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Los Alamos National Laboratory in New Mexico has targeted the healthcare sector for defense technology conversion for peace-time use. As part of that transfer, a new teleradiology repository and network may soon give pulmonary specialists a powerful new information weapon to fight tuberculosis and other lung diseases.
Delivery of good care, ability to communicate effectively about patient care and the decision-making during the care process depends on the quality of the information available to all professions and between sectors. The main purpose of an electronic health record is to support the multidisciplinary communication, cooperation and decision-making in the patient's care process. In addition, the data in electronic health records are used, e.g. in clinical research, health system management, the planning of health services and government reporting. A nationwide electronic health record will be introduced in Finland by the end 2007. Reaching this target has been a special part of the national health project. In a subproject of the introduction of a national electronic health record, core data elements of electronic health record have been defined through a consensus-based approach. The main elements are the patient identification information, the provider's identification information, care episode, risk factors, health patterns, vital signs, health problems and diagnosis, nursing minimum data set, surgical procedures, tests and examinations, information about medication, preventive measures, medical statements, functional status, technical aids, living will, tissue donor will, discharge summary, follow-up care plan and consent information. Furthermore, existing vocabularies, nomenclatures, classifications and codes were clarified. The HL7 Finland has defined the manner in which this information is expressed in the CDA R2 structure. The core information elements will be implemented in regional development projects which are partly funded by the Ministry of Social Affairs and Health. This paper presents the defining process of the national core data elements of electronic health record systems in Finland.
It is the aim of an epidemiologically sound health reporting to present concisely relevant health data in a manner similar to that of management information systems and to comment and interpret them for rational action. Its goal is to deliver the right information at the right time at the right place and in suitable form. Health reports render facts transparent by information and evaluation in the health care sector, help decision makers to act competently by guiding and orientating them in respect of recognising the underlying problems, and thus contribute to coordination and, to setting priorities. Today's health reporting supplements the usual health statistics by primary data collection focussed on current health problems in a population. Computer-assisted telephone interviews provide an equally good coverage as the traditional methods. All this enables to record behavioural changes nearly as sensitively as a seismograph and also to monitor prevention and corrective action in their effects almost in real-time, and, moreover, for a long time (i.e. longitudinally). This approach could be a model for a scientific modernisation of Public Health Service information services.
This report has to describe the activity of INAIL for improve information and training in the field of occupational health and safety. The discussion start from accident and professional illness data and gives evidence about social and economic cost of this phenomenon. INAIL want work together with other institution, social body, professional association for promote the integration of occupational health and safety in businesses management. The principal target are SMEs - Small and Medium size Enterprises. Information and training must follow this approach and sustain it. Information and training have to develop knowledge, competence and awareness like value for the organisations. This report describe models and tools for information and training which INAIL's improving even for the building sector.
This paper reports on a study of the cross-national trends in health status during the economic transition and associated health sector reforms in Central and Eastern Europe (CEE). The central premise is that before long-run gains in health status are realized, the transition towards a market economy and adoption of democratic forms of government should lead to short-run deterioration as a result of: (i) reduction in real income and widening income disparities; (ii) stress and stress-related behaviour; (iii) lax regulation of environmental and occupational risks; and (iv) breakdown in basic health services. Analysis focused on three broad indicators of health status: life expectancy at birth, infant mortality rate and the probability of dying between the ages of 15 and 65 years, shown by the notation '50q15'. The study revealed significant new information about health status and the health sector which could not have been obtained without a proper cross-national study. Infant mortality rates in former socialist economies (FSE) follow the global trend, declining as per capita income rises. However, rates are lower than would be predicted given their income levels. Despite declining infant mortality, life expectancy at birth in the former socialist economies decreases as per capita income rises, in marked contrast to global trends. This is because rising income level is associated with greater probability of death between the ages of 15 and 65: the wealthier the society, the less healthy is its population, particularly for its males. Causes of death in the FSE follow global trends: higher death rates due to infectious and parasitic diseases in poorer countries, and higher death rates due to chronic diseases in wealthier countries. However, age-standardized death rates for chronic diseases generally associated with unhealthy lifestyles and environmental risk factors are very high when compared with wealthier established market economies (EME). Policies and procedures which alter the effectiveness of health services have had a demonstrable but mixed impact on health status during the early phase of transition. Effective preventive health strategies must be formulated and implemented to reverse the adverse trends observed in Central and Eastern Europe.
Clinical pharmacologists have a service role in the provision of drug information to individuals both in hospitals and primary health care. We present here a systematic approach in answering questions in a drug information centre (DIC), and describe the working method and the documentation of the work in a question answer (Q/A) data base. Drugline is a full-text data base offering problem-oriented drug evaluation comparable to a clinical consultation. The drug information is produced in a non-commercial drug information centre sponsored by the national health care sector and the National Corporation of Swedish Pharmacies, and run jointly by clinical pharmacologists and pharmacists. A minor part of Drugline is available in English for online searching, in parallel with Medline at the database host, the Medical Information Centre at the Karolinska Institute Library and Information Centre, and the users represent mainly medical libraries, hospital pharmacies, university clinics, and the pharmaceutical industry. A network of DICs has been organized in Swedish university hospitals with access to Drugline for searching and the storage of questions and answers. This network has the potential for expansion throughout Europe. It offers the unique possibility of complementing drug product information with problem-oriented drug information emerging from cases in the real world of prescribing.
Transoesophageal echocardiography imaging is limited by the proximity of the transducer to many cardiovascular structures. The location of the transducer causes these structures to appear near the apex of the backscatter image, and since the angle of the scan cannot exceed 90 degrees, much of the image information appears in a constricted area. We describe a computer-based, wide-field reconstruction technique which pieces together the picture fields from adjacent sector scans to form composite images. This description includes information regarding lessons learned, as well as technical details of the algorithms, in sufficient depth to permit reproduction of the system by interested parties. Significant aspects of wide-field image reconstruction, including computational complexity, image-pair alignment processes, requirements of alignment resolution, and image acquisition techniques, are addressed in depth. We believe that wide-field presentation of echocardiographic backscatter data enhances the utility of the transoesophageal approach, particularly when dealing with posteriorly located cardiovascular lesions.
Information poverty is one of the most significant obstacles to better health in the developing world. To address this problem, SatelLife, a Boston-based nonprofit organization has created HealthNet, a computer-based network linking healthworkers throughout the world to facilitate the exchange of health-related information. Using low-cost, sustainable technologies, SatelLife provides both electronic mail communications services and a variety of information services including electronic publications, electronic access to remote databases, and ongoing electronic conferences on topics of special relevance to health in the developing world. The article cautions that simply bringing high-speed Internet access to the developing world will not solve problems of information poverty, because such technology will be prohibitively expensive for all but the elite private sector and because of the need to provide targeted, high-quality information, not simply access to the vast, disorganized universe of information available on the Internet.
The formation and the information, announced by the mother directive and recepiti with the legislative decree 626/94, they are essential actions that the employer has to put the prevention of the accidents and the professional illnesses towards the workers into effect. They are fundamental elements for the safety and the health on the places of job, the formation and the information they bring the inherent dangers to the knowledge of the worker in the duty that has to develop, in the useful technologies to the productive trial and the place where the productive trial is in action. Transferring to the sector of the constructions the formation and the information that the employer has to guarantee is immediately thought about the workers that realize the work and that youlthey can result then object of accidents and job illnesses. The directive yards 92/57CEE and subsequently the D.Lgs 494/96 involve the subjects that with their decisions, their actions, consequent to evaluations and choices operational respect the work to be realized they condition the safety. The subjects that they compile the safety plan and coordination with their formation and they manage the safety in the executive phase are the coordinators. Necessary is the formation of subjects that with theirs to act and their choices could condition the safety of other interactive subjects in the phases of job that characterize the work, therefore it is fundamental to individualize the necessary components to their formation.
BACKGROUND: This paper describes the Judge project, the aim of which was to explore the need for health website quality assessment guidelines for the voluntary sector. Such guidelines would enable health consumers to assess the quality of health sites and assist support groups to produce their own good quality sites. The project was a partnership between the Information Management Research Institute, School of Informatics, Northumbria University and Contact a Family. It was supported by the Health Foundation. METHODS: The views of health consumers and support group members and workers were obtained by focus groups (35 attendees) and questionnaires (55 responses). They were asked questions about quality issues and concerns about Internet health information and any help they needed with judging the quality of health websites. RESULTS: The results supported the need for guidelines. The guidelines were written to reflect the requirements of health consumers and support groups articulated from the focus group and questionnaire data. They were then disseminated via a website. CONCLUSIONS: There is a need to improve communication and information exchange between health consumers and professionals and official organizations; publicise support groups to patients and carers; set up local Webs of Trust, linking together voluntary and statutory organizations within a locality. Professionals and official organizations in the public sector should make information provision to patients and health consumers a priority. Information provision should be embedded in the clinical setting via guidelines, protocols and administrative structures. Professionals should be trained in the role of information and how to provide it in appropriate ways. Support groups should use the Judge guidelines to assist them in producing good quality websites. Support groups should promote the Judge guidelines to health consumers, to help them make their own quality judgement about health-information websites.
The role of the private sector in public healthcare systems is much debated, but there is little research to inform the debate. In the Nordic countries the extent and type of private sector involvement is largely unknown and the changes and the consequences have not been studied. This paper presents a conceptual framework and some limited data about the changing private-public mix and privatization in the Nordic countries between 1985 and 2000. The data suggest a small increase in both private financing and provision which has accelerated in recent years, especially in specific healthcare fields such as diagnostic centres, dentistry, primary medical care and care for older people. The overall increase is small, but large in certain sectors. Differences between the countries can only be understood in relation to their historical, financial, economic and political context, even though there are many commonalities. Impact also is context dependent, but the findings do show a cross-country pattern of a willingness to experiment and a change in underlying assumptions. The findings show a more extensive interpenetration of private and public than previously recognized but more research is required, especially about changes in recent years about which data are scarce. The paper considers the factors driving these trends, the likely larger changes in the next 10 years and the possible consequences for patients, professionals, managers and governments. It notes the different ways governments can control or influence finance and provision. It proposes that the Nordic and other governments improve regulation and data collection about the private sector and consider influencing private providers through partnership arrangements, rather than leaving the developments to be shaped by growing consumer demands or market logic alone.
Quality has become the hallmark of industrial excellence. Many diverse factors have heightened national concern about managing quality control throughout the health-care industry, including laboratory services. Industry-wide focus on quality control has created a need for an administrative program to evaluate its effectiveness. That program is medical quality assurance. Because of national and industry-wide concern, development of quality assurance theory has gained increasing importance in medical accreditation and management circles. Scrutiny of the application of quality assurance has become particularly prominent during accreditation inspections. Implementing quality assurance programs now demands more of already finite resources. The professional laboratory manager should understand how quality assurance has developed in the United States during the past 150 years. The well-informed manager should recognize why the health-care industry only recently began to develop its own expertise in quality assurance. It is also worthwhile to understand how heavily health care has relied on the lessons learned in the non-health-care sector. This three-part series will present information that will help in applying quality assurance more effectively as a management tool in the medical laboratory. This first part outlines the early industrial, socioeconomic, and medicolegal background of quality assurance. Terminology is defined with some distinction made between the terms management and administration. The second part will address current accreditation requirements. Special emphasis will be placed on the practical application of accreditation guidelines, providing a template for quality assurance methods in the medical laboratory. The third part will provide an overview of quality assurance as a total management tool with some suggestions for developing and implementing a quality assurance program.
There are essentially four main approaches used in attempts to strengthen the management of health services in developing countries. These are: information system development; management training; use of planning and evaluation methodologies; and, health sector reform. As part of a collaborative research project based in Kisarawe District, Tanzania, we tested the hypothesis that a combination of the first three of these approaches would be sufficient to ensure that decisions and actions were taken to bring about major improvements in the management of health services. It was assumed that the decentralization, which took place as part of the 1982 reorganization of local government responsibilities, had provided managers with sufficient decision-making autonomy to allow them to bring about improvement in health service performance, provided that the other conditions were met. In fact, it was found that despite being presented with clear evidence of serious inefficiencies and inequities in the allocation of health resources, managers were often highly reluctant to decide upon actions which would alleviate the problems in situations where there were potential losers as well as winners, even if the benefits greatly outweighed the costs. This article argues that interventions based solely on training, information systems, or planning and evaluation protocols will make only marginal improvements to health service management, and that changes to the system as a whole are needed in order to provide managers and health professionals with incentives to rectify performance failings. Some ideas for health sector reform, to give managers power and incentives for improving efficiency and quality of care, are put forward. Since it is likely that the systemic problems of the health sector in Tanzania are shared by many other developing countries, the lessons drawn from this study probably have more general applicability.
OBJECTIVES: To gather information on existing prescription practices, dispensing practices and patient satisfaction in government health services of the NWFP, Baluchistan and Punjab province. METHODS: A cross sectional study design was used for this purpose. Ten health care facilities were selected from each province keeping appropriate representation from first level health facilities, district health facilities and tertiary care hospital. Analysis of selected indicators was carried out on the basis of provinces, health facilities, gender and different age groups. RESULTS: Documentation of 914 responses was completed from three provinces. Almost equal distribution of encounters was maintained representing different health facilities. Forty seven percent of encounters involved children under 15 years of age. Female patients comprised of 56% and the mean age of the entire sample was 26 years. The mean dispensing time was only 38 seconds, the mean consultation time was 1.79 minutes and the average number of drugs per prescription turned out to be 2.7 out of which only 1.6 drugs were being dispensed from the facility. More than half of the prescriptions contained antibiotics and 15% of patients were prescribed with injectables. Only half of the patients expressed satisfaction with their visit to health facility. CONCLUSIONS: Like many other developing countries, prescription and dispensing practices are not satisfactory in public sector health facilities of Pakistan. Appropriate and workable solutions need to be developed and implemented in the country to improve systems. Regular audits and qualitative studies should become part of the effort.
In the early 1990s, most Latin American and Caribbean countries were beginning, or planning to begin, health sector reform processes. This paper presents the status and trends of health sector reform at the end of the 1990s. The authors relied on information in 20 health system and services profiles completed by the Pan American Health Organization between August 1998 and October 1999. The analysis, which follows a methodology that had been applied earlier, was organized on two different levels: (1) monitoring the reform processes (dynamics and content) and (2) evaluating their outcomes. In looking at the dynamics of the reform processes, the article examines the context in which they take place and the actors involved in their different phases: inception, design and negotiation, implementation, and evaluation. The description and analysis of the contents of health sector reform initiatives are organized into 12 broad thematic areas. Outcomes evaluation was only possible in the eight countries that provided enough pertinent information, and should be viewed as preliminary. Nevertheless, the article does present detailed information on the outcomes of health sector reform in terms of equity, effectiveness and quality, efficiency, sustainability, and societal participation and control. The article also discusses the potential causes and determining factors for the observed outcomes.
There is a growing awareness of the need to approach health problems intersectorally. This has important implications for health policy management, centrally so for the informations systems which should enable 'managers' to monitor performance and also provide feedback to those with broader policy responsibilities. Yet relatively little is being done to adjust the information systems to this new intersectoral awareness: the focus of health information systems remains the collection of health service data. Much of the information collected is not used to provide adequate feedback to planners and managers, and to influence programme implementation. The paper--which focuses on the problems in less developed countries--argues that more attention needs to be paid to analysing the expected links between interventions and outcomes, as well as to cost considerations. Flexible procedures are required to address locally or regionally relevant problems. Thought must be given to making information of interest to health workers by linking it to the outcomes of activities, and by enabling them to discuss the implications of findings. Community members may also be thus involved. Often such processes are wholly neglected. The paper examines institutional and political arrangements that influence the capacity to use information for management and policy making, and which need to be understood if information systems are to be broadened beyond the health sector. The paper ends by discussing the main indicators which have been proposed, and occasionally used, to broaden health monitoring in an intersectoral direction. It argues that much relevant information is being routinely produced by the various departments and discusses briefly how such information can be used to build up gradually an intersectoral information system for health.
In September 1999 the MRC Institute for Environment and Health hosted a multidisciplinary seminar on the harmonisation of strategies to protect environmental quality and human health. The objectives of the meeting were to share information about ways in which the protection of the environment and human health can be harmonised, and, by bringing together an audience representing a range of disciplines, interests and sectors, to explore how these may be integrated to inform policy, decision-making and the management of risks. Key conclusions from the seminar focused on the importance of sustainable development, harmonising risk assessment and the role of stakeholder involvement. The necessary move from an expert-based to a dialogue-based process will require concerted efforts on the part of scientists, policy-makers, regulators, industry and the public.
This paper reports a study which examined the specific information needs and sources of information for 105 women with breast cancer at two time points, the time of diagnosis and a mean of 21 months from diagnosis. At diagnosis the priority information needs concerned survival issues. Further from diagnosis survival issues were still a concern, but information about the risk to family members of getting breast cancer showed a significant increase in importance. Information about sexual attractiveness was ranked last at both the newly diagnosed and follow-up stages. Information sources at the time of diagnosis centred around the specialist breast care service, while further from diagnosis few professional or voluntary sector sources were utilized, with women receiving most of their information from media sources such as women's magazines. The relevance of these findings for nurses and other health care professionals is discussed.