patients with advanced HIV-1 subtype C infection

Please read abstract in article.This research was partially funded by a Grant from the Delegation of the European Union to South Africa: “Drug Resistance Surveillance and Treatment Monitoring Network for the Public Sector HIV Antiretroviral Treatment Programme in the Free State,” Sante 2007/147-790 and Medical Research Council of South Africa, Unlocking the Future 61509.http://www.hindawi.comam201

First experiences in the implementation of biometric technology to link data from Health and Demographic Surveillance Systems with health facility data

BACKGROUND: In developing countries, Health and Demographic Surveillance Systems (HDSSs) provide a framework for tracking demographic and health dynamics over time in a defined geographical area. Many HDSSs co-exist with facility-based data sources in the form of Health Management Information Systems (HMIS). Integrating both data sources through reliable record linkage could provide both numerator and denominator populations to estimate disease prevalence and incidence rates in the population and enable determination of accurate health service coverage. OBJECTIVE: To measure the acceptability and performance of fingerprint biometrics to identify individuals in demographic surveillance populations and those attending health care facilities serving the surveillance populations. METHODOLOGY: Two HDSS sites used fingerprint biometrics for patient and/or surveillance population participant identification. The proportion of individuals for whom a fingerprint could be successfully enrolled were characterised in terms of age and sex. RESULTS: Adult (18-65 years) fingerprint enrolment rates varied between 94.1% (95% CI 93.6-94.5) for facility-based fingerprint data collection at the Africa Centre site to 96.7% (95% CI 95.9-97.6) for population-based fingerprint data collection at the Agincourt site. Fingerprint enrolment rates in children under 1 year old (Africa Centre site) were only 55.1% (95% CI 52.7-57.4). By age 5, child fingerprint enrolment rates were comparable to those of adults. CONCLUSION: This work demonstrates the feasibility of fingerprint-based individual identification for population-based research in developing countries. Record linkage between demographic surveillance population databases and health care facility data based on biometric identification systems would allow for a more comprehensive evaluation of population health, including the ability to study health service utilisation from a population perspective, rather than the more restrictive health service perspective

Application of handheld devices to field research among underserved construction worker populations: a workplace health assessment pilot study

This is the final version of the article. Available from BioMed Central via the DOI in this record.BACKGROUND: Novel low-cost approaches for conducting rapid health assessments and health promotion interventions among underserved worker groups are needed. Recruitment and participation of construction workers is particularly challenging due to their often transient periods of work at any one construction site, and their limited time during work to participate in such studies. In the present methodology report, we discuss the experience, advantages and disadvantages of using touch screen handheld devices for the collection of field data from a largely underserved worker population. METHODS: In March 2010, a workplace-centered pilot study to examine the feasibility of using a handheld personal device for the rapid health assessment of construction workers in two South Florida Construction sites was undertaken. A 45-item survey instrument, including health-related questions on tobacco exposure, workplace safety practices, musculoskeletal disorders and health symptoms, was programmed onto Apple iPod Touch® devices. Language sensitive (English and Spanish) recruitment scripts, verbal consent forms, and survey questions were all preloaded onto the handheld devices. The experience (time to survey administration and capital cost) of the handheld administration method was recorded and compared to approaches available in the extant literature. RESULTS: Construction workers were very receptive to the recruitment, interview and assessment processes conducted through the handheld devices. Some workers even welcomed the opportunity to complete the questionnaire themselves using the touch screen handheld device. A list of advantages and disadvantages emerged from this experience that may be useful in the rapid health assessment of underserved populations working in a variety of environmental and occupational health settings. CONCLUSIONS: Handheld devices, which are relatively inexpensive, minimize survey response error, and allow for easy storage of data. These technological research modalities are useful in the collection and assessment of environmental and occupational research data.This study was supported in part by the National Institute for Occupational Safety and Health (NIOSH)'s Deep South Educational Research Center at the University of Alabama (sub-contract: 288477-10) as a Graduate Student Pilot Grant Award; the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) grant F31AR057687 and the National Institute for Occupational Safety and Health (NIOSH) grant R01 OH003915

Technological Change in Economic Models of Environmental Policy: A Survey

This paper provides an overview of the treatment of technological change in economic models of environmental policy. Numerous economic modeling studies have confirmed the sensitivity of mid- and long-run climate change mitigation cost and benefit projections to assumptions about technology costs. In general, technical progress is considered to be a noneconomic, exogenous variable in global climate change modeling. However, there is overwhelming evidence that technological change is not an exogenous variable but to an important degree endogenous, induced by needs and pressures. Hence, some environmenteconomy models treat technological change as endogenous, responding to socio-economic variables. Three main elements in models of technological innovation are: (i) corporate investment in research and development, (ii) spillovers from R&D, and (iii) technology learning, especially learning-by-doing. The incorporation of induced technological change in different types of environmental-economic models tends to reduce the costs of environmental policy, accelerates abatement and may lead to positive spillover and negative leakage

Modeling HIV-1 Drug Resistance as Episodic Directional Selection

The evolution of substitutions conferring drug resistance to HIV-1 is both episodic, occurring when patients are on antiretroviral therapy, and strongly directional, with site-specific resistant residues increasing in frequency over time. While methods exist to detect episodic diversifying selection and continuous directional selection, no evolutionary model combining these two properties has been proposed. We present two models of episodic directional selection (MEDS and EDEPS) which allow the a priori specification of lineages expected to have undergone directional selection. The models infer the sites and target residues that were likely subject to directional selection, using either codon or protein sequences. Compared to its null model of episodic diversifying selection, MEDS provides a superior fit to most sites known to be involved in drug resistance, and neither one test for episodic diversifying selection nor another for constant directional selection are able to detect as many true positives as MEDS and EDEPS while maintaining acceptable levels of false positives. This suggests that episodic directional selection is a better description of the process driving the evolution of drug resistance