The Current Quality of Health Plan Report Cards

In general, health plan report cards can provide valuable information to consumers, physicians, and health care purchasers regarding plan performance and quality to assist in the selection of a health plan. However, significant limitations of health plan report cards currently exist. It is only with further evolvement and refinement that health plan report cards can live up to their potential and become a distinctive and useful tool in evaluating and selecting among various health plans.     

Managing Medical and Insurance Information Through a Smart-Card-Based Information System

The continuously increased mobility of patients and doctors, in conjunction with the existence of medical groups consisting of private doctors, general practitioners, hospitals, medical centers, and insurance companies, pose significant difficulties on the management of patients' medical data. Inevitably this affects the quality of the health care services provided. The evolving smart card technology can be utilized for the implementation of a secure portable electronic medical record, carried by the patient herself/himself. In addition to the medical data, insurance information can be stored in the smart card thus facilitating the creation of an "intelligent system" supporting the efficient management of patient's data. In this paper we present the main architectural and functional characteristics of such a system. We also highlight how the security features offered by smart cards can be exploited in order to ensure confidentiality and integrity of the medical data stored in the patient cards.     

死亡报告卡管理现状调查与对策

目的调查死亡报告卡的管理现状并探讨增强其监测效果和预警能力的方法。方法采用书信访问的方式对14所综合性医院进行了相关的问卷调查。结果85.7%的医院规定死亡报告卡的院内上报时间为病人死亡的当日和次日,客观地造成了死亡报告卡早于病案的回收时间,在死亡报告卡不能完全满足编码需求的情况下,可能会出现编码不准而导致死亡疾病信息失误的现象,从而失去或降低死亡统计的监测效果和预警能力。结论医院在上级部门允许的范围内,推迟死亡报告卡的院内上报时间而要求报告卡与病案一起回收,这是解决存在问题的最好方法;其次是在死亡报告卡上增设内容,以完全满足编码的需求。     

一个值得关注的问题：医生疲劳与患者安全

医务人员由于长时间工作及生理周期破坏所导致的睡眠剥夺，使患者不能得到高质量的医疗服务，这在我国医患关系比较紧张的客观实际情况下是不容忽视的。因此，关注医生疲劳与患者安全的问题在我国有其现实意义。积极采取各种策略妥善解决医生疲劳问题，保证医疗安全，建立安全、高质量的医疗保障体系，不仅直接关系到患者的治疗效果，而且对融洽医患关系，保证医疗安全都是十分重要的。     

301模式一卡通自助服务设计与实现

自助服务终端同时与HIS系统、银行系统和北京医保中心3个系统实时连接、交互业务数据。病人使用中、农、工、建等四大银行的银行卡,在自助服务终端上即可完成挂号、缴费、银行卡扣费等操作。使用银行卡,从源头上保证了病人在医院身份的实名信息,在医院内,银行卡除本身金融功能外同时具有病人标识作用。301模式除支持传统的预交金模式外,还包括具有特色自助服务和功能,挂号、预约取号、自助办理医疗卡、白助充值、自助缴费和自助打印检验报告单及执行地计价等。传统上这些都是常规的、需要排队的非医疗活动,通过在大量白助设备中部署这些功能,减少了病人排队次数,改善了病人就诊体验。     

Provision of health care for persons with developmental disabilities living in the community. The Morristown model

Persons with developmental disabilities living in the community have a greater number and variety of health care needs than the average population of the same age and sex. The erroneous assumption that the generic health care system would be able to provide all necessary services to the large number of individuals recently transferred from state residential facilities to the community has proved to be an unexpected disappointment to human service policymakers. In an effort to remedy this situation, a program of health care services was established by the New Jersey Department of Human Services at a community teaching hospital to supplement the existing generic system of medical care. Within four years, the program had rapidly grown to provide care for 729 patients who had come to rely on the center for primary care, specialty medical and dental services, and medical case management. The demographic characteristics of this program are described as well as data on morbidity, service utilization, and special problems encountered when care was provided to this complex and medically underserved population.     

以居民身份证编号的健康信息归结与共享作用探讨

依据居民身份证编码基本特征与优势,分析了就医过程中应用各种各样“就医卡”所产生的问题,探讨了利用居民身份证号码作为统一“就医卡”编码的可行性及作用意义。得出结论：利用居民身份证编号创建就医卡,不仅可以简化就医登记手续,方便管理,提高就医效率,而且减少资源浪费,还是消除信息孤岛的有力举措之一,对于区域医疗信息交换共享具有重要的意义。     

Internet report cards on quality: what exists and the evidence on impact

Report cards based on publicly disclosed data abound. Consumers can use the internet to review grades on physicians, hospitals, nursing homes, home health agencies, and insurance plans. The reports differ in their combinations of mortality data, process measures, access scores, and satisfaction surveys. The internet sites also differ by access charge, data sources, and presentation of information. Public disclosure of quality data has had little impact on the behavior of consumers, larger purchasers of health care, and physicians. However, health care provider organizations have responded to the public reports of quality. Analysis of the impact of public report cards is lagging as web-available reports rapidly grow and pay for performance programs emerge.     

Mini Medical Record Application: Annual Register for Flu Shot Vaccinations

This application is an Intranet-based system. A database has been established utilizing patient information on the basis of age, medical diagnosis and employment history. If a health care provider or support staff states that a patient is over 65 years of age or has been diagnosed with a chronic disease and this limits the patient’s ability to fight off infection, the need for preventive care is activated. In this situation the preventive care is the administration of an annual flu shot. For anyone over 65 years of age or with a chronic illness, a bulk mail of reminder cards with the dates of availability of injection is generated and mailed. All health care workers are notified at work of vaccination sites that they can use. In addition, should a patient have an appointment with a provider and a preventive flu injection is indicated, a reminder appears on the registration form. This reminder indicates a flu shot is needed as well as other preventive intervention.     

农村社区卫生技术人才现状分析与对策研究

农村医疗卫生服务队伍主要存在以下问题：临床医生数量不足、临床医生素质较低、职称结构失调、年龄老化。通过对浙江省湖州市农村社区卫生技术人才现状的调查和分析,根据农村社区居民对医疗卫生服务的新需求,提出定向农村社区培养临床医生的新对策。     

A Non-Repudiated and Traceable Authorization System Based on Electronic Health Insurance Cards

Since anamnesis management in health care is directly relative to patients’ privacy protection, how to resist malicious behaviors is an important issue in information security. In recent years, the developed electronic health insurance cards (eHIC) has been widely adopted as an identification certificate, which involves lots applications and provides convenience to both the patients and relative medical workers as well. There always existed some disputes and moral standards for these medical doctors who are to be confronted with these challenges. For example: The doctor discloses patient’s anamnesis without patient’s consent and anamnesis by the illegal access…etc. As required in E-Health, the current systems are almost offline system, which are not suitable to support online E-anamnesis sharing access to reduce the consumption of the medical treatment and fulfill a secure audit channel. In this paper, to solve these problems, an eHIC-based online authorization system with non-repudiated and traceable properties is proposed. According to our simulation results, not only the patient’s privacy could be fully protected, but also the medical revenue could be raised extensively.     

疫情直报系统建设探析

在分析武警部队卫勤应急任务需求、卫勤部门业务需求的基础上,提出武警部队疫情直报系统的建设目标和任务,阐述系统建设内容,分别描述其疫情报告卡管理、突发事件管理、传染病自动预警管理、GIS展示管理和系统管理5个应用模块。     

处方药量监管的探讨

处方开药量在医政及医保管理都有相关的规定,但在临床工作中仍面临诸多未能详尽阐明的问题。医疗保险处于费用控制需要,对10种特殊疾病做出了可开出不超过1个月的可操作的具体规定,但多年未进一步进行疾病增补和完善。同时,由于医保在控制费用中片面强调单次开药量的网络审核和控制,卫生行政部门又疏于医疗行为的监控,给患者、医师和医院管理都带来一系列的现实难题。面对目前医保资源的不合理消耗及药品使用的不规范现象,医保和医政管理应做好顶层设计,从基本医保药品目录管理以及医师和参保人医疗行为规范等方面入手,加强对患者个体异常费用整体监控,注重临床医师的职业素养和道德规范教育,医政和医保分工合作,各司其职,才能真正合理高效的利用好医保资源,合理施治,实现医、患、保三方共赢。     

Consumer competence and the reform of American health care.

This report examines the role of the expert in the American health care system, both as provider and administrative policymaker. It shows that the guiding assumption of American health care policy, ie, that the medical system can and should be managed by experts on behalf of consumers and patients, does not hold up to scrutiny. It also demonstrates that the important theme in American history of placing authority and responsibility for action in the hands of the individual has not been sufficiently influential in American health care. Drawing on this theme and creating consumer competence and responsibility in health care choices as the keys to health care reform in the United States are advocated.     

Development of a Telecare System Based on ZigBee Mesh Network for Monitoring Blood Pressure of Patients with Hemodialysis in Health Care Centers

In Taiwan, the number of the patients needing dialysis increases rapidly in recent years. Because there is risk in every hemodialysis session, monitoring physiological status, such as blood pressure measurement every 30 min to 1 h is needed during about 4 h hemodialysis process. Therefore, an assisted measurement on blood pressure is needful in dialysis care centers. Telecare system (TCS) is regarded as one of important technique in the medical care. In this study, we utilized ZigBee wireless technique to establish a mesh network for monitoring blood pressure automatically and data storage in medical record system for display and further analysis. Moreover, while the blood pressure exceeds the normal range, the system could send a warning signal to remind, or inform the relatives and clinicians in health care center through the personal handy-phone system (PHS) immediately. The proposed system provides an assisted device for monitoring patients’ blood pressure during hemodialysis process and saving medical manpower.     

A six-minute video-clip to ponder the values fostered by health technology

As part of our research team''s knowledge transfer and exchange (KTE) initiatives, we developed a six-minute video-clip to enable productive deliberations among technology developers, clinicians and patient representatives. This video-clip summarises in plain language the valuable goals and features that are embedded in health technology and raises questions regarding the direction that should be taken by health care innovations. The use of such video-clips creates unique opportunities for face-to-face deliberations by enabling participants to interact and debate policy issues that are pivotal to the sustainability of health care systems. In our experience, we found that audiovisual-elicitation-based KTE initiatives can fill an important communication gap among key stakeholders: pondering, from a health care system perspective, why and how certain kinds of medical technologies bring a more valuable response to health care needs when compared to others.     

蚌埠市医保卡使用现状调查与浅析

目的了解医保卡的现行使用规定以及使用时出现的各种问题，针对性地提出改进策略，为完善医疗卫生保障体制改革做出贡献。方法采用文献参考和调查研究相结合。收集150份关于医保卡使用现状的问卷，对其进行分析。结果医保患者已经接受了医保卡并在使用，医保卡的确带来了医疗保障。医保患者对现行使用规定尚存不满，另外还存在资源浪费和编制外人员使用的现象。结论加大宣传力度，使群众更多的了解医保卡；加大医疗卫生保障的投入；加强监督管理，完善医保制度，防止资源滥用和浪费；完善医院、药店管理，提高服务质量和医保卡使用绩效。     

Computerized Physician Order Entry: Helpful or Harmful?

Computerized physician order entry (CPOE) is touted as a major improvement in patient safety, primarily as a result of the Institute of Medicine''s 1999 report on medical errors and the subsequent formation of the “Leapfrog Group” of companies to preferentially direct their employees'' health care to those institutions that install such systems (as part of directives that “Leapfrog” feels will improve patient care). Although the literature suggests that such systems have the potential to improve patient outcomes through decrease of adverse drug events, actual improvements in medical outcomes have not been documented. Installation of such systems could actually increase the number of adverse drug events and result in higher overall medical costs, particularly in the first few years of their adoption.In the last five years, hospitals, including our own, have begun to use computerized systems that require physicians and other health care providers to electronically enter patient care orders.¹ Before this time, only a handful of hospitals used such systems. These computer programs contain algorithms that alert health care providers to potentially harmful therapeutic decisions before orders are processed. The installation of these systems is costly (millions of dollars) and requires major behavioral changes, not only by physicians, but also by the entire health care organization.² In January 2003, Cedars-Sinai Health System in Los Angeles removed its recently installed computerized physician order entry (CPOE) system from use after almost unanimous protest from the medical staff. Why are hospitals and other health care organizations pursuing this avenue at this time? Does the literature support the premise that these systems are beneficial for patient care? Do such systems decrease total health care costs? The answers to these questions are still evolving. In this forum, we address these questions and describe some of the pertinent medical literature on this subject.     

Just health: On the conditions for acceptable and unacceptable priority settings with respect to patients' socioeconomic status

It is well documented that the higher the socioeconomic status (SES) of patients, the better their health and life expectancy. SES also influences the use of health services-the higher the patients' SES, the more time and specialised health services provided. This leads to the following question: should clinicians give priority to individual patients with low SES in order to enhance health equity? Some argue that equity is best preserved by physicians who remain loyal to 'ordinary medical fairness' in non-ideal circumstances when health disparities persist; ie, doctors should allocate care according to needs only and treat everyone with equal regard by being neutral with respect to patients' SES. This paper furthers a discussion of this view by questioning how equitable needs relate to SES. To clarify, it distinguishes between four versions of 'healthcare need' and approaches an acceptable conceptualisation of the notion supported by Norman Daniels' theory on health equity. It concludes that doctors should remain neutral to patients' SES in cases in which several patients require the same health care. However, equitable health care requires considerations of the impact of socioeconomic factors (SEF) on patients' capacity to benefit from the care. Remaining neutral towards patients' SES in this respect does not promote equal regard. It follows that priority setting on the basis of SEF is required in fair clinical distribution of care, eg, through allocating more time to patients with low SES. In order to advance equity accurately, the concept of ordinary medical fairness should be amplified according to this clarification.