The SARA methodology has effectively been used in resource-limited countries to assess: general health facil- ity readiness , progress towards universal health coverage , maternal and child healthservices and non-communicable diseases in Bangladesh [33, 34], sur- gical services in Africa , and readiness of Ugandan healthservices for the management of outpatients with chronic diseases . That said, based on a rigorous internet-based review of literature search, there are no studies that have been conducted to assess the readiness of public health facilities to provide geriatric friendly ser- vices in low- and middle-income countries. In the same line, the WHO building blocks approach enables an as- sessor to evaluate the six critical pillars for health service delivery: leadership and governance, health financing, health service delivery, human resources for health, medical products, logistics and technologies, and health management informationsystems (HMIS)  (Fig. 1).
As RHIO/HIEs work to define the value proposition and a sustainable business model, we need to ensure that we are addressing local end-user needs. The Colo- rado IIS is one component of the stakeholder group. End-users perceive Colorado’s RHIO as an integrated data resource, where a master patient and provider in- dex resolves identity management issues and supports retrieval of federated or distributed data through a record locator service. A common vocabulary engine permits data standardization and then aggregation, to present in a user-friendly screen for review. Decision support systems permit clinical guideline applications at the point of care and in population-aggregated views. Use of the common vocabulary engine allows organiza- tion of data along a “concept” or disease. The informa- tion about the 4-year-old boy in the use case would be organized around “seizure disorder,” with most of the desired information available in a single, clear, chrono- logic view.
The Integrated Care Collaborative (ICC) of Central Texas is a fully functional HIE facilitating effort established in 1997 encompassing Austin, Texas area safety-net provi- ders. The ICC exists as a separate nonprofit entity with 24 member organizations including: hospital systems, clinics, and governmental agencies. The study sample includes all ED encounters among patients less than 18 years old between 1/1/2006 and 6/30/2009 included in the ICC’s master patient index/clinical data repository, I- Care. I-Care is a centralized database containing electro- nic patient level demographic and clinical information. ICC member organizations contribute patient level elec- tronic data to I-Care on medically indigent patients. In turn, authorized users at each location may access data from I-Care through a secured website. Authorized users vary by location, but can include physicians, nurses, and/ or administrative staff. Parents or guardians provide con- sent for minors to be included in the information exchange and this study only included consenting patients. We also excluded emergency encounters occur- ring at facilities before the hospital employed an author- ized user of the I-Care system. The final dataset included 179,445 encounters from 11 emergency departments.
Accordingly, poor records management tends to affect patient care adversely since clinical treatment of patients is dependent on case histories contained in their medical files (Asunmo and Yaya 2016: 2). Literature reviewed shows similar challenges arising out of poor medical recordkeeping practice across Africa. In Zimbabwe, a study by Chikuni (2006) found that there was no effective storage of patients’ records. As a result, it was the responsibility of patients to maintain and preserve their own patient records. According to Chikuni (2006), this practice slowed down the provision of healthservices because in most cases, patients felt it was a burden to carry around their medical records. As a consequence, medical staff could not effectively deliver healthservices since they had no records to inform their decisions. In Uganda, hospital staff appeared unaware of the importance of medical records to the treatment and follow-up of patients (Mayanja 2005: 11). In Ghana, the existing record keeping systems of some public hospitals were found not to be designed to collect information on some diseases, leading to poor monitoring, supervision, and decision-making (Adjei 2000: 5). A researcher at a rural hospital in Ethiopia described a similar challenge in which patient registration numbers were replicated, records were lost and patients were assigned new registration numbers, clinical information was recorded on loose scraps of paper, and medical records were poorly archived (Wong & Bradley 2009: 3). In South Africa, Ngoepe (2004) documented that the Western Cape Government’s Desai Commission reported that poor records management affected service delivery. Similarly, in North West and Gauteng provinces, unpaid patient bills from 1994 to 1999 totalling millions of rands had to be written off due to incomplete patient records.
Tremendous resources are required to build inte- grated informationsystems that meet the needs of di- verse practices and environments. Since 1999, HRSA/ MCHB has provided financial and technical support to 25 state public health programs to promote communi- cation among programs and linkage of information, to ensure (1) minimal duplication of data tracking between programs that serve the same populations, (2) rapid follow-up evaluation coupled with efficient effective de- livery of medicalservices and ancillary and social ser- vices, (3) adequate privacy protection, and (4) collection of appropriate outcome data for system evaluation and improvement. 26 This effort has resulted in qualitative
When we identify clusters of n-plicates, we have to decide, furthermore, whether they are real n-plicates. The last step is then to merge, not only on the identities – which is already a problem – but also the medical records relating to these identities. Even if all the global similarities are 1 in a given cluster, identified n-plicates stay "possible n-pli- cates" and only a very close examination can allow us to discard homonymic identities (in our case, same names, same first name, same date of birth, same gender and same address but different subjects). If merging clients' addresses is not so risky, the problem is quite different in the case of medical records. Complete traceability should be possible for "un-merging" clusters if necessary. The necessity of a human decision for merging is the most important limitation for a completely automatic process. Using matching variables other than the minimum set we defined would dramatically improve the efficiency of the records matching. For example, parents name or the city of birth is a very discriminatory matching variable. Fur- thermore, the first name seems to be less reliable than the birth name for comparing records, and difficulties with married names yield a complex algorithm for the calcula- tion of global similarity. Hence, perhaps the minimal set for identifying individuals is neither really reliable nor sufficient.
Although the Institute of Medicine reports have focused primarily on system failures as the source of most of the quality problems in US health care, there is increasing interest in the role that physicians play in the delivery of quality care. For almost 75 years, the American Board of Pediatrics (ABP) has addressed the issue of physician quality. The pediatric medical community created the ABP in 1933, in the aftermath of the Flexner revolution, to assure the public that physicians who were board-certified had the knowledge and skills to deliver quality care to children. The ABP has certified ⬎ 80 000 pediatric generalists and subspecialists throughout its history. Today, the almost 250 pediatric leaders from around the country who constitute the ABP set standards and develop tools to help pediatricians assess their levels of knowledge and skills to deliver quality care. The model for assessing physician quality for the past 7 decades has been based on the demonstration of medical knowledge (“the more you know, the better the care you deliver”). This model worked well until the quality revolution began to show that even well-trained, well-intentioned, board-certified physicians have unexplained variations in utilization rates, appropri- ateness, and quality. From such studies, it has become clear that medical knowledge is necessary but not sufficient for delivery of quality care.
From this study’s results and the US Depart- ment of Health and Human Services recommenda- tions for the reading levels of medicalinformation text, the readability gap between published medical research and the average American patient’s read- ing ability appears equal to 7 grade levels. Bridg- ing this chasm in accessibility will likely require interventions for both the researcher and patient. Shoring up the “health literacy” of Americans would involve a concerted effort to increase the average reading ability of patients. Purposefully addressing health literacy in K-12 education set- tings and Adult Basic Education settings may prove beneficial (Nielsen-Bohlman et al., 2004; Rudd et al., 1999). Such efforts, however, will likely not bridge the 7 grade level gap entirely. Instead, the medical research community should consider taking steps—for example, developing reading guides or parallel publications aimed at lay readers—to increase the readability of their re- search given patients’ information needs and to support patient self-advocacy.
Prehospital emergency care typically involves emergency medical technicians, paramedics, and other licensed medical providers who work in emergency medicalservices (EMS) systems in ground ambulances and ﬁxed- or rotor-wing aircraft that are dispatched to an emergency when either a bystander calls 9-1-1 or when a patient requires interfacility transport for a medical illness or traumatic injury. Because prehospital emergency care of children plays a critical role in the continuum of health care, which also involves primary prevention, hospital-based acute care, rehabilitation, and return to the medical home, the unique needs of children must be addressed by EMS systems. 1–5 Pediatric readiness encompasses the presence of equipment and medications, usage of guidelines and policies, availability of education and training,
performance by using measures to identify opportunities for improving patient care. Such improvements can include changes in policies, addition or revision of clinical protocols, and ensuring access to appropriate resources and health care facilities. Pediatric EMS QI includes several important elements, starting with the integration of pediatric-relevant content into prearrival dispatch instructions. Other components are the inclusion of pediatric data elements into prehospital patient care charts and data-reporting technology and collaboration with pediatric content-matter experts in off-line protocol development. Of critical importance are the development of relationships and a communication process between EMS and hospitals to facilitate the exchange of QI information including patient outcomes and case reviews and to include both EMS and hospitals in system data analysis. 5,56 The EIIC is spearheading a QI collaborative to assist state programs in accelerating their progress in improving the pediatric readiness of EDs through
Our findings suggest a high rate of new HIV diagnoses especially in Western Kenya. Whereas this could indicate background incidence of HIV, intensified HIV testing and case finding may have contributed to this phenomenon. The rate of new diagnoses appears to decrease especially in regions with a high HIV testing coverage. This could be an effective way of measuring the success of targeted HIV testing strategies that aim to increase the yield for case detection. It would be desirable to enhance the surveil- lance tools to further characterize these new HIV dia- gnoses in terms of their sexual behaviors, partnerships, geospatial location and access to HIV care, and viral suppression. In San Francisco and British Columbia, HIV- cased based systems have been used to estimate HIV out- comes through meticulous documentation of new cases [21, 22]. With sufficient time-series, cased-based HIS provides high-time resolution data and could also be used
Many people who live in their own homes, and who are frail or have chronic health problems, need support from a range of professionals. These include general (or family) practitioners, community nurses, therapists, social workers, and planned and emergency hospital services. There is good evidence that treatment and care is often fragmented [8–10]. Linking IT systems across a health economy can, policy makers reason, help to improve the coordination of services. Professionals can, the thinking goes, use the IT networks to communicate with one another, and hence effectively coordinate a patient’s treatment and care. The value of this function might be particularly evident at tran- sition points, for example in a health emergency or at the point of returning from hospital to home. The IT systems can also be designed to enable access to all parts of a patient’s record, so that professionals can search for and lo- cate information wherever it is held. The Obama adminis- tration in the USA committed considerable sums to linking hospital, family physician, pharmacy and other IT systems. Similarly, and more recently, the National Health Service in
reason that the use of the system will make them attain higher status than their colleagues who do not. It also sug- gests that the hospitals in Ghana might have encouraged and supported them to adopt HEIMS in the provision of quality healthcare services to their clients. UTAUT model descrip- tion of FCs is the necessary IT resources to use a system and the technical infrastructure that exists to support this usage as well as the degree to which an individual believes that an organization can provide the necessary knowledge and train- ing for HEIMS. Pertinently, since healthcare providers like nurses are likely to resist technology, there is the need to ad- equately equip them with technological equipment required for HEIMS usage and good training, else the adoption of any HEIMS could be rejected. The influence of FC with BI as the mediator on UB to use and adopt HEIMS was not statisti- cally significant (Table 4 and Fig. 2). The structural model standardized estimates and their probability values are usu- ally known (as p-values) showed that FC did not reach statis- tical significance level. In view of this, the direct influence of FC on UB to use HEIMS hypothesis was rejected. Notwith- standing, FC recorded a strong significant relationship with UB (Table 5) which indicates that when nurses receive ad- equate training, they will be confident to accept and use new and advanced health technologies in future. The Pear- son correlation between FC and BI was statistically signifi- cant (p < 0.01). From Table 4, it could be deduced that the results of the structural model of FC showed a significant positive influence on BI resulting in the acceptance of the hypothesis. The direct influence of BI on UB to use HEIMS was significant (Table 4) with explained 39.6% of variance associating with UB to use HEIMS. The hypothesis that BI will directly influence UB to use or adopt HEIMS was, therefore, accepted. Wholly, SI explained 43.2% of the vari- ance associated with UB. Hence, SI, FC and BI all directly explained 51.7% of the variance associated with usage be- havior (Table 6 and Fig. 2).
Abstract: More than half of all pregnant women take prescription medications, raising con- cerns about fetal safety. Medical databases routinely collecting data from large populations are potentially valuable resources for cohort studies addressing teratogenicity of drugs. These include electronic medical records, administrative databases, population health registries, and teratogenicity informationservices. Medical databases allow estimation of prevalences of birth defects with enhanced precision, but systematic error remains a potentially serious problem. In this review, we first provide a brief description of types of North American and European medical databases suitable for studying teratogenicity of drugs and then discuss manifestation of system- atic errors in teratogenicity studies based on such databases. Selection bias stems primarily from the inability to ascertain all reproductive outcomes. Information bias (misclassification) may be caused by paucity of recorded clinical details or incomplete documentation of medication use. Confounding, particularly confounding by indication, can rarely be ruled out. Bias that either masks teratogenicity or creates false appearance thereof, may have adverse consequences for the health of the child and the mother. Biases should be quantified and their potential impact on the study results should be assessed. Both theory and software are available for such estimation. Provided that methodological problems are understood and effectively handled, computerized medical databases are a valuable source of data for studies of teratogenicity of drugs.
Telemedicine implies the use of information technology in order to exchange medicalinformation from one site to another via electronic communications and its goal is to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology. Such applications of information technology in healthcare services can eliminate barriers regarding physical distances between patients and healthcare providers and can extend medicalservices in effective time to areas otherwise poorly or occasionally covered, like remote rural locations, isolated communities or countries with deficient medical infrastructure. As both telecommunications and medical investigation tools are domains of major scientific and
To understand the current situation of eHealth, a The aim of this paper is to take stock of the use of information and communication technologies in delivering healthservices in Nepal and identify bottlenecks in implementation for improving delivery of healthservices. A descriptive review was conducted from May to September 2016. Data were collected from organizations working on the different thematic areas in health where information and communication technologies was used. Fifteen ongoing eHealth projects were identified in the areas of monitoring and surveillance, electronic health records/electronic medical records, healthinformation system, and telemedicine. Common challenges were addressed, including a lack of funding, infrastructure, electricity and network, and national capacity. Most eHealth projects were not integrated into the national system. Working at a national level to address the challenges, centralizing eHealth projects and developing national policies would ensure to adopt eHealth at a right place and to accelerate eHealth initiatives.
The entry point into this model of care begins in the acute care inpatient setting. Once individuals are admitted, the process of care coordination begins. Admissions are defined as medical / surgical admission, behavioral health admission, or substance abuse admission. Once participation is established, follow-up appointments are made for care to continue in the medical neighborhood. The neighborhood is located in the town that is the center of the zip codes identified as the target population. All services are co-located in the facility that was once the community hospital for this population. This will enable the use of shared support resources, such as registration and reception. More importantly, the co-location concept is a core part for providers to easily communicate and collaborate with the patient and multiple caregivers to support a patient-centered care plan. It should be noted, the location of the “neighborhood” is not restricted to the brick and mortar of the facility. The staffing plan includes a community health worker (CHW) who will spend the majority of her time in the community connecting patients to existing community supports.
Overview: Despite the similarities in the UK ’ s and Dutch health care systems, such as universal health coverage, there are differences in the number of patients presenting at the Emergency Departments and the burden of crowding between these countries. Given the similarities in funding, this paper explores the similarities and differences in the organisational structure of acute care in the UK and the Netherlands. In the Netherlands, less patients are seen at the ED than in England and the admission rate is higher. GPs and so-called GP-posts serve 24/7 as gatekeepers in acute care, but EDs are heterogeneously organised. In the UK, the acute care system has a number of different access points and the accessibility of GPs seems to be suboptimal. Acute ambulatory care may relieve the pressure from EDs and Acute Medical Units. In both countries the ageing population leads to a changing case mix at the ED with an increased amount of multimorbid patients with polypharmacy, requiring generalistic and multidisciplinary care.