Provider automation. Focusing on the big picture

St. Vincent's Hospital in Birmingham, Ala., is preparing for a new world of health care by creating an enterprisewide information systems strategy rather than developing automation solutions for departmental "islands."     

Windows NT continues its battle for market share

A growing number of health care organizations are implementing applications that run on the Microsoft Windows NT network operating system. But most of the early adopters are applying NT at the department level rather than using it for enterprisewide tasks. And the many flavors of Unix continue to dominate the market for network operating systems in health care.     

Intranets are the key to new database strategies

Health care organizations are finding that easy-to-use intranets can improve access to data. Because intranets are easier to navigate than other networks--and often less expensive--many provider and payer organizations are reorienting their database plans. But some organizations move too fast with new plans and have difficulty standardizing enterprisewide data, threatening intranet viability.     

Provider automation. Where should we start?

For an integrated delivery system in Memphis, the starting point for its enterprisewide automation efforts was obvious. It had an immediate need to improve business operations.     

Will CHINs be able to mesh with enterprise networks?

The current proliferation of enterprisewide information networks developed by integrated delivery systems wasn't foreseen when the community health information network concept was spawned. Now, many are wondering how enterprise networks will mesh with CHINs and whether there will be needless and expensive duplication of services.     

Network support critical in choosing a lab system

When providers acquire laboratory information systems, they're looking beyond improving their lab operations to determine how the software will provide data to build computerized patient records throughout an integrated delivery system. Vendors are beginning to differentiate themselves based on how effectively their systems support the formation of enterprisewide information networks.     

Software program to systematize data for planning public health actions

OBJECTIVE: To describe and evaluate a software program to provide basic health care teams with primary health services data. METHODS: It was described the PACOTAPS (software program for primary health care), developed using Visual Basic 5.0, and secondary data and outpatient care demand modules were tested in a basic health care unit in Pelotas, Brazil. Age/gender structure of the reference population was obtained from secondary data. Outpatient care demand allowed the characterization of all 4,170 visits carried out in a month by analyzing Outpatient Care Files. RESULTS: Age and gender distribution as well as main diagnoses and referrals were identified for all patients seen at the health care unit. In addition, there were detected differences among the health care centers due to either different organization and care models or as a result of different actual needs of improvement in patient register systems. CONCLUSIONS: PACOTAPS, a user-friendly software program, can contribute to health care unit management evaluation within the national Unified Health System (SUS). The availability of an electronic tool combining resources allows decision making in healthcare facilities, and even at municipal health policy level, to be based on more adequate and effective data.     

A review of data on the U.S. health sector spring 2006.

This report presents information on the state of the U.S. health system in the spring of 2006. It includes data on the uninsured and underinsured and their access to health care, on socioeconomic inequality in health care, and on the rising costs of the U.S. health system. It also presents information on the role of corporate money in health care, focusing on the pharmaceutical industry, Medicare HMOs, and corporate-government conflicts of interest. The author includes a survey of recent public opinion polls on health care and health system reform and an update on the U.S. national health insurance legislation. The article ends by reviewing recent data on international health systems and international system comparisons.     

The distribution of health needs and services in South Africa

The authors recognize that social, economic and political factors play a larger role in determining public health policy than do epidemiological principles such as the analysis of needs, demand and supply. Nevertheless, demographic and mortality statistics, information from the 1983 registers of medical and dental practitioners, and that of nurses, as well as information on hospital beds were reviewed to describe health care requirements and resources in South Africa. The maldistribution observed in health needs and services closely parallel the divisions in South African society imposed by the apartheid policy. It is concluded that fundamental political change is required to reduce this maldistribution. The provision of preventive and promotive health services for children in African rural and peri-urban areas was identified as a health care requirement of high priority. It is thought that the need in these geographical regions might best be met by employing primary health care workers at a lower level of training than doctors with an accessible, supporting referral system. In addition, the quality of health care data being collected needs to be improved. It is suggested that both these problems be approached on a regional basis, and preferably under a single health authority, rather than the current fragmented health service.     

Rereading contraceptive policy: health professionals' views of daily routine in public health services

This essay is part a larger study on the relationship between the Brazilian government and contraceptive policy and precedes a survey performed in health services in Rio de Janeiro. It is also intended to analyze what health care professionals and users think about contraception. It presents considerations by a social worker with experience in family planning activities in outlying public health care services and also provides data facilitating activities in this area. It thus touches on some elements that interfere in practical work in this field, such as academic life and social representation, in addition to submitting a written critique to PAISM (the Brazilian Ministry of Health's Program for Integrated Women's Health Care) as an official contraceptive policy.     

Organization of ambulatory care provision: a critical determinant of health system performance in developing countries

Success in the provision of ambulatory personal health services, i.e. providing individuals with treatment for acute illness and preventive health care on an ambulatory basis, is the most significant contributor to the health care system's performance in most developing countries. Ambulatory personal health care has the potential to contribute the largest immediate gains in health status in populations, especially for the poor. At present, such health care accounts for the largest share of the total health expenditure in most lower income countries. It frequently comprises the largest share of the financial burden on households associated with health care consumption, which is typically regressively distributed. The "organization" of ambulatory personal health services is a critical determinant of the health system's performance which, at present, is poorly understood and insufficiently considered in policies and programmes for reforming health care systems. This article begins with a brief analysis of the importance of ambulatory care in the overall health system performance and this is followed by a summary of the inadequate global data on ambulatory care organization. It then defines the concept of "macro organization of health care" at a system level. Outlined also is a framework for analysing the organization of health care services and the major pathways through which the organization of ambulatory personal health care services can affect system performance. Examples of recent policy interventions to influence primary care organization--both government and nongovernmental providers and market structure--are reviewed. It is argued that the characteristics of health care markets in developing countries and of most primary care goods result in relatively diverse and competitive environments for ambulatory care services, compared with other types of health care. Therefore, governments will be required to use a variety of approaches beyond direct public provision of services to improve performance. To do this wisely, much better information on ambulatory care organization is needed, as well as more experience with diverse approaches to improve performance.     

Health status and medical expenditures: is there a link?

Until now, cross-national studies have not demonstrated a positive relationship between health care expenditures and improved health status, as measured by such indicators as age-adjusted mortality rates. It has therefore been argued that cutting expenditures will not have a negative effect upon health status. Using health and life-style data from the OECD for Germany, the United Kingdom, The Netherlands, France, Sweden and the United States, this study finds that when one holds constant those changes in life style that have an impact upon health (e.g. smoking, drinking, traffic accidents, dangers on the job) and adjusts for inflation and population size, health care expenditures do bear a positive relationship to health status. This suggests that reductions in health care expenditures may well have some cost in terms of overall health.     

Exploring patients' experience of receiving information about cancer: a comparison of interview and questionnaire methods of data collection

Patient information is widely regarded both as a resource and an entitlement: a means of 'empowering' patients to behave as 'consumers' of health care. Patient 'satisfaction' has come to be regarded as an important outcome of care. This article presents qualitative interview data regarding the experience of patient information provision and the results of a self-completed Information Satisfaction Questionnaire (ISQ) among patients and relatives affected by cancer. It considers the implications of the differences between these for service evaluation and current policy implementation promoting patients as informed and expert consumers of health care. The study findings contribute to growing evidence that the high rate of patients' expressed satisfaction with different aspects of service provision as indicated by structured questionnaire responses is largely an artefact of the method of data collection. Accounts of negative experiences were common, but did not translate into expressed criticism or overt dissatisfaction. It is important that the limitations of such surveys are contextualized in relation to qualitative findings such as those of the present study. Especially in the face of serious and life-threatening illness, professional constructs such as 'information delivery', 'satisfaction' and 'shared decision making' have little resonance for many patients, who prefer to trust in professional expertise and to eschew the acquisition of specialist knowledge and active involvement in decisions about health care.     

Holistic Self-Management Education and Support: A Proposed Public Health Model for Improving Women's Health in Zimbabwe

The primary health care model of public health has been implemented in many countries around the globe since the Declaration of Alma Ata in 1978, without pilot testing the primary health care model. Therefore, many public health researchers have sought methods of improving primary health care by creating evidence-based models. Many of these researchers recognize the role of behavioral models in public health. These offshoots of primary health care include the ecological, care, central human capabilities, and the SPECIES models. Holistic self-management education and support is a capacity-building philosophy that ensures active involvement of consumers of health care in the planning and implementation and evaluation of health care services. It helps consumers of health care to achieve the desired improved quality of health and life in managing and sustaining their health at the grassroots level. The care model addresses disease management ideals of the in the original primary health care model. The SPECIES model addresses those aspects of the primary health care model that include the cultural and social factors, as well as individual health education and support in the original primary health care model. The ecological model offers an improvement of the socioeconomic ideal in the original primary health care model. Improving the health of individuals will prevent illness, thereby reducing health care costs and lessening the current strain on an overburdened health care system in Zimbabwe. Holistic self-management education and support links health care delivery systems with social processes. It is a best practices model that could better serve Zimbabwean girls and women by contributing positively to the national challenges in health care, thereby meeting the Zimbabwean primary health care and safe motherhood goals. It is here recommended that holistic self-management education and support must be pilot tested before being adopted as the most appropriate model for ensuring population health.     

Holistic self-management education and support: a proposed public health model for improving women's health in Zimbabwe

The primary health care model of public health has been implemented in many countries around the globe since the Declaration of Alma Ata in 1978, without pilot testing the primary health care model. Therefore, many public health researchers have sought methods of improving primary health care by creating evidence-based models. Many of these researchers recognize the role of behavioral models in public health. These offshoots of primary health care include the ecological, care, central human capabilities, and the SPECIES models. Holistic self-management education and support is a capacity-building philosophy that ensures active involvement of consumers of health care in the planning and implementation and evaluation of health care services. It helps consumers of health care to achieve the desired improved quality of health and life in managing and sustaining their health at the grassroots level. The care model addresses disease management ideals of the in the original primary health care model. The SPECIES model addresses those aspects of the primary health care model that include the cultural and social factors, as well as individual health education and support in the original primary health care model. The ecological model offers an improvement of the socioeconomic ideal in the original primary health care model. Improving the health of individuals will prevent illness, thereby reducing health care costs and lessening the current strain on an overburdened health care system in Zimbabwe. Holistic self-management education and support links health care delivery systems with social processes. It is a best practices model that could better serve Zimbabwean girls and women by contributing positively to the national challenges in health care, thereby meeting the Zimbabwean primary health care and safe motherhood goals. It is here recommended that holistic self-management education and support must be pilot tested before being adopted as the most appropriate model for ensuring population health.     

Standards and the integrated electronic health care record

The goal of creating an integrated electronic health care record is within our reach. It will depend chiefly on the creation and adoption of standards for health care data. This article explains why standards development is important, gives examples of the different types of standards relevant to health care, offers examples of data sets used in health care, and, finally, presents examples of standards development organizations that health care supervisors should be familiar with.     

Development and implementation of an information management and information technology strategy for improving healthcare services: a case study

PeaceHealth is a multistate, not-for-profit integrated delivery network that owns and operates five acute care hospitals, one critical access hospital, and twenty-five outpatient clinics. PeaceHealth employs approximately two hundred physicians and seventy allied health professionals; it has relationships with one thousand affiliated physicians. In 1990, PeaceHealth developed a set of strategic priorities for delivering seamless care across the continuum, and creating partnerships between caregivers and patient-consumers. A major component of these strategies was development and implementation of the technology, knowledge, organizational, and community infrastructures that would support delivering and using high-quality, timely information when and where it is needed for effective clinical, operational, and financial decision making. Executing this strategy has resulted in implementation of standard enterprisewide information systems, including a computer-based patient record system in inpatient and outpatient settings, tactical and strategic decision support systems, a well-developed intranet and access to the Internet, and a knowledgeable workforce that have enabled PeaceHealth to support and improve its services and business by bringing interactive information directly to patients, caregivers, managers, directors, and executives. This case study discusses the drivers behind the development of this strategy, specific components of the information management and information technology infrastructure, examples of the impact they have had on patients, caregivers, and the organization, and lessons learned.