The challenges in making electronic health records accessible to patients

It is becoming increasingly apparent that there is a tension between growing consumer demands for access to information and a healthcare system that may not be prepared to meet these demands. Designing an effective solution for this problem will require a thorough understanding of the barriers that now stand in the way of giving patients electronic access to their health data. This paper reviews the following challenges related to the sharing of electronic health records: cost and security concerns, problems in assigning responsibilities and rights among the various players, liability issues and tensions between flexible access to data and flexible access to physicians.     

Information seeking and social support in online health communities: impact on patients' perceived empathy

Objective

Many healthcare organizations (HCOs) including Kaiser Permanente, Johns Hopkins, Cleveland Medical Center, and MD Anderson Cancer Center, provide access to online health communities as part of their overall patient support services. The key objective in establishing and running these online health communities is to offer empathic support to patients. Patients'' perceived empathy is considered to be critical in patient recovery, specifically, by enhancing patient''s compliance with treatment protocols and the pace of healing. Most online health communities are characterized by two main functions: informational support and social support. This study examines the relative impact of these two distinct functions—that is, as an information seeking forum and as a social support forum—on patients'' perceived empathy in online health communities.

Design

This study tests the impact of two variables that reflect the above functions of online health communities—information seeking effectiveness and perceived social support—on perceived empathy. The model also incorporates the potential moderating effect of homophily on these relationships.

Measurements

A web-based survey was used to collect data from members of the online health communities provided by three major healthcare centers. A regression technique was used to analyze the data to test the hypotheses.

Results

The study finds that it is the information seeking effectiveness rather than the social support which affects patient''s perceived empathy in online health communities run by HCOs. The results indicate that HCOs that provide online health communities for their patients need to focus more on developing tools that will make information seeking more effective and efficient.     

基层医疗卫生机构医防“五融合”健康管理服务模式研究

推进基层医防深度融合,做实家庭医生签约服务,是深化医药卫生体制改革的重要任务。本文以高血压、糖尿病健康管理为突破口,以家庭医生签约服务为载体,探索基层医防融合健康管理服务模式。通过基层医疗卫生机构内部的“管理融、队伍融、服务融、绩效融、信息融”,实现由全科医生团队统揽医疗和公共卫生服务,做到一次门诊既满足患者诊疗需求,同时也完成必需的基本公共卫生服务。医防“五融合”提供“防、治、管”一体的健康管理,既有利于提升服务质量,增强居民获得感,又有利于推动机构内部横向的基本医疗和基本公共卫生的融合及机构外部纵向的医疗资源整合。     

全科医生开展性健康服务的优势及模式研究

性健康是人类健康的重要组成部分，忽视或误解性健康及错误的性健康观念会极大地影响人们的生活质量。全科医学的整体观和生物-心理-社会医学模式、以家庭为单位的原则、保护患者隐私的特点，使全科医生在开展性健康服务方面具有明显优势，而我国基层医疗卫生机构在性卫生保健知识普及、性健康问题筛查、诊治方面还有待加强。为此，香港大学深圳医院全科医学科从全科核心理念出发，通过组建性健康服务专业小组、开展性史问诊及性器官查体技能工作坊、制定诊治工作流程等方式率先开展性健康服务，探索新的服务模式，希望为国内全科医生开展性健康服务提供一些参考。     

Comparison of consumers’ views on electronic data sharing for healthcare and research

New models of healthcare delivery such as accountable care organizations and patient-centered medical homes seek to improve quality, access, and cost. They rely on a robust, secure technology infrastructure provided by health information exchanges (HIEs) and distributed research networks and the willingness of patients to share their data. There are few large, in-depth studies of US consumers’ views on privacy, security, and consent in electronic data sharing for healthcare and research together.Objective This paper addresses this gap, reporting on a survey which asks about California consumers’ views of data sharing for healthcare and research together.Materials and Methods The survey conducted was a representative, random-digit dial telephone survey of 800 Californians, performed in Spanish and English.Results There is a great deal of concern that HIEs will worsen privacy (40.3%) and security (42.5%). Consumers are in favor of electronic data sharing but elements of transparency are important: individual control, who has access, and the purpose for use of data. Respondents were more likely to agree to share deidentified information for research than to share identified information for healthcare (76.2% vs 57.3%, p < .001).Discussion While consumers show willingness to share health information electronically, they value individual control and privacy. Responsiveness to these needs, rather than mere reliance on Health Insurance Portability and Accountability Act (HIPAA), may improve support of data networks.Conclusion Responsiveness to the public’s concerns regarding their health information is a pre-requisite for patient-centeredness. This is one of the first in-depth studies of attitudes about electronic data sharing that compares attitudes of the same individual towards healthcare and research.     

Planning and response to the influenza A (H1N1) pandemic: ethics, equity and justice

This paper aims to highlight three ethical considerations related to influenza pandemic planning and response: ethical allocation of scarce resources; obligations and duties of healthcare workers to treat patients, and the balance between conflicting individual and community interests. Among these, perhaps the most challenging question facing bioethics is how to allocate scarce, life-saving resources given the devastating social and economic ramifications of a pandemic. In such situations, the identification of clear overall goals for pandemic planning is essential in making difficult choices. The dilemma between the duty to save patients and the right to protect the healthcare personnel's own life and health is a key issue. During the course of a pandemic, civil liberties may also be threatened, requiring limits on individual freedom to protect individuals as well as entire communities. Yet, individual liberty should be restricted with great care, and only when alternative approaches are not effective. Pandemic influenza planning and response should be a cooperative and shared responsibility that balances community and individual interests.     

Sociotechnical challenges to developing technologies for patient access to health information exchange data

Background

Providing patients with access to their medical data is widely expected to help educate and empower them to manage their own health. Health information exchange (HIE) infrastructures could potentially help patients access records across multiple healthcare providers. We studied three HIE organizations as they developed portals to give consumers access to HIE data previously exchanged only among healthcare organizations.

Objective

To follow the development of new consumer portal technologies, and to identify barriers and facilitators to patient access to HIE data.

Methods

Semistructured interviews of 15 key informants over a 2-year period spanning the development and early implementation of three new projects, coded according to a sociotechnical framework.

Results

As the organizations tried to develop functionality that fully served the needs of both providers and patients, plans were altered by technical barriers (primarily related to data standardization) and cultural and legal issues surrounding data access. Organizational changes also played an important role in altering project plans. In all three cases, patient access to data was significantly scaled back from initial plans.

Conclusions

This prospective study revealed how sociotechnical factors previously identified as important in health information technology success and failure helped to shape the evolution of three novel consumer informatics projects. Barriers to providing patients with seamless access to their HIE data were multifactorial. Remedies will have to address technical, organizational, cultural, and other factors.     

大学生社会责任感与心理健康、应对方式及父母教养方式的关系研究

目的　了解大学生社会责任感现状,并探讨其与心理健康、应对方式及父母教养方式的关系。方法　采用整群抽样法,于2017年4月在南京市某所高校抽取一、二、三3个年级的学生共3 000例进行实测,采用大五人格“尽职性”分量表、大学生人格问卷、简易应对方式问卷、父母教养方式评价量表对大学生进行测量,分析大学生社会责任感与心理健康、应对方式及父母教养方式的关系。结果　研究得到有效问卷2 814份,有效率93.80%。大学生的社会责任感高于全国常模,差异有统计学意义（t=2.779,P=0.005）。男生、贫困生、父母共同抚养者的社会责任感分别高于女生、非贫困生、非父母共同抚养者,差异有统计学意义（P<0.05）;心理健康水平不同的大学生社会责任感不同,差异有统计学意义（P<0.001）;大学生社会责任感与积极应对方式呈线性正相关,而与消极应对方式呈线性负相关（r值分别为0.361、-0.265,P<0.001）。大学生社会责任感与父亲的情感温暖和理解呈线性正相关（r值为0.243,P<0.01）,与父亲的惩罚与严厉、父亲的过分干涉、父亲的拒绝与否认、父亲的过度保护呈线性负相关（r值分别为-0.077、-0.152、-0.121、-0.092,P<0.001）;大学生社会责任感与母亲的情感温暖和理解呈线性正相关（r值为0.154,P<0.01）,与母亲的惩罚与严厉、母亲的拒绝与否认、母亲的过分干涉和过度保护呈线性负相关（r值分别为-0.133、-0.183、-0.199,P<0.001）。性别、家庭经济状况、大学生人格问卷得分、积极应对得分、消极应对得分、专制型母亲和理解关爱型父母是大学生社会责任感的影响因素（P<0.001）。结论　大学生社会责任感处于良好状态;性别、经济情况、抚养方式对责任感有影响;责任感与心理健康水平和应对方式有密切的关系;父母的理解和关爱有利于社会责任感的形成,父母消极的教养方式,特别是专制型母亲不利于社会责任感的形成。     

新医改以来社会资本办医政策综述简

目的：对新医改以来中央和地方出台的社会资本办医相关政策进行梳理归纳、总结分析,描述政策现状,揭示改进方向,提出对策建议。方法：运用文献分析法,通过检索文献、查阅中央有关部委和地方省市官方网站,获得相关政策资料;并对文献资料进行分析。结果：新医改以来,中央出台了一系列鼓励社会资本办医的政策;在这一大框架下,各省市从市场准入、税收、价格、土地政策等方面出台优惠政策,并提出社会资本办医的近期发展目标。然而,目前民营医疗机构的发展现状与发展目标相去甚远,说明目前不少政策还属于倡导性法规,缺乏实施细则。结论：中央和地方应尽快出台与宏观性鼓励政策相配套的实施细则和法律法规,增加现有政策的可操作性,以使更多社会资本进入医疗领域。     

基于地理分级标准的偏远地区卫生人力资源优化：澳大利亚改良版蒙纳士模型及其对我国的启示

澳大利亚28%的人口居住在农村或偏远地区,因为地理条件问题,该类人群在卫生服务利用上面临着诸多挑战,健康状况普遍劣于沿海大都市区居民。为解决该类地区的医疗服务难题,澳大利亚卫生部自1994年起使用基于地理分级的人力资源分类系统以改进医疗服务,并定时更新地理分级系统以适应新的社会人口情况与医疗服务状况,同时制定了一系列配套的卫生政策来支持农村及偏远地区的医疗服务。2018年起,澳大利亚卫生部开始启用新的分级标准,即改良版蒙纳士模型(MMM)。本文回顾性分析了澳大利亚的做法并认为：为更好地为我国医疗资源薄弱地区提供优质、可及的医疗服务,我国可借鉴澳大利亚的相关经验,适时推进并分阶段细化医疗服务的地理分级系统,系统化制定相应资源优化政策,并发挥现代化与高新科学技术的作用。     

个人健康管理信息系统技术研究

建立健全公民健康档案对完善我国公共卫生和医疗服务体系,加强疾病防治和预防保健等工作具有重要意义。目前。我国医疗卫生行业信息化发展迅速,医院信息系统（HIS）、社区卫生服务系统（CHSS）等正在不断开发、应用。但由于各信息系统难以互通,不能形成完整的社会健康信息,难以实现对健康信息的深度挖掘和利用。为解决以上问题,应致力于个人健康信息,研究出一套在时间上涵盖个体从出生到死亡、内容上涵盖从预防接种到疾病诊治转归等医学健康行为的数据标准及数据管理标准.     

“片医负责制”社区卫生服务模式推广的操作流程

“片医负责制”社区卫生服务模式是以人为中心,通过地图式责任划分和服务监管,主动提供全面健康服务,实现人群全覆盖。“片医负责制”社区卫生服务模式所建立的网络化社区卫生服务体系符合新医改的基本要求,也体现了十八大三中全会的精神,是一种值得在全国推广的社区卫生服务模式。本文将郑州的实践经验提升到理论层面,研制具有可推广性的方法和操作流程,为“片医负责制”在其他地区的推广提供理论依据。     

Non-health determinants of health and healthcare in Delhi

With only 0.05% of the total area of the country, Delhi is home to 1.34% of India's population. This creates enormous pressure on natural and man-made resources, and generates situations in which non-health determinants may take precedence over the conventional determinants directly associated with health and healthcare. With the rising advocacy on social determinants of health, several of these factors may rightly seem to be part of the broader territory of health-related variables, and in that context, they may be designated as conventional non-medical determinants. We discuss some more visible domains, such as demography, migration and floating population; the physical and biological environment; economic determinants; social determinants; legislation and enforcement, and underscore some less explored yet critical domains of the determinants related to culture, governance and politics. What emerges as a compelling reality is a wide differential in physical environment, urban planning and access to infrastructural inputs between the privileged and marginalized areas of Delhi. Inequities in physical quality of life are so gross that even a value-neutral, official narrative betrays them helplessly. We propose actionable areas to address some of the pressing non-health determinants of health and healthcare.     

Ethical issues in healthcare financing

The four goals of good healthcare are to relieve symptoms, cure disease, prolong life and improve quality of life. Access to healthcare has been a perpetual challenge to healthcare providers who must take into account important factors such as equity, efficiency and effectiveness in designing healthcare systems to meet the four goals of good healthcare. The underlying philosophy may designate health as being a basic human right, an investment, a commodity to be bought and sold, a political demand or an expenditure. The design, policies and operational arrangements will usually reflect which of the above philosophies underpin the healthcare system, and consequently, access. Mechanisms for funding include fee-for-service, cost sharing (insurance, either private or government sponsored) free-of-fee at point of delivery (payments being made through general taxes, health levies, etc) or cost-recovery. For each of these methods of financial access to healthcare services, there are ethical issues which can compromise the four principles of ethical practices in healthcare, viz beneficence, non-maleficence, autonomy and justice. In times of economic recession, providing adequate healthcare will require governments, with support from external agencies, to focus on poverty reduction strategies through provision of preventive services such as immunization and nutrition, delivered at primary care facilities. To maximize the effect of such policies, it will be necessary to integrate policies to fashion an intersectoral approach.     

上海市基本卫生服务均等化财政补助探讨

由于我国地区经济发展差异较大,实现基本公共卫生服务逐步均等化的主要职责应由政府承担。为此,要实现2011年国家基本公共卫生服务项目普及和2020年基本卫生服务逐步均等化目标,均需要持续的政府财力作保障。分析上海市各区县间实现基本卫生服务“五级包”所需的财政补助,并得出上海市分阶段实现基本卫生服务均等化的财政补助情况,以期为实现全国范围内的基本卫生服务均等化提供借鉴。     

上海市闵行区卫生服务供需方对家庭医生责任制服务的认知情况调查研究

目的　了解目前上海市闵行区社区居民和社区卫生服务中心家庭医生对家庭医生责任制服务的认知情况,为上海市在医疗卫生改革中进一步完善、推广家庭医生责任制服务提供参考。方法　2015年4—6月,选取闵行区13家社区卫生服务中心家庭医生400名（供方）,采用方便抽样法抽取闵行区13家社区卫生服务中心的社区居民700名（需方）进行问卷调查,调查内容包括双方基本信息、签约情况、认为家庭医生责任制服务最需要改善的方面,社区居民对家庭医生责任制服务的知晓情况、就诊意愿、对家庭医生责任制服务的主观需求情况,家庭医生对就诊对象了解情况、对家庭医生责任制服务落实情况。结果　社区居民中共发放问卷700份,回收有效问卷657份,有效回收率93.9%;家庭医生中共发放问卷400份,回收有效问卷363份,有效回收率90.8%。在社区居民中,知晓社区卫生服务中心开展家庭医生责任制服务432名（65.8%）。在家庭医生提供的所有服务中,社区居民需求排名前3项为健康体检,计划免疫、妇幼保健、精神卫生、传染病控制等公共卫生服务,健康教育与健康咨询服务。家庭医生提供服务排名前3项为：慢性病建卡及随访管理、家庭病床及上门服务、双向转诊服务。在已签约的216名社区居民中,选择签约的家庭医生就诊率为50.0%（108名）;家庭医生对于就诊对象是否为自己签约对象的了解率为78.2%（284/363）。居民和家庭医生认为目前服务中最需要改善的方面为家庭医生诊治水平、基本药物制度的药物种类和对于疑难杂症向专科医院的快速有序转诊。结论　供需方对于家庭医生责任制服务的认知情况存在一定差异。社区卫生服务中心的家庭医生队伍应不断提高服务能力,进一步满足居民日益增长的基本医疗卫生服务需求,保证居民健康,保障家庭医生责任制的顺利实现和正常运转。     

新时期社区卫生服务与社会和谐发展

目的探讨新时期社区卫生服务对建设和谐社会的积极补充作用。方法运用全科医学、经济学和社会学相关理论，结合国家现阶段的任务讨论社区卫生服务与社会发展的相互关系。结果社区卫生服务具有激发和推进社会发展的重要功能。结论坚持发挥社会卫生服务功能，进一步释放其推动社会和谐的积极作用，彰显社区卫生工作的时代责任。     

The relationship between healthcare services and the political economy with reference to the Jamaican experience

The availability of and equitable access to, health services have challenged healthcare providers with a greater degree of urgency since the end of World War II. Prior to that time, concepts such as equity and social justice were just that, concepts but no real attempts were ever made to operationalize them. Goods and services were still produced and distributed based on market forces, that is, one's ability and willingness to pay for something. Health in that context was a service, some say a commodity, to be bought and sold, hence its availability was not necessarily commensurate with its accessibility.     

医疗卫生机构的组织间网络形成机制分析框架

互操作是我国卫生信息化的建设重点,也是推进医疗改革的必要条件。组织互操作是互操作当中直接作用于医疗服务的一个层面,其形成机制亟待了解。以网络视角看待组织互操作,转而分析组织间网络的形成机制问题,继而借鉴社会网络分析的经典理论,从节点、二元组、整体结构这三个层面提出医疗卫生机构的组织间网络的分析框架,并介绍相关统计推断方法,为未来的相关研究和政策制定提供参考。     

家长对儿童口腔保健家庭医生签约服务意愿及影响因素研究

背景　儿童口腔患龋率高,事态严峻。而目前我国口腔医疗服务供给体系总量不足,分布不均,对于群体性的口腔保健服务供给不足。目的　本文旨在研究家长对儿童口腔保健家庭医生签约服务的意愿及其影响因素,为儿童全面、持续、协调的口腔预防保健服务后续推进及儿童龋齿的防治提供参考。方法　2019年10月-2020年1月,分层选取成都市武侯区内的6家社区卫生服务中心,将进行儿童保健的家长作为研究对象。采取偶然抽样方法,采集其基本信息、儿童及家长口腔情况和保健干预情况、口腔就医习惯,采用多因素Logistic回归分析影响家长儿童口腔保健签约服务意愿的因素。结果　共发放问卷311份,实际回收303份,有效回收率为97.4%。39.6%（120/303）的儿童发生过口腔疾病问题,11.6%（35/303）的儿童接受过窝沟封闭或涂氟预防措施,36.3%（110/303）的儿童接受过儿童口腔卫生指导,68.3%（207/303）的儿童家长有意愿接受儿童口腔保健签约服务。孩子是否曾经做过窝沟封闭或者涂氟等预防措施、是否接受过专业口腔卫生指导及家长口腔健康知识知晓情况,不同情况的家长对儿童口腔保健家庭医生签约服务意愿比较,差异有统计学意义（P<0.05）。多因素Logistic回归分析显示,孩子是否做过窝沟封闭或者涂氟等预防措施是家长对儿童口腔保健家庭医生签约服务意愿的影响因素（P<0.05）。结论　儿童做过窝沟封闭或者涂氟等预防措施的家庭、接受过专业口腔卫生指导的家庭及家长具备口腔健康知识的家庭,更愿意签约儿童口腔保健服务。大力持续深入开展学校儿童口腔疾病综合干预项目的同时,基层医疗卫生机构应结合儿童健康管理与学校卫生工作,以健康教育与预防性门诊干预为主,积极开展儿童口腔保健签约服务,覆盖全龄儿童,进一步降低患龋率。