Electronic Medical Record Adoption in New Zealand Primary Care Physician Offices

Describes EMR adoption in New Zealand's primary healthcare system, including how government investment was secured and data protection laws, unique patient identifiers, and standards and certification were established, with lessons for the United States

Electronic Health Records: An International Perspective on "Meaningful Use"

Examines the extent of meaningful use of electronic health records in Denmark, New Zealand, and Sweden, including sharing information with organizations, health authorities, and patients. Outlines challenges of and insights into encouraging U.S. adoption

Mode Structure of a Transparent Cathode Discharge

In this paper, we characterize a Transparent Cathode Discharge (TCD), a type of Inertial Electrostatic Confinement (IEC) plasma, operated in helium and argon in the pressure range of 1-100 Pa. The discharge was investigated using a combination of electrical and optical diagnostic techniques. The imaging of the discharge indicated distinct operating regimes related to the background gas pressure, with each mode being characterized by different patterns of optical emission. The spectroscopic analysis of the optical emission showed that this mode structure represented an electron-driven discharge at higher pressures, and a discharge sustained by the activity of energetic heavy particles at lower pressures. The high-pressure discharge is shown to be assisted by the hollow cathode effect toward its low-pressure limit, and the visible color of emission from the discharge in helium is found to provide a convenient diagnosis of active species. The identification of a stable discharge mode in which energetic heavy particles are responsible for collisional processes has the potential to lead to new industrial applications based on this novel heavy particle-driven reactive plasma source

Adoption of information technology in primary care physician offices in New Zealand and Denmark, part 1: healthcare system comparisons

Denmark and New Zealand are two small countries whose primary care physicians are at the forefront of the use of electronic medical records (EMRs). This is the first of a series of five papers which contrasts the health care systems in Denmark and New Zealand. Though the delivery of care at the patient level is virtually the same in New Zealand and Denmark the way in which the health care is financed; administered and managed does vary. This paper highlights the differences; particularly in terms of the approaches taken to primary care and out-of-office-hours services

Adoption of information technology in primary care physician offices in New Zealand and Denmark, part 2: historical comparisons

This second paper in a series of five looks at how computing in primary care began and provides background to the driving forces for automation in Danish and New Zealand primary care physician offices. It addresses topics such as government funding support, the role of professional colleges and associations, peer influence, change management, and comparative cultures. It also highlights the power of a unifying organisation and introduces the concept of a Health Systems Integrator

Adoption of information technology in primary care physician offices in New Zealand and Denmark, part 5: final comparisons

This is the last in a series of five papers about the use of computing technology in general practitioner (GP) practices in Denmark and New Zealand. This paper introduces a unique comparison instrument developed for this study using the best evidence available namely data was pulled from centralised databases and was indisputable (e.g. percentage of primary care physicians who send medication prescriptions electronically to pharmacies). Where the data was simply not available, estimates were made. Since the reliability of the data on the use of computers by primary care physicians is so variable and in some case simply not available, the authors also introduce the use of a Cochrane-like confidence factor (CF) to each comparison measure. The paper draws particular attention to the fact that both countries have a highly visible central unifying body or what might be called a Health System Integrator; though Denmark s Medcom is a pseudo government agency New Zealand's HealthLink is a private company, both play critical roles in the success story of these two countries

Adoption of information technology in primary care physician offices in New Zealand and Denmark, part 3: medical record environment comparisons

This is the third in a series of five papers about the use of computing technology in general practitioner (GP) practices in Denmark and New Zealand. This paper looks at the environments within which electronic medical records (EMRs) operate, including their functionality and the extent to which electronic communications are used to send and receive clinical information. It also introduces the notion of a longitudinal electronic health record (versus an EMR)

Adoption of information technology in primary care physician offices in New Zealand and Denmark, part 4: benefits comparisons

This is the fourth in a series of five papers about the use of computing technology in general practitioner (GP) practices in Denmark and New Zealand. This paper looks at the reasons why physicians use computers with a particular emphasis on the benefits gained from automated medication prescriptions. It includes an assessment of the growth of key applications in New Zealand as well as a comparative summary of the success factors in both countries

Sensitivity to missing not at random dropout in clinical trials:Use and interpretation of the trimmed means estimator

Outcome values in randomized controlled trials (RCTs) may be missing not at random (MNAR), if patients with extreme outcome values are more likely to drop out (eg, due to perceived ineffectiveness of treatment, or adverse effects). In such scenarios, estimates from complete case analysis (CCA) and multiple imputation (MI) will be biased. We investigate the use of the trimmed means (TM) estimator for the case of univariable missingness in one continuous outcome. The TM estimator operates by setting missing values to the most extreme value, and then “trimming” away equal fractions of both groups, estimating the treatment effect using the remaining data. The TM estimator relies on two assumptions, which we term the “strong MNAR” and “location shift” assumptions. We derive formulae for the TM estimator bias resulting from the violation of these assumptions for normally distributed outcomes. We propose an adjusted TM estimator, which relaxes the location shift assumption and detail how our bias formulae can be used to establish the direction of bias of CCA and TM estimates, to inform sensitivity analyses. The TM approach is illustrated in a sensitivity analysis of the CoBalT RCT of cognitive behavioral therapy (CBT) in 469 individuals with 46 months follow‐up. Results were consistent with a beneficial CBT treatment effect, with MI estimates closer to the null and TM estimates further from the null than the CCA estimate. We propose using the TM estimator as a sensitivity analysis for data where extreme outcome value dropout is plausible

The Pennsylvania Environmental Resource Consortium: A State-Wide Collaborative Network for Sustainable, Outreach, Education, and Action

This paper explores the organizational theory, programs, and concomitant challenges faced by a state-level higher education consortium for sustainability in the United States, the Pennsylvania Environmental Resource Consortium (PERC). We provide insights for other institutions of higher education that may want to form consortia or consider changes to existing consortia. PERC members collaborate to advance sustainability on member campuses, in local communities, and across the Commonwealth. PERC envisions thriving, just communities on a healthy planet, and seeks to inspire higher education communities throughout the Commonwealth to lead transformational sustainability efforts through example, expertise, and collaboration. This chapter provides a brief theoretical background in PERC as a collaborative. It shares history and context for PERC’s mission and activities as well as an overview of its programs. It includes reflections on challenges to collaboration and coordination, including from COVID-19, changing digital technology, disparities among PERC institutions, accelerating sustainability challenges in the Anthropocene, anti-intellectualism and hyperpartisanship in the Commonwealth and the United States, and PERC’s own staffing, volunteerism, participation, and funding challenges. The chapter closes by revisiting the organization’s 2021–2025 Strategic Plan as an invitation to consider how cooperation, coordination, and collaboration among higher education institutions can positively impact sustainability across sectors