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PubMed1999

Alternatives for protecting privacy while respecting patient care and public health needs.

This paper begins with a discussion of the value of privacy, especially for medical records in an age of advancing technology. I then examine three alternative approaches to protection of medical records: reliance on governmental guidelines, the use of corporate self-regulation, and my own third hybrid view on how to maintain a presumption in favor of privacy with respect to medical information, safeguarding privacy as vigorously and comprehensively as possible, without sacrificing the benefits of new information technology in medicine. None of the three models I examine are unproblematic, yet it is crucial to weigh the strengths and weaknesses of these alternative approaches.

Access to Information↗
PubMed1973

Small area variations in health care delivery.

Health information about total populations is a prerequisite for sound decision-making and planning in the health care field. Experience with a population-based health data system in Vermont reveals that there are wide variations in resource input, utilization of services, and expenditures among neighboring communities. Results show prima facie inequalities in the input of resources that are associated with income transfer from areas of lower expenditure to areas of higher expenditure. Variations in utilization indicate that there is considerable uncertainty about the effectiveness of different levels of aggregate, as well as specific kinds of, health services. Informed choices in the public regulation of the health care sector require knowledge of the relation between medical care systems and the population groups being served, and they should take into account the effect of regulation on equality and effectiveness. When population-based data on small areas are available, decisions to expand hospitals, currently based on institutional pressures, can take into account a community's regional ranking in regard to bed input and utilization rates. Proposals by hospitals for unit price increases and the regulation of the actuarial rate of insurance programs can be evaluated in terms of per capita expenditures and income transfer between geographically defined populations. The PSRO's can evaluate the wide variations in level of services among residents of different communities. Coordinated exercise of the authority vested in these regulatory programs may lead to explicit strategies to deal directly with inequality and uncertainty concerning the effectiveness of health care delivery. Population-based health information systems, because they can provide information on the performance of health care systems and regulatory agencies, are an important step in the development of rational public policy for health.

Clinical Laboratory Techniques↗
PubMed2006

Evaluation--the Cinderella science of ICT in health.

OBJECTIVES: Information systems are expensive to create, and consume resources in their operation. They are justified in order to achieve clearly defined objectives in health service quality and efficiency. To ensure that these objectives are being met, and in order to build up an evidence-base to support well focused policies, systems, and practice, evaluation would seem to be fully justified and indeed essential. However, there are major factors jeopardising good evaluation practice, ranging from reluctance to commit resources or expose decisions to scrutiny, through to lack of appreciation of the full range of dimensions which should be studied. This paper seeks to create fuller appreciation of the issues and their importance. METHODS: Experiential and literature reviews form the basis of an exposition of principles, methods, and key current activities. RESULTS: A summary has been produced of the key challenges to health ICT evaluation, and its adverse comparison with other sectors. An explanation of the viewpoints and levels of health information evaluation is followed by a short history of principal milestones, current scientific methodology activity, and key collaborative activities. CONCLUSION: The need for a stronger commitment to health ICT evaluation is demonstrated if the application of health informatics systems is to receive due recognition as scientifically and empirically justified. Commitment of resources and scientific endeavour are needed, and thus the recent Declaration of Innsbruck, arising out of an event sponsored by the European Science Foundation, is timely and fully justified.

Evaluation Studies as Topic↗
PubMed1997

Undergraduate training in the European Union. Convergence or divergence?

A survey of dental schools in the European Union was carried out for two main reasons. Firstly to promote the exchange of information in respect of curriculum objectives in the different countries and secondly to ascertain the differences in the interpretation of the 1978 EU sectoral directives for dental education and training. Out of 127 schools, only 30 responded, yet the information provided is of considerable importance. It demonstrates wide divergence in the interpretation of the 1978 Directives and methods of assessment of clinical competence. There is a considerable difference throughout Europe in hours devoted to the various subjects included in the Dental Directives. There is little evidence of convergence in methods of assessment or quality assurance. The survey demonstrates the difference in resources, levels of staff, availability of clinical training places, output in research and patient treatments throughout the European Union. The results question the effectiveness of the 1978 Dental Directives in promoting convergence of standards. As there is free movement of dentists throughout the European Union, it is concluded that a different approach may be necessary to ensure that all European Union dental graduates achieve comparable standards in their education and training.

Curriculum↗
PubMed1993

State policies and programs that address the needs of mentally ill mothers in the public sector.

OBJECTIVE: The authors sought to determine whether state departments of mental health have specific policies and programs addressing the needs of mentally ill women served in the public sector who have preschool-age children. METHODS: A questionnaire was sent to the commissioner of mental health for each state and the District of Columbia. Questions addressed whether information was routinely collected on the parenting status of women who receive public-sector psychiatric services, whether services targeting mentally ill women with young children were available, and whether the state had policies concerning hospitalized women who are pregnant or who have young children. RESULTS: Sixteen states routinely collect data on whether women who receive public-sector services have young children. Four states have residential programs for mentally ill women and their children. About half of the states have programs for assessing parenting skills and outpatient services focused on improving those skills. No state has a policy about visitation between a hospitalized mentally ill mother and her children. Twenty states have policies for the care of hospitalized pregnant patients, primarily for their medical management. CONCLUSIONS: Further efforts are needed to identify mentally ill women in the public sector who have young children, to enhance the parenting skills of mentally ill patients, and to promote positive outcomes for their children.

Child↗
PubMed2001

The untapped potential of Telehealth.

The people of Malaysia generally enjoy a high standard of health. This is largely attributed to the comprehensive range of health services provided by the Government and the private sector at affordable costs. However, there are changing trends that now seriously challenge this status quo. The changing population structure, lifestyle, disease patterns and globalization are causing healthcare costs to rise. New and innovative ways will have to be devised to further improve the health status and at the same time contain costs. Information and Communication Technology (ICT) presents unprecedented opportunities to help the health sector in Malaysia reinvent itself and transform the way health and healthcare is managed and delivered in the future. Malaysia's Telehealth initiative under the Multimedia Super Corridor (MSC) project is designed to realize Malaysia's health vision and goals and meet future health challenges. Multimedia and Internet technology will be fully harnessed to deploy services that will shift the emphasis from episodic management of illness to proactive promotion of lifelong wellness and disease prevention. Health information content and interactive applications will engage the people to work as partners of health with healthcare professionals in maintaining their own health or managing their illnesses.

Delivery of Health Care, Integrated↗
PubMed1993

Medical confidentiality and data protection as influenced by modern technology.

Confidentiality has been considered to be a basic element of the doctor-patient relationship worldwide since the time of Hippocrates. On the verge of entering a society in which communication plays a leading role, confidentiality alone can no longer protect the patient's rights. Increasing diagnostic activity multiplies the amount of data available for processing in health systems. On the other hand, the use of electronic medical records allows practically unlimited amounts of data to be saved. The compilation of any personal data, however, requires a legal basis such as the consent of the individual concerned, which is generally given within the doctor-patient relationship. Compiled medical data can be assigned to four main sectors: therapy, financing, administration and research. This division into four sectors is based on the need to reconcile the conflicting needs of the patient's right to informational self-determination and third-party interests. Data can be processed for one or more of these purposes insofar as a legal basis therefore (law or consent) exists. Using the data for purposes outside the sector for which they were compiled interferes with the individual's right to informational self-determination. Thus most data compiled in the course of therapy may not be processed for research purposes, unless made anonymous, thereby losing the chance of retracing the source of the data. However, new informational techniques can procure secure anonymized and retraceable data flow. The legislature has to consider these technologies in order to enable the enormous opportunities presented by new methods of data processing to be fully exploited in research.

Computer Security↗
PubMed1996

[Health information systems at the local level]

Information systems have assumed paramount importance in modern society, becoming an strategic resource of power in all areas. Therefore, it is important that the process of decentralization of the health sector should not be limited to services, but should also consider the decentralization of information. The author discusses the sharing of political and technical responsibility between various governmental spheres, and the need to rethink and redirect the process of making accessible information on health. This is a matter of overcoming vertical relations between government and society and of moving toward cooperative management capable of minimizing regional inequalities and optimizing the utilization of resources.

Journal Article↗
PubMed1984

The dynamics of tetanus epidemiology and control in rural Uttar Pradesh studied through computer simulation.

An epidemiological model is constructed for tetanus. The assumptions as well as the steps involved in the construction of the model, are detailed. The impact of alternate immunisation strategies to control tetanus in rural Uttar Pradesh, is studied using this model. The quantification of the expected decline in incidence and mortality over 30 years, for different control strategies, provides the health planner with valuable information. It is seen that the incidence of tetanus neonatorum and tetanus in adults, as well as deaths due to tetanus, progressively decreases as the level of coverage is increased. The most marked reduction is seen over the initial period of intervention. Mass immunisation of the total population, or of just the females in the reproductive age group, leads to temporary decline in the endemic level. Such models are useful for planning in the health sector in India since, they can be constructed with the limited information available.

Adult↗
PubMed1998

Overcoming the barriers: national to European to G7.

An information revolution is underway which will have an impact on all sectors of society. It will fundamentally change national and international health systems. The global Internet is a key influence and will change the balance of power within and between healthcare professions, and between them and the general public. This revolution offers enormous potential benefits to global health but there is also potential for harm. There are a wide range of barriers to realising the potential benefits. They lie in areas such as the protection of personal information; ownership and legal accountability; data meanings: structures and database navigation; deficiencies in the global Internet and lack of access by many communities. This paper considers the nature of those barriers. In 1994, the Group of Seven Nations launched an initiative to stimulate a global information society. Theme 8 deals with healthcare and therein Sub-project 5 'Enabling Mechanisms', which the author leads, is seeking to identify barriers and the authoritative international sources of advise and good practice. It is conducting an international survey, the results of which should be published by the end of 1997. This paper describes the aims of this Sub-project.

Computer Communication Networks↗
PubMed1995

The Georgia Information Network for Public Health Officials (INPHO): a demonstration of the CDC INPHO concept.

The Georgia Division of Public Health is serving as the first demonstration model of a statewide implementation of the Centers for Disease Control and Prevention Information Network for Public Health Officials. The goals of the project are to make communication easy, to make information accessible, and to make data exchange as swift and as smooth as technology will allow. By having a state-of-the-art telecommunications network, public health officials will be able to rapidly collect health data and transform them into meaningful health status information that can be used to inform health policy decisions. The Georgia Information Network for Public Health Officials is a unique consortium of private and public sector partners funded with a grant from the Robert W. Woodruff Foundation. The project will install the telecommunications infrastructure and the supporting software to position Georgia public health as the health information leader of the state.

Centers for Disease Control and Prevention, U.S.↗
PubMed1998

Access to health information and support: a public highway or a private road?

Information and communication technologies may help reduce health disparities through their potential for promoting health, preventing disease, and supporting clinical care for all. Unfortunately, those who have preventable health problems and lack health insurance coverage are the least likely to have access to such technologies. Barriers to access include cost, geographic location, illiteracy, disability, and factors related to the capacity of people to use these technologies appropriately and effectively. A goal of universal access to health information and support is proposed to augment existing initiatives to improve the health of individuals and the public. Both public- and private-sector stakeholders, particularly government agencies and private corporations, will need to collaboratively reduce the gap between the health information "haves" and "have-nots." This will include supporting health information technology access in homes and public places, developing applications for the growing diversity of users, funding research on access-related issues, ensuring the quality of health information and support, enhancing literacy in health and technology, training health information intermediaries, and integrating the concept of universal access to health information and support into health planning processes.

Delivery of Health Care↗
PubMed1998

Quality of care information makes a difference: an analysis of market share and price changes after publication of the New York State Cardiac Surgery Mortality Reports.

OBJECTIVES: Quality report cards are becoming increasingly more common and receive much publicity. They can have significant impact on competition among providers, costs, and quality of health care. The authors test the hypotheses that hospitals and surgeons with better outcomes reported in the NYS Cardiac Surgery Reports experience a relative increase in their market share and prices. METHODS: Information from the New York State Cardiac Surgery Reports was linked with physicians' claims submitted to Medicare and was used to calculate market shares and average prices for hospitals and physicians performing CABG surgeries. Regression models were estimated to test hypotheses. All 30 hospitals offering coronary artery bypass graft (CABG) were studied as well as a majority of surgeons (114 or approximately 80%) performing CABG surgery in New York State during the 1990-1993 period. RESULTS: Findings indicate that hospitals and physicians with better outcomes experienced higher rates of growth in market shares. Physicians with better outcomes also had higher rates of growth in charges for this procedure. CONCLUSIONS: Patients (and referring physicians) seem to respond to information about quality of individual surgeons and hospitals as expected. The magnitude of the association between reported mortality and market shares varies geographically, potentially reflecting differences in sociodemographic characteristics. The association tends to decline over time, suggesting that it is primarily due to "new" information.

Attitude to Health↗