Showing papers in "Health policy and technology in 2017"

A review of PHR, EMR and EHR integration: A more personalized healthcare and public health policy

Abstract: Objective To review and present the relationship and need for integrating EMR, EHR and PHR data, by highlighting its use and value challenges and threats. Method Critical overview of the literature. Results Electronic Medical Records (EMR) and Electronic Health Records (EHR) are used by physicians to improve quality of care and contain costs. Whereas EMR is usually considered an internal organizational system, the EHR is defined as an inter-organizational system. Recently, a computerized platform for patient-centered medical care known as Personal health records (PHR) was introduced, as an enabler for self-management of medical records. PHRs are online systems used by patients. Their transparency of information should lead to better informed and engaged patients. PHR, EMR and EHR can reside on different platforms under various technologies and standards. Although EMR contains local information and provides fast and accurate delivery, the major advantage of EHR in medical practice is the availability of cross-provider medical information. Patient-centered health initiatives such as PHR enable the integration of the prime information components in the EMR and the EHR systems. Conclusion This integration of medical information combines demographic, lifestyle and behavioral data with health records, thus providing a comprehensive view that coincides with the definition of patient-centered medical care. It can lead to a dramatic amelioration in personalized care as well as public health decision-making, resulting in improved health and wellness, but also poses serious challenges and threats to security and privacy.

Patient access to electronic health records : Differences across ten countries

Abstract: Objectives Patient-accessible electronic health records (PAEHRs) are being implemented at international scale. Comparing policies and systems could allow countries to learn from each other to address global and nation-specific challenges. We compare national PAEHR policy (hard and soft regulation) and services in 10 countries. Methods PAEHR policy and system documentation was gathered from Australia, Denmark, Estonia, Finland, France, the Netherlands, New Zealand, Norway, Sweden and the United States. A basic analytic model for policy analysis was used to delimit our focus to policy content, followed by an inductive thematic analysis across countries, in which we clustered initial themes into a set of categories of PAEHR service “approaches” related to three specific content areas. Results Although all 10 countries ensured some patient rights to access medical records, policies and systems were highly variable, as were the technological processes arising from these. In particular, three policy areas showed great variability. Depending upon country of origin, a patient would encounter differences in: login procedures (security), access to own and other patients’ data during adolescence (user rights), and types of medical data made available to the patient (data sets). Conclusions Individuals encounter very different access rights to their medical data depending on where they live. Countries may be able to develop improved policies by examining how other nations have solved common problems. Harmonizing policies is also an initial step likely to be needed before cross-national PAEHRs could be possible.

Privacy and security issues in mobile health: Current research and future directions

Abstract: Mobile health (mHealth) is being recognized as an innovative approach to deliver health care in an accessible, portable and cost effective manner. Despite the numerous benefits associated with the use of mobile devices, there are major concerns with mhealth in the area of privacy and security. These aspects need to be considered at every stage of design and development of mHealth devices and applications which need to be developed by security-trained, trusted manufacturers who should be accountable to minimize damages in the healthcare industry. It is also crucial for users and/or organizations to be more cautious and responsible to use mobile devices. Major stakeholders, including those in the user׳s community (patients and providers), vendors and developers, and policy makers need to come together to survey the landscape, identify the issues, and develop policies, regulations, safeguards and industry standards.

Investigation of Physicians' Awareness and Use of mHealth Apps: A Mixed Method Study

Abstract: Objective The study aims to understand physicians' awareness of mobile health (mHealth) apps and their intentions to use these apps in medical practice. Method Mobile Health Technology Acceptance Model (M-TAM) was tested employing the sequential explanatory mixed method. An online survey and focus group interviews were conducted for data collection. Physicians were invited to participate in the survey. Structural Equation Modeling (SEM) was used in quantitative data analysis. Qualitative data were analyzed using coding, memo, and contextual analyses. Results 151 physicians participated in the survey, representing a 15% response rate. The model was able to explain physicians' intention to use mHealth apps by explaining 59% of the total variance. Performance Expectancy, Mobile Anxiety, Perceived Service Availability and Personal Innovativeness were major influencing factors of Behavioral Intention. Qualitative codes outlined that information gathering and communication purposes were the major enablers in mHealth app usage. In that regard, Communication and Consulting, Clinical Decision Making, Reference and Information Gathering, and Information Management are the most popular app categories. On the other hand, lack of knowledge and lack of investment were seen as the major barriers to mHealth app usage. Conclusions User perception and intentions are important factors in technology use. Thus, the preferences, expectations, and characteristics of physicians which were outlined in this research could be significant inputs for researchers, app developers, managers and policymakers.

Changing of China׳s health policy and Doctor–Patient relationship: 1949–2016

Abstract: Objective To identify the changing of health policy decisions and Doctor–Patient relationship in different periods in China during 67 years (1949–2016) Methods We followed a systematic approach to analyze the development stage of China׳s healthcare reform and Doctor–Patient relationship over time Based on the extant literature and statistical data, the current five issues in Chinese health policy and three aspects of Doctor-Patient Relationships are classified The reasons for the current situation and recommendations for future policy are discussed Results There are four main problems of Chinese Health Policy: funding shortage, excessive market-oriented operation, health insurance limited reimbursement amount, and media coverage a lot of non-neutral health events In different historical periods, these problems are not prominent, but have become increasingly serious in recent years On the other hand, three participants contributed to the growing tense relationship between doctors and patients: doctors (hospitals), patients and governments Conclusions In formulating future health care policy, the government should change: increase investment in the medical field, change the income structure of doctors and hospital, propagate medical news in an objective way, and increase the amount and scope of medical insurance repayment

Patient access to electronic psychiatric records: A pilot study

Abstract: Background OpenNotes, a national movement offering patients access to their doctor׳s notes, lies at the intersection of health policy and health technology. Despite interest in OpenNotes, little is known about how such may be implemented in psychiatry departments using electronic medical records. This study reports on the first pilot project to examine the experience of patients and clinicians when open access to psychiatric records was provided within an ongoing treatment relationship. Methods Fifteen clinicians in an outpatient psychiatry clinic in a Boston medical center agreed to participate in the study and 52 of their patients to participate. Those patients had the opportunity to read their progress notes through a patient site linked to an electronic medical record. Patients and clinicians were surveyed 20 months later. Results Results from this select group suggest that open access to notes was perceived as helpful to patients and did not negatively impact the patients or the treatment relationship. In addition, our experience was that mental health clinicians could be engaged in the process of OpenNotes. Conclusion This is the first study to implement and assess the impact of patients’ access to psychiatric records in an outpatient setting. Although many questions remain to be studied and a more diverse sample is needed for future research, the potential impact to enhance mental health treatment and the patient-clinician relationship is suggested for selected psychiatric patients. Policy around providing psychiatry patients access to their notes can be informed by reactions of both clinicians and patients.

Access policy and the digital divide in patient access to medical records

Abstract: Background Patient access to medical records may help them manage their healthcare. After socioeconomic disparities were found in early adoption of a patient portal, a safety net medical organization implemented universal access policies, a mobile portal app, and a Spanish version. The objective of this study was to estimate the effect of the changes on socioeconomic disparities in use of the patient portal. Methods Retrospective cohort study of 129,738 adult patients visiting the Institute for Family Health between 2011 and 2014. Logistic regression was used to model the odds of receiving portal access and using the portal. Results In 2011, members of socioeconomically disadvantaged groups were less likely to receive offers to use the portal and subsequently to use it. In 2014, black patients became just as likely as other racial groups to use the portal, but publicly insured and uninsured patients were still less likely to become users. Uptake of the mobile app was slow. Conclusions Replacing an opt-in policy with a universal access policy was associated with a large reduction in socioeconomic disparities between those who did and did not access their medical records. However, a small digital divide remained evident in use of the technology, probably due to structural factors beyond the control of the healthcare system such as lack of computer access by less affluent patients.

Predicting obesity rate and obesity-related healthcare costs using data analytics

Abstract: Objective Obesity is a worldwide problem that has been linked to serious medical issues. Obesity-related conditions drain healthcare expenditures globally, and in particular in the U.S. This article suggests methods to forecast future costs associated with obesity-related healthcare in the next two decades. Methods An Auto Regressive Integrated Moving Average (ARIMA) time series analysis was implemented to model the data published by the Center for Disease Control and Prevention. Results The findings suggest that the proportion of individuals in the population defined as overweight will decline slowly in the next 20 years. However, the proportion of the population considered obese will increase substantially and could represent as much as 45% of the entire population by 2035. The proportion of morbidly obese will also increase considerably. These trends are likely to impact the actual costs of healthcare considerably. Conclusions Policy makers in the healthcare sector should be aware of this trend and prepare to deal with increasing numbers of medical problems related to obesity. Concrete recommendations for policy makers are put forward in the discussion as well as avenues for future research.

Enablers and inhibitors: A review of the situation regarding mHealth adoption in low- and middle-income countries

Abstract: Objective The objective of this review is to identify enabling and inhibiting factors for mHealth adoption in low resource settings, by giving emphasis on the stakeholders representing the caregiving side. Another objective of this study is to support implementation agencies (governmental and non-governmental) in designing scalable mHealth interventions. Methods A PEO (Population, Exposure, Outcome) approach was used to formulate the review question. A pre-defined search strategy was implemented; Google Scholar, PubMed and gray literature were searched using alternate terms for “mHealth”, “adoption” and “developing countries”. CASP [7] tools were used to assess the quality of selected evidence. After applying inclusion and exclusion criteria on search results and critical appraisal of the selected evidence, twelve studies were selected for the review. Results Adoption factors operated at the levels of organization, facility-based service provider and frontline health worker. Engagement of end users during design phase, informed clinical decision making, utilization of mHealth evidence, employers’ tolerance of some personal use of devices, automation of tasks and user-friendliness of application are key enabling factors for mHealth adoption in developing countries. On the contrary, absence of national policy on mHealth, poor knowledge base on mHealth, using two systems in parallel, duplication of efforts, poor Internet connectivity and shortage of electricity are important inhibiting factors for mHealth adoption. Conclusions The review provides an insight about the challenges and opportunities related to mHealth adoption in developing countries. Implementation agencies should give careful consideration to these factors before designing and deploying any mHealth-enabled intervention. It is also important to understand the concept of incremental innovation so that resources spent on pilot interventions are optimized and full potential is achieved.

Textual analysis and visualization of research trends in data mining for electronic health records

Abstract: Objectives Medical data mining is one of the most widely used techniques for discovering latent knowledge from databases, which in turn contributes to clinical decisions. In the past decade, medical data mining has advanced rapidly. The objective of this study is to analyse research trends and explore the general research framework in data mining for electronic health records (EHRs). Methods We first conducted a literature retrieval in PubMed, the Web of Science (WOS) core collection, and the Association for Computing Machinery (ACM) digital library for peer-reviewed records (n = 2516) related to data mining for EHRs from 2000 to 2016. Then, we adopted the Latent Dirichlet Allocation (LDA) and Topics over Time (TOT) models to extract topics and analyse topic evolution trends in the retrieved records. The former mainly analysed topic generation, division, mergers and extinction, while the latter analysed the evolution of topic intensity over time. Results We extracted the important topics and analysed topic evolution. We present the general research framework of data mining for EHRs by combining the topic co-occurrence relations and domain knowledge, including the data, methods, knowledge, and decision levels. Conclusions Our work can provide high-level insight for scholars in this emerging field and guide their choices of medical data mining techniques in healthcare knowledge discovery, medical decision support, and public health management.

Patient empowerment and engagement with a health infomediary

Abstract: Objectives This study explores the role of three types of empowerment, psychological, discretionary, and leadership, on sustained engagement with a health infomediary. Discretionary empowerment refers to authority, psychological empowerment is the manifestation of inherent motivation and response, and leadership empowerment is the trait of knowledge-based control and governance for a group in an infomediary. Sustained engagement is critical for patients to derive long-term benefits from an infomediary. Relationships between the three types of patient empowerments on sustained patient engagement is conceptualized and operationalized with testable hypotheses. Methods Data from a health infomediary providing a knowledge exchange platform for patients interested in cosmetic surgery was obtained through the website. Probit regression models were used to test hypotheses using daily activity observations of 21,715 patients during the first 30 and 60 days of their engagement with the infomediary platform. Results All three empowerment types have positive association with sustained engagement. In addition, leadership empowerment is shown to play a higher role than discretionary or psychological empowerments in sustaining patient engagement. Conclusions Identifying empowered patients is likely to benefit health infomediaries. Leadership empowerment has a greater role than discretionary or psychological empowerments in sustaining patient engagement with infomediaries. Incentive structures around promoting patients towards leadership empowerment are likely to generate positive returns for health infomediaries.

Assessing eHealth skills across Europeans

Abstract: The Internet has made health information more assessable to the general public. However, some serious concerns remain about the quality and reliability of that information, and the ability of the population to accurately interpret these data. An important aspect interpreting healthcare information are eHealth skills. To date, the available evidence is usually based on national analyses of composite measures of eHealth skills. To contribute to the debate our paper analyses particular eHealth skills based on data from a pan-European Union data set. In particular, with microdata from a representative sample, five skills are analysed, viz. searching, locating, understanding, evaluating and using online health information. We use a discrete choice model to identify statistical associations between respondent socio-demographic characteristics and skills. Our analysis reveals a complex pattern of eHealth skills is present across socio-demographic groups, with only self-reported health status and Internet experience influential for all skills. This finding suggests that targeted training actions are necessary to improve eHealth kills, with the seniors and the less educated the groups most in need of training.

Telemedicine services: How to make them last over time

Abstract: Objectives Telemedicine is extensively used in healthcare settings, although we still lack knowledge on how to make telemedicine services last over time. This study aims to: investigate how the factors supporting the implementation of telemedicine services affect their duration over time; explore if further factors need to be considered, to foster the services duration. Methods We conducted a six-year in-depth study on three Italian cases of telemedicine services lasting more than 10 years. Dimensions explaining the duration of services over time are explored and discussed against existing literature. Results The three cases show that, to support the duration over time, financial and organizational stability should be set before the “champion” leaves the service. Financial stability was reached through different strategies. About organizational stability, we found that providing opportunities to enrich the competences and getting more responsibilities over the patients enhanced the professionals’ acceptance, which, in turn, supports the organizational stability of the service over time. About patients, to meet their crucial needs for their health and to receive the nurses’ support on the use of technologies contains the abandon and increases the chances for the service to last over time. Last, the three services observed pursued a strategy of focalization on a specific need. Conclusions The findings provide insights for policy makers and hospital managers on how to set effective services and avoid service abandon, thus reducing waste of resources, and on how to motivate the professionals and patients, by increasing the chances of duration of the services over time.

Promoting China's mHealth market: A policy perspective

Abstract: Background The mobile health (mHealth) service is experiencing worldwide escalation due to the invaluable support it provides to a rapidly expanding elderly population and patients with chronic conditions. However, the mHealth market in China is aberrated in comparison with other countries in two major aspects: 1) the monitoring service is a minority market; and 2) the potential users (the elderly and patients with chronic conditions) lack the interest for using this service. Method To explain this understated condition, we examine the specific policies on the mHealth service and the current healthcare system in China, with suggestions for forming mHealth policies. Results Based on our policy analysis, this research proposes several political and practical suggestions for mHealth implementation in China. Along with the characteristics of the mHealth market, this research further develops a healthcare ecosystem connecting major stakeholders, including the government, the community, service providers, health professionals, drug manufacturers, and data-analysis organizations. Our suggestions will be beneficial to China's mHealth market in the business sense and provide insights for policymakers on how to regulate the market.

Development of Nationwide Electronic Health Record (ΝEHR): An international survey

Abstract: The primary aim of this research is to capture the existing experience from countries where nationwide EHR systems have already been implemented or the development is in a mature phase. To capture the necessary information, an international survey has been conducted with expert participants from 13 countries. The results of this research show that private vendors׳ involvement in most of the system development lifecycle phases is inevitable. However, the phase where most private vendors are involved in during the development of an EHR system is System Design. Interestingly, their involvement does not depend on who has the responsibility of the EHR system development (either a national organization or a private vendor). Finally, examining the supported standards by EHR systems and their interoperability with other information systems, in respect to both technical and semantic interoperability, it is found that more efforts should be made for the integration of the most widely supported standards, and the enhancement of interoperability among health information systems, which will lead to the successful integration of a NEHR system.

Constructing a nationwide interoperable health information system in China: The case study of Sichuan Province

Abstract: Objectives China has set up an ambitious goal to complete the construction of a nationwide interoperable health information system (HIS) by the end of 2020. This paper provides a policy analysis, from the perspective of a province, on how China achieves nationwide interoperability through integrating Population Health Information Platforms (PHIP), developed by healthcare authorities at different levels, with HIS implemented by healthcare institutions. Methods An analytical framework, with a focus on interoperability between PHIPs and healthcare institutions’ HIS, is proposed and used to analyze Sichuan Province׳s interoperable HIS to shed light on China׳s approach. To assure the validity of our research, this study analyzed data collected from multiple sources including literature review, web-based search, and interviews with staff from healthcare institutions. Results China׳s approach to constructing a nationwide HIS offers great potential and flexibility through delegating PHIP construction to healthcare authorities at different levels. Our findings reveal that developed PHIPs have strong capacities for health information exchange. China׳s approach provides clear guidelines and standards such that healthcare authorities able to complete the construction of PHIPs on time. However, remedial policies are needed to improve the effective use and sustainability of completed systems. Conclusions To maximize use of developed systems, China government should: a) define a monitoring policy to ensure full observation of construction guidelines; b) promote a new payment mechanism to motivate information sharing; c) clarify the role of PHIPs, at different levels, to assure their effective use; d) provide incentives for non-public institutions to participate in EMR adoption.

Factors influencing health data sharing preferences of consumers: A critical review

Abstract: The purpose of this critical review is to synthesize available literature and identify factors influencing consumer data sharing preferences, while presenting a logic model for legal / public policy development that aligns with consumer expectations for management of ePHI. Eighteen articles were included for the critical review; including 16 studies from three countries. The fourteen cross-sectional studies were evaluated using Olsen and St. George׳s (2004) Cross-sectional Study Design and Data Analysis framework and two qualitative studies were assessed using Kuper, Lingard, & Levinson (2008) [14] Critically Appraising Qualitative Research strategies. An emerging classification schema of statistically significant factors identified in this critical review shows that, (1) Trust relationship, (2) Harm Threshold, (3) Balance Risk and Benefits, (4) Transparency of Data Exchange and (5) Access and Control of Data are important when considering how to best include the consumer voice in the development of legal / public policies related to the privacy, security and consent management of ePHI.

eHealth strategies and platforms – The issue of health equity in Sweden

Abstract: Objective This paper critically reviews the national strategies on e-health development in Sweden during the last decade. The aim is to identify the discourses that drive the development and implementation of eHealth in Sweden, with a particular focus on the rationales behind the government initiated PHR platform HalsaForMig (HealthForMe), and discuss them in relation to health equity. Methods The empirical base for this study is government policy documents and interviews made with policy makers in the e-health sector in Sweden. The research design builds on qualitative text analysis method drawing on epistemological and ontological assumptions from discourse analysis. Results Our framework for analysis focuses on governing aspects of the eHealth sector drawing on the works of governmentality theorists. We have identified how the eHealth sector is increasingly governed through market mechanisms, healthism and responsibilisation and is forming individuals into self-managing health-conscious consumers in a way that may undermine reaching other core values in society such as health equity. It also shows that the design and administration of HalsaForMig aim to stimulate innovation in the eHealth sector thereby illustrating the interrelationship between the governing techniques of market mechanism and healthism. Conclusion In order to close health gaps in a population the core governing rationalities driving the development in the eHealth sector have to be identified, monitored and evaluated to foresee if they help or hinder health equity.

Assistive technology for independent living with dementia: Stylized facts and research gaps

Abstract: Background Recent advancement in assistive technologies (AT) have fueled the debate on new, IT-reliant ways of providing cure and care of dementia. Still the impact on practice has been little. With this paper, we want to find out to which extent current studies have discussed the impacts of AT for dementia. Methods We conduct a scoping review of the literature on impacts of AT usage in the context of dementia. We search disciplinary (ACM, EMBASE, PsycInfo) as well as cross-disciplinary databases (EBSCO, Web of Science). Based on the identified relevant papers, we extract a list of original statements, which we aggregate to stylized facts. The method of stylized facts is a common research method to derive knowledge in the form of generalized and simplified statements describing interesting characteristics and relationships concerning empirically observable phenomena. Results We identify n=539 unique articles, out of which n=36 report impacts of AT usage in the context of dementia. We aggregate 6 stylized facts that describe common findings. Furthermore, we identify research gaps in this domain. There is little known about the suitable design of social systems around assistive technologies. Conclusions While the identified stylized facts indicate how much evidence there is behind certain common statements in the reviewed literature, we additionally find that studies in the area of AT for dementia often neglect the socio-economic and ethical dimension. These are important research gaps for future work.

Dynamic capabilities in e-health innovation: Implications for policies

Abstract: Objective To mitigate the effect of caregiver shortage, collaborative networks in Norwegian municipalities are exploring the possibilities provided by e-health and welfare technologies. However, extracting benefits from such technologies depends on many factors. Methods In this study, an extensive literature review is performed to compare e-health and other sectors in terms of the critical success factors in collaborative business process management. Using the dynamic capabilities view as a general theoretical lens, and a process orientation framework for operationalization, these factors are then conceptualized and validated in a cross-sectional study of cases in the Norwegian municipal e-health sector. Results The study contributes to e-health research by identifying the key factors that influence performance. These factors are significantly driven by government policies and regulations. Our findings challenge the assumption that welfare technology networks can be built from the bottom up without government intervention. Regulatory interventions are needed, to obtain process performance metrics and foster viable, long-term business models for the participating institutions. Conclusion The findings have an impact on research and practice, especially in local public management, for predicting and prescribing future development in this context. There are indications of significant gaps in government policies and regulations. Further research should examine whether and how these findings transcend the chosen context.

Evolving large scale healthcare applications using open standards

Abstract: Electronic Health Records (EHRs) are becoming more prevalent in health care. Worldwide exchange of healthcare data demands adherence to semantic interoperable standards to overcome the language and platform barriers. Various healthcare organizations in developing countries such as, India adopt their own independent information systems without adhering to standard guidelines. Thus, this tends to sacrifice interoperability. This affects permanent persistence of longitudinal health records for future reference and research purpose. Current research implements a standard based clinical application to be used for healthcare domain in India. The study has been done for enhancing the data quality through standardization. It aims at providing a generic permanent persistence to track life-long interoperable health records of patients. This is the first effort for exploring its adoption for various regional languages in India. The user interfaces have been generated for various Indian languages for testing on a sample set of archetypes. The clinical application deployed in ‘Hindi’ language can be easily deployed for other people in ‘Tamil’ language, while maintaining semantic interoperability. The persistence will also be maintained, with the same meaning (of data) for both the regions. Implementing these standard based healthcare applications helps in reducing the costs while enhancing patient care. Thus, this study aims to build a standard based, and platform independent healthcare application to provide support for interoperability, usability and generic persistence.

Barriers and facilitators of a near real-time feedback approach for measuring patient experiences of hospital care.

Abstract: Objectives To contribute towards the current policy directive and recommendations outlined in the Francis Report (1) to strengthen relational aspects of hospital care and increase the use of a near real-time feedback (RTF) approach. This article offers insight into the challenges and enablers faced when collecting near real-time feedback of patient experiences with trained volunteers; and using the data to facilitate improvements. Methods Feedback was collected from staff and volunteers before, during and after a patient experience data collection. This took the form of both formal mixed methods data collections via interviews, surveys and a diary; and informal anecdotal evidence, collected from meetings, workshops, support calls and a networking event. Results Various challenges and enablers associated with the RTF approach were identified. These related to technology, the setting, volunteer engagement and staff engagement. This article presents the key barriers experienced followed by methods suggested and utilised by staff and volunteers in order to counteract the difficulties faced. Conclusions The results from this evaluation suggest that a near real-time feedback approach, when used in a hospital setting with trained volunteers, benefits from various support structures or systems to minimise the complications or burden placed on both staff and volunteers.

Guidance for the development of a National HTA-strategy

Abstract: Background Health Technology Assessment (HTA) has gained importance and is emphasized as instrument to guide health policy in rational decisions on resource allocation on health technologies. In 2015 the development of a National HTA strategy in Lithuania was undertaken. It is the intention of this paper to offer generic guidance for similar future initiatives. Methods A mixed-methods and multi-perspective approach was used to collect data and information: a detailed health care system analysis of the regulative and legislative environment, complemented by international experiences on possible linkages between decision making and HTA, extensive interviews on existing decision making processes and specific system needs for HTA. Results The guidance for the development of a National HTA strategy follows a step-wise approach: The first step is the definition of specific strategic objectives that can be operationalized in concrete activities that can be monitored in their implementation. Next - in a detailed system analysis - data and information are collected. The collected information is assessed according to an analytical framework within four areas: assessment of system needs, assessment of potential benefits of and challenges in the utilization of HTA, analysis of human resources and capacities as well as need for training and analysis of options for institutionalization and financing. During the final step concrete activities guided by the pre-defined objectives are planned based on the identified needs. Conclusion The implementation of HTA with transparent processes and products may take years. Careful planning, monitoring and eventual adaptation of the National HTA strategy will be needed.

The root causes of ineffective and inefficient healthcare technology management in benin public health sector

Abstract: This study aims to identify the root causes and solutions of main problems facing Healthcare Technology Management in Benin׳s public health sector. Conducted in Benin from 2008 to 2010, two surveys were used with key actors in Healthcare Technology Management. The first survey was based on 377 questionnaires and 259 interviews, and the second involved observation and group interviews at selected health facilities The findings of the two surveys show that the problems are based on both high- and low-level corruption, characterized by self-interest and unwillingness of the policy makers to solve healthcare care equipment and maintenance problems. Appropriate solutions include: (i) development of policy and management tools to guide distribution, (ii) the use of reference price lists for procuring equipment, (iii) development of policy and management tools to guide financial resource allocation on the life cycle cost of the equipment, (iv) creation of a healthcare equipment and maintenance directorate, (v) development of policy and management tools for obsolete equipment, and (iv) the development of a new healthcare technology management policy with a budgeted action plan. We suggest that much can be improved by the strict development and implementation of policy and management tools, as well as regulations at each level of the Healthcare Technology Management process. A key role has to be attributed to the technical specialists, and the end users of equipment in healthcare facilities. Furthermore, there is a need for capacity building in Healthcare Technology Management institutions.

An examination of EHR implementation impacts on patient-flow

Abstract: Introduction This study builds upon prior knowledge to integrate data from an EHR system to investigate EHR implementation on patient -flow for operations within a pediatric practice. We compare pre-implementation administrative data from a practice management system with paper-based documents, and post-implementation data from a cloud-based EHR system. Methods This study reports on visits from a clinic within a network of eleven pediatric clinics during the period of April 16, 2012 to April 15, 2014. Results 2448 independent patient visits were used in the study. 838 pre-implementation visit records were collected for the period April 16, 2012 to May 15, 2012 period, 789 visit records for the period April 16, 2013 to May 15, 2013, and 821 visit records for April 16, 2014 to May 15, 2014. Overall mean process time increased to 81.43 min immediately after implementation of the new EHR system. This was followed by a decrease (16.83 min) in time from check in to check out post-implementation. Discussion There were significant improvements observed in patient-flow relative to initial EHR adoption; such improvements resulted in gains in operational efficiency in several steps within the process. Conclusion Findings suggests the effective use of knowledge-sharing among employees in complement with EHR training cannot be overlooked. While expected gains in operational efficiency may initially be achieved within some steps of the process, sustained overall gains can only be accomplished by overcoming the barriers and challenges to organizational learning.

Drug utilization patterns in the global context: A systematic review

Abstract: Objectives Standard drug use indicators have been developed by the World Health Organization/International Network for Rational Use of Drugs (WHO/INRUD). The purpose of this systematic review was to examine and report the current status of health facilities in different regions of the world in terms of drug use based on WHO/INRUD core drug use indicators. Design Systematic review of the literature following PRISMA guidelines. Methods The INRUD bibliography, WHO archives, Google Scholar, Medline, PubMed, SpringerLink, ScienceDirect and Management Sciences for Health (MSH) resource databases were searched between 1985 and 2015 for studies -containing 12 WHO/INRUD core drug use indicators. Secondary data sources were also searched. Results Four hundred and sixty three studies were retrieved and 398 were excluded as they did not provide relevant information or fulfill the selection criteria. Sixty articles met the criteria and were selected for final review. With respect to prescribing indicators, studies of “drug use” showed mixed patterns across geographic regions. Overall trends in “patient-care” and “facility-specific” indicators were similar across most of the World Bank regions. However, based on the Index of Rational Drug Use (IRDU) values, East Asia and the Pacific region demonstrated relatively better drug use practices compared with other regions. Conclusions This systematic review revealed that the drug use practices in all regions of the world are suboptimal. A regulated, multi-disciplinary, national body with adequate funding provided by governments throughout the world are a basic requirement for coordination of activities and services, to improve the rational use of drugs at a local level.

Engaging stakeholders into an electronic patient-reported outcome development study: On making an HIV-specific e-PRO patient-centered

Abstract: Background The use of patient-reported outcome (PRO) measures in care and research is proposed to foster patient-centered care but this outcome may depend on stakeholder engagement in their development and implementation. Hence, we subsequently engaged HIV patients and clinicians into a study aimed at creating a new electronic PRO (e-PRO) for monitoring barriers to antiretroviral therapy adherence in HIV care. As detailed examples of such engagement are lacking, we describe our rationale, methods and first results of these engagement initiatives. Methods We established a 10-member patient committee. Periodic focus groups engaged HIV clinicians. Focus groups were conducted with both groups to assess needs for the e-PRO: 3 mainly with patient committee members ( n =12) and 5 with clinicians ( n =31). Content on the e-PRO׳s targeted concept (adherence barriers) was analysed with Grounded Theory (patients) and with typological analysis (clinicians). Results Patients' discussions reflected three temporal categories (imprinting, domino effects, future-shadowing) and one overarching theme (weathering) in the experience of adherence and its many barriers. Latent within HIV clinicians' discussions was a typology of patients organized by distinct barriers to adherence, life conditions, and attitudes to care. Discussion Results emphasize the lived experience of managing barriers and its complexity. They suggest the new e-PRO should accommodate patient diversity, contextualize scores longitudinally, and address the personal significance of individual barriers (e.g., distressfulness) beyond their mere presence. These initial results and the opportunities presented by our long-term engagement initiatives should ensure the production of a useful and used patient-centered e-PRO.

Introduction of e-mental health in national health systems – A health professionals' perspective

Abstract: Objectives Evidence exists that e-mental health applications for maternal depression could assist in diagnosing such conditions in an early stage. This study explores the intention of health professionals to use and recommend e-mental health applications and how they think these applications should be integrated in the national health system. Methods We applied an exploratory sequential mixed-method research design. First, we collect and analyze responses from 131 health professionals in the field of pregnancy and maternal care. Based on these findings, we conduct semi-structured interviews with 16 experts to expand on the initial results. Results Our study reveals that health professionals would in general intend to recommend and use e-mental health applications. However, their attitude towards e-mental health applications varies with respect to the coverage of the mental health process. Conclusion The results are of relevance for research and practice. Two scenarios are described that show how health professionals perceive an introduction of e-mental health to be useful.

A conjoint analysis of inpatient satisfaction ratings in Indonesia

Abstract: Objective The purpose of this study is to examine Indonesian men and women׳s satisfaction rating of the different attributes associated with the location, convenience, accessibility, and affordability of inpatient care and how the ratings differ across clusters of individuals. Methods The empirical work of this study is based on using the 2007 Indonesian Family and Life Survey. A conjoint analysis is used to examine Indonesian men and women׳s satisfaction rating of the above-mentioned attributes. Results Indonesians who utilizes the inpatient care are responsive to the type, cost, quality, and location of the inpatient care even though individuals in different clusters attach different importance to the different attributes associated inpatient care. Conclusion There is a pressing need for sound policies that seek to reduce the cost of treatment and consultation, to improve the quality of care facility, to build more care facilities, and to improve public transport infrastructure. Priority should be given to patients who visited facilities located outside their province of residence. Efforts to enhance the quality of inpatient care should focus on public facilities and facilities located in Sumatra.