America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost.The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009--roughly $750 billion--was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances.About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care.This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.

Best Care at Lower Cost: The Path to Continuously Learning Health Care in America

In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. However, more than a decade after the Institute of Medicine (IOM) first studied the quality of cancer care, the barriers to achieving excellent care for all cancer patients remain daunting. Care often is not patient-centered, many patients do not receive palliative care to manage their symptoms and side effects from treatment, and decisions about care often are not based on the latest scientific evidence. The cost of cancer care also is rising faster than many sectors of medicine--having increased to $125 billion in 2010 from $72 billion in 2004--and is projected to reach $173 billion by 2020. Rising costs are making cancer care less affordable for patients and their families and are creating disparities in patients' access to high-quality cancer care. There also are growing shortages of health professionals skilled in providing cancer care, and the number of adults age 65 and older--the group most susceptible to cancer--is expected to double by 2030, contributing to a 45 percent increase in the number of people developing cancer. The current care delivery system is poorly prepared to address the care needs of this population, which are complex due to altered physiology, functional and cognitive impairment, multiple coexisting diseases, increased side effects from treatment, and greater need for social support. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis presents a conceptual framework for improving the quality of cancer care. This study proposes improvements to six interconnected components of care: (1) engaged patients; (2) an adequately staffed, trained, and coordinated workforce; (3) evidence-based care; (4) learning health care information technology (IT); (5) translation of evidence into clinical practice, quality measurement and performance improvement; and (6) accessible and affordable care. This report recommends changes across the board in these areas to improve the quality of care. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis provides information for cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industry to reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality care delivery system. By working toward this shared goal, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.

/pdf/delivering-high-quality-cancer-care-charting-a-new-course-2u1fq5ml3k.pdf

Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

Healthcare applications are considered as promising fields for wireless sensor networks, where patients can be monitored using wireless medical sensor networks (WMSNs). Current WMSN healthcare research trends focus on patient reliable communication, patient mobility, and energy-efficient routing, as a few examples. However, deploying new technologies in healthcare applications without considering security makes patient privacy vulnerable. Moreover, the physiological data of an individual are highly sensitive. Therefore, security is a paramount requirement of healthcare applications, especially in the case of patient privacy, if the patient has an embarrassing disease. This paper discusses the security and privacy issues in healthcare application using WMSNs. We highlight some popular healthcare projects using wireless medical sensor networks, and discuss their security. Our aim is to instigate discussion on these critical issues since the success of healthcare application depends directly on patient security and privacy, for ethic as well as legal reasons. In addition, we discuss the issues with existing security mechanisms, and sketch out the important security requirements for such applications. In addition, the paper reviews existing schemes that have been recently proposed to provide security solutions in wireless healthcare scenarios. Finally, the paper ends up with a summary of open security research issues that need to be explored for future healthcare applications using WMSNs.

https://www.mdpi.com/1424-8220/12/1/55/pdf

Security Issues in Healthcare Applications Using Wireless Medical Sensor Networks: A Survey

https://cyberleninka.org/article/n/693122.pdf

Survey of main challenges (security and privacy) in wireless body area networks for healthcare applications

Background Communication between primary care physicians (PCPs) and specialists regarding referrals and consultations is often inadequate, with negative consequences for patients. We examined PCPs' and specialists' perceptions of communication regarding referrals and consultations. We then identified practice characteristics associated with reported communication. Methods We analyzed the nationally representative 2008 Center for Studying Health System Change Health Tracking Physician Survey of 4720 physicians providing at least 20 hours per week of direct patient care. Outcome measures were physician reports of communication regarding referrals and consultations. Results Perceptions of communication regarding referrals and consultations differed. For example, 69.3% of PCPs reported “always” or “most of the time” sending notification of a patient's history and reason for consultation to specialists, but only 34.8% of specialists said they “always” or “most of the time” received such notification. Similarly, 80.6% of specialists said they “always” or “most of the time” send consultation results to the referring PCP, but only 62.2% of PCPs said they received such information. Physicians who did not receive timely communication regarding referrals and consultations were more likely to report that their ability to provide high-quality care was threatened. The 3 practice characteristics associated with PCPs and specialists reporting communication regarding referrals and consultations were “adequate” visit time with patients, receipt of quality reports regarding patients with chronic conditions, and nurse support for monitoring patients with chronic conditions. Conclusions These modifiable practice supports associated with communication between PCPs and specialists can help inform the ways that resources are focused to improve care coordination.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/226367/ioi05120_56_65.pdf

Referral and Consultation Communication Between Primary Care and Specialist Physicians: Finding Common Ground

This report provides a summary and explanation of the provisions in the HITECH Act, which is intended to promote the widespread adoption of health information technology (HIT) for the electronic sharing of clinical data among hospitals, physicians, and other health care stakeholders. It gives an overview of prior actions taken by Congress and the Administrations to promote HIT, and briefly describes efforts by the 109th and 110th Congresses to enact comprehensive HIT legislation.

/pdf/the-health-information-technology-for-economic-and-clinical-2rsywlq70a.pdf

The Health Information Technology for Economic and Clinical Health (HITECH) Act

The Mental Capacity Act 2005 (MCA) regulates decision-making for people without capacity. Post-legislative scrutiny of the Act in 2014 by a House of Lords Select Committee concluded that the MCA was neither well understood nor working well in practice. The aim of the research discussed in this article was to consider how the Act’s principles are understood and interpreted in hospice practice, specifically considering the patient’s role in the decision-making process. 
The research proceeded through four distinct, but linked, phases which, together, offered a ‘life story’ of the MCA from legislative intent to current hospice practice (in 2019). The research was informed by relational theory and legal consciousness theory and the methods described are underpinned by a narrative approach to analysis. Phase one was an innovative genealogical analysis of policy and legislative documents (n=24) influencing the ‘coming to be’ of the MCA. In phase two, a systematic review of Court of Protection judgments (n=63) ‘historicises’ the empirical research, which was the focus of phases three and four (group interviews and individual interviews, respectively). Staff from two participating hospices participated in two group interviews and six individual interviews (13 participants), providing empirical data. Template analysis was used in all four phases of the study, and adapted to facilitate a synthesis of the findings across the study as a whole.

/pdf/from-legislative-intent-to-hospice-practice-exploring-the-2ophk3q1.pdf

From Legislative Intent to Hospice Practice: Exploring the Genealogy of The Mental Capacity Act 2005

How do donor conceived people, their parents and donors use direct-to-consumer genetic testing (DTCGT)? DTCGT is changing how information about donor conception is accessed and managed by parents, donors and donor conceived people. Following the development and rapid expansion of DTCGT, there have been claims that ‘anonymity is dead’ in relation to donor conception (Darroch & Smith, 2021; Harper et al., 2016). Small-scale studies (Crawshaw, 2018) and media articles have reported that donor conceived adults are often finding out about the circumstances of their conception after using DCTGT. However, there is a gap in the evidence about how donor conceived people already aware of their donor conception, as well as parents through donor conception and donors, are using DTCGT. The ConnecteDNA project is an ongoing qualitative research study (March 2021-February 2024). It investigates how people in the UK, involved in donor conception, are impacted by DTCGT and considers the implications for policy and practice. This presentation focusses on phase two of the project: in-depth interviews with parents through donor conception, donors and donor conceived adults who have used, or considered using, DTCGT. So far, six donors, 13 parents through donor conception and 18 donor conceived adults have been interviewed via telephone or video call. Interviews are ongoing until September 2022. Participants were recruited by advertising the project via a range of support groups and organisations for donor conception and/or DTCGT user communities. Our findings show that people involved in UK donor conception are using DCTGT to access and manage information about donor conception. This includes donor conceived people, previously unaware of the circumstances of their conception, discovering they are donor conceived after using DTCGT. We have found that donor conceived people, already aware that they are donor conceived, may also use DTCGT in search of information about ‘donor relatives’ and/or their genetic make-up, including understandings of their ethnicity and health risks. Furthermore, some donors are using DTCGT to make themselves contactable to people conceived via their donation(s), whilst others are traced via relatives who have used DTCGT. Parents through donor conception may use, or consider using DTCGT, to trace people related to their children through donor conception. This may be done when the child is very young, with the intention of finding relatives (particularly half siblings) who they can then grow up with. Others take a more responsive approach, only using DTCGT to support a child’s request or interest in more information. DTCGT is also used to trace genetic relatives alongside, or instead of, ‘official’ routes for accessing information about donor conception, as well as social media and public records. Participants in this study are self-selecting and some groups may be under-represented in our sample (e.g. fathers through donor conception). We make no claims regarding the relative prevalence of different views and experiences. However, findings demonstrate the range of ways in which people involved in donor conception are using DTCGT. DTCGT is transforming how people involved in donor conception seek information about genetic relatives. UK law and HFEA policies will require reform to account for this. Professionals who work with people using, or considering, donor conception, should make their clients aware of the potential uses and outcomes of DTCGT. Not applicable 

C. S. Redhead

Papers

The Health Information Technology for Economic and Clinical Health (HITECH) Act

From Legislative Intent to Hospice Practice: Exploring the Genealogy of The Mental Capacity Act 2005

O-219 Donor conception and Commercial Genomics: how are donor conceived people, their parents and donors using direct-to-consumer genetic testing?