Options for Improving Timely Access to Care Reporting in California
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The state of California has taken the lead in developing metrics, standards, and a methodology for collecting the needed data for monitoring timely access to health care, but health plans have faced numerous challenges in collecting and reporting this information. This report focuses on specific concerns with the methodology; the authors use a multipronged approach to describe and document these issues and identify and assess potential solutions.Keywords:
Data access
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The fundamental need for better information management capabilities in health care is at risk of being overlooked in the proposals for major national changes aimed at providing health security, controlling costs, enhancing quality, and expanding access for citizens. In addition to these proposed macro changes (e.g., universal access, guaranteed benefit package, national health board, regional health alliances), successful reform will require transformation of health care delivery at the micro level. We must overcome provider-dependent variations in clinical practice patterns, in quality of performance, and in costs of services. We must ensure movement toward appropriate care rather than simple rationing. Individual health care professionals and institutions must acquire and use tools that will enable them to provide their services cost-effectively with consistent results. We must be able to assess and ensure value--i.e., appropriateness, effectiveness, and cost--of health services, apply that knowledge in each and every patient encounter, and track the impact of clinical decisions through an analysis of aggregated databases.
Rationing
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The appropriate use of state of the art technologies for health care service provision is of a great use and importance, not only for enhancing the patient’s health care but also for facilitating, automating and streamlining patient’s identification processes and record managements in the hospitals. According to the World Health Organization, hospitals nowadays are experiencing problems towards collecting, monitoring and management of health care data due to the fragmented structures and lack of regulation. In this study, the functioning and limitations of an existing healthcare software system were analysed with the development of an improved system to address the limitations. The study introduced the adaptation of both Electronic Medical Record System and Health Monitoring System, with the use of prototyping software development methodology; a justification for the chosen methodology is discussed. Among the critical elements of the health care systems analysed in this study includes schedule management, records management, patient care management and monitoring patient’s medication with a detailed description of each phase of the prototyping development methodology.
Medical record
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American public policy makers recently established the goal of providing the majority of Americans with electronic health records by 2014. This will require a National Health Information Infrastructure (NHII) that is far more complete than the one that is currently in its formative stage of development. We describe a conceptual framework to help measure progress toward that goal.The NHII comprises a set of clusters, such as Regional Health Information Organizations (RHIOs), which, in turn, are composed of smaller clusters and nodes such as private physician practices, individual hospitals, and large academic medical centers. We assess progress in terms of the availability and use of information and communications technology and the resulting effectiveness of these implementations. These three attributes can be studied in a phased approach because the system must be available before it can be used, and it must be used to have an effect. As the NHII expands, it can become a tool for evaluating itself.The NHII has the potential to transform health care in America--improving health care quality, reducing health care costs, preventing medical errors, improving administrative efficiencies, reducing paperwork, and increasing access to affordable health care. While the President has set an ambitious goal of assuring that most Americans have electronic health records within the next 10 years, a significant question remains "How will we know if we are making progress toward that goal?" Using the definitions for "nodes" and "clusters" developed in this article along with the resulting measurement framework, we believe that we can begin a discussion that will enable us to define and then begin making the kinds of measurements necessary to answer this important question.
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Health information technology
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Quality measures developed to quantify health care provider-specific performance can be useful tools for informed decision-making by consumers, purchasers, and regulators. Additionally they can stimulate improvements in the quality of care and provide insight in targeting of quality improvement activities. Following up on the spring 2001 issue of the Review on performance measures for health plans, this issue addresses provider-specific measures of quality and refinements to existing plan-specific measures.
The first five articles in this issue of the Health Care Financing Review report on recent initiatives to develop and implement new provider-specific measures of quality in health care delivery, focusing on settings other than health plans. This set of articles provides insights into the processes used in the design, development, and implementation of these initiatives and each offers lessons learned for future work. Aspects addressed in these articles include the crafting of the measures as well as the challenges of presenting, explaining, and disseminating the information to the public. The spectrum of providers covered includes nursing homes, dialysis facilities, hospitals, and primary care case management programs.
These new initiatives have balanced concerns of validity, reliability, timeliness, and value to the user. Despite acknowledged shortcomings, these projects have expanded the information available to the public and to health care providers, often under constraints of aggressive timelines to meet legislative mandates. The authors acknowledge that each of these projects is only a first step, and relay that the importance of advancing the quality process outweighs limitations in the indicators. Use of these new measures affords opportunities for continued improvement and evolution of the measures, their implementation, and the supporting communication strategies.
The next four articles in this theme focus on refinements and new applications of existing quality measurement tools used in health plans. These studies illustrate the further evolution and application of established quality measures. The contrast between the levels of refinement in these two sections of this issue highlights the advancements that have been made in quality measurement for health plans, a health care delivery setting that has a history of systematically using established quality measures.
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Within the health system policymakers program managers and health care providers require needs-driving and evidence-based information to inform decision making and improve the quality of services delivered. However many international health and development organizations continue to rely on a push model of information dissemination routinely sending information to health care professionals in low- and middle-income countries but failing to fully take into consideration the needs of information consumers in these settings. Over the past decade the world has experienced an information revolution with the exponential growth of information and communication technologies and the surge in Internet and mobile phone users worldwide. These advances have dramatically increased access to health information for many health care professions. However those who live in remote areas work at grassroots level and are most in need of information at the point of care continue to have the least access to these technologies. An adequate assessment of health information needs including opportunities barriers and gaps is necessary for designing effective communication strategies. The articles in this special issue contribute to the evidence base of the information needs of health care professionals working at various levels of the health system. Through an examination of information flow throughout an entire health system the research studies provide concrete findings on the information needs and wants of individual health care professions and document the role of professional networks. The commentary pieces further explore these issues to help design sound programs that improve knowledge management and sharing.
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The purpose of this paper is to assess the current status of information system specifically in the areas of health sector, role of health information technology (HIT) and its importance in improving the delivery of health care services; to assess the challenges/issues faced and future recommendation to improve the status of health IT in India. Secondary data is used. Various articles and research papers published in national and international journals are used. India is hub of IT and its use is increasing in health sector. Currently HIT is used through electronic health records (HER); telemedicine; digital health knowledge resource; hospital information management system; e-learning technologies, health informatics etc. Health Inter Network India project was designed to access the impact the IT in health. Various challenges and issues are involved with the use of information technology such as non availability of internet facility in all the geographical areas, absence of policy, guidelines and standards, lack of proper infrastructure and competent human resource. On the basis of the current status and challenges associated with Health IT, some recommendations are suggested such as formulation of policy, standards and guidelines to maintain the quality, improve the government funding to improve the current infrastructure, purchasing and installing technology and recruiting the competent staff or train existing health staff.
Health information technology
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The dominance of managed care as an organizing principle for health care delivery suggests that cost-effectiveness analysis (CEA) may be applied increasingly to decision-making at all levels. Health services researchers now need to address questions of how to further the underlying methods of CEA, how to make it a more practical tool for market-based as well as public policy decisions, and how to enhance CEA's ability to lead to responsible decisions that result in more effective and efficient care.
Dominance (genetics)
Health Care Delivery
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Health Information Exchange
Unintended consequences
Information exchange
Health information technology
Data Exchange
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Ontario has been a leader in performance-reporting in clinical areas such as surgery, cardiac care and drug use in the elderly.Data used to report on these areas are readily available for performance evaluation and are of reasonable quality.But other key areas like managing chronic disease and preventive care cannot be fully evaluated because relevant data are either unavailable or of poor quality.A focus on timely access to good quality demographic and vital statistics data would enhance our ability to evaluate components of the Ontario health system.New comprehensive primary care, laboratory services and drug prescriptions data sources are also necessary for health-system evaluation and planning.In the short term, a dedicated, centralized agency with legislative authority is proposed to move Ontario's health information agenda forward in a holistic, strategic and timely manner.
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Purpose – This chapter reports on experts’ perspectives on health information technology (HIT) and how it may be used to improve health care quality and to lower health care costs.Design/methodology/approach – Two roundtables were convened that focused on how to best use HIT to improve the quality of health care while ensuring it is accessible and affordable. Participants drew upon lessons learned in the Netherlands, the United States, and other countries.Findings – The first roundtable focused on the use of (1) electronic health records (EHRs) by health care providers, (2) cloud computing for EHRs and health portals for consumers, and (3) data registries and networks for public health surveillance. The second roundtable highlighted (1) the rapid growth of personalized medicine, (2) the corresponding growth and sophistication of bioinformatics and analytics, (3) the increasing presence of mobile HIT, and (4) the disruptive changes in the institutional structures of biomedical research and development.Practical implications – Governmental sponsorship of small pilot projects to solve practicable health system problems would encourage HIT innovation among key stakeholders. However, large-scale HIT solutions – developed through small pilot projects – should be pursued through public–private partnerships. At the same time, governments should speed up legislative and regulatory procedures to encourage adoption of cost-effective HIT innovations.Social implications – Mobile HIT and social media are capable of fostering disease prevention and encouraging personal responsibility for improving or stabilizing chronic diseases.Originality/value – Both health services researchers and policy makers should find this chapter of value since it highlights trends in HIT and addresses how health care quality may be improved while costs are contained.
Sophistication
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