'Fit-for-purpose?' - challenges and opportunities for applications of blockchain technology in the future of healthcare.

Blockchain is a shared distributed digital ledger technology that can better facilitate data management, provenance and security, and has the potential to transform healthcare. Importantly, blockchain represents a data architecture, whose application goes far beyond Bitcoin - the cryptocurrency that relies on blockchain and has popularized the technology. In the health sector, blockchain is being aggressively explored by various stakeholders to optimize business processes, lower costs, improve patient outcomes, enhance compliance, and enable better use of healthcare-related data. However, critical in assessing whether blockchain can fulfill the hype of a technology characterized as 'revolutionary' and 'disruptive', is the need to ensure that blockchain design elements consider actual healthcare needs from the diverse perspectives of consumers, patients, providers, and regulators. In addition, answering the real needs of healthcare stakeholders, blockchain approaches must also be responsive to the unique challenges faced in healthcare compared to other sectors of the economy. In this sense, ensuring that a health blockchain is 'fit-for-purpose' is pivotal. This concept forms the basis for this article, where we share views from a multidisciplinary group of practitioners at the forefront of blockchain conceptualization, development, and deployment.

Human resource technology disruptions and their implications for human resources management in healthcare organizations.

Concern among the public and policymakers about current and future major staff shortages is increasing. Strengthening Human Resource (HR) practices and adopting HR technologies such as Human Resource Information Systems (HRIS), that can collect, store and report workforce data are often described as a potential solution to this problem. Indeed, examples from other industries show that HRIS can help to launch or manage, as well as provide ongoing insights concerning the whole career cycle of an employee. However, few of the existing studies that discuss technology or its impacts on the future of work have focused on health organizations, and those that do have not received sufficient attention in health literature. Furthermore, such contributions as there have been have either prioritized a particular type of technology or focused mainly on the effect of automation on health professionals' work. They have thus overlooked the full range of possible uses of these technologies and, specifically, have neglected the topic of HR for Health (HRH) management in health organizations. The primary aim of this paper is to address this lacuna, with specific reference to the existing categorization of HR technological disruptions. To conclude, health organizations and the health and HR professionals who work within them need to use HRIS responsibly, finding a balance between the drive for innovation, productivity and efficiency and respect for all potential legal, ethical and compliance issues, as well as taking account of the importance of HRH wellbeing and satisfaction.

[Management System of Implantable Medical Device in Accordance with JCI Standard Based on HRP System].

JCI standard is the most professional and authoritative certification standard of medical quality and safety system in the world. HRP information system is a systematic hospital resource management platform which integrates the existing hospital information resources and establishes a set of unified, efficient, interconnected and information sharing operation and management of the hospital. In order to meet the requirements of closed-loop management of implantable medical devices in the JCI standard, our hospital has established a set of standards which based on the HRP system platform, including access permission, purchase application, entering and leaving the warehouse, bookkeeping charge, cost accounting and postoperative traceability of implanted medical device management system. HRP system improves the management level of implantable medical devices, and realizes the closed-loop management of the whole process of implantable medical devices.

Placenta, cord and membranes: a dual center validation study of midwives' classifications and notifications to the Medical Birth Registry of Norway.

INTRODUCTION: A validation of data regarding the placenta, cord and membranes in Medical Birth Registry of Norway (MBRN) is lacking. Here we investigate the inter- and intra-observer agreement of observations regarding the placenta, cord and membranes to the MBRN in two institutions. MATERIAL AND METHODS: We conducted a dual center validation study of data regarding placenta, cord and membranes. In the inter-observer study, 196 placentas in two institutions were examined by the attending midwife and a blinded colleague, whereas in the intra-observer study registrations by the attending midwife on 195 placentas were compared with her own registrations to the MBRN. In a separate sample consisting of 51 placental pathology reports, midwives' registrations to the MBRN were compared with the pathology report. For categorical and continuous variables, agreement was assessed by kappa value and paired sample t-test, respectively. RESULTS: Inter-observer agreement between two midwives for cord insertion site and bi-placenta, cord knots and vessel anomalies were good (kappa values >0.79 and >0.96, respectively). The inter- and intra-observer study showed no significant differences regarding placental weight and cord length (p = 0.31 and 0.28, p = 0.71 and 0.39, respectively). The inter-observer agreement between the pathology reports and midwives' registrations was good for gross placental and cord variants (kappa 0.73-1.0), but there were significant differences in placental weight and cord length (p < 0.0001). CONCLUSIONS: The results suggest that the validity of data regarding placenta and cord in the MBRN is sufficiently high to justify future large-scale epidemiologic research based on this database.

Trends in OSHA Compliance Monitoring Data 1979-2011: Statistical Modeling of Ancillary Information across 77 Chemicals.

OBJECTIVES: The Integrated Management Information System (IMIS) is the largest multi-industry source of exposure measurements available in North America. However, many have suspected that the criteria through which worksites are selected for inspection are related to exposure levels. We investigated associations between exposure levels and ancillary variables in IMIS in order to understand the predictors of high exposure within an enforcement context. METHODS: We analyzed the association between nine variables (reason for inspection, establishment size, total amount of penalty, Occupational Safety and Health Administration (OSHA) plan, OSHA region, union status, inspection scope, year, and industry) and exposure levels in IMIS using multimodel inference for 77 agents. For each agent, we used two different types of models: (i) logistic models were used for the odds ratio (OR) of exposure being above the threshold limit value (TLV) and (ii) linear models were used for exposure concentrations restricted to detected results to estimate percent increase in exposure level, i.e. relative index of exposure (RIE). Meta-analytic methods were used to combine results for each variable across agents. RESULTS: A total of 511,047 exposure measurements were modeled for logistic models and 299,791 for linear models. Higher exposures were measured during follow-up inspections than planned inspections [meta-OR = 1.61, 95% confidence interval (CI): 1.44-1.81; meta-RIE = 1.06, 95% CI: 1.03-1.09]. Lower exposures were observed for measurements collected under state OSHA plans compared to measurements collected under federal OSHA (meta-OR = 0.82, 95% CI: 0.73-0.92; meta-RIE = 0.86, 95% CI: 0.81-0.91). A 'high' total historical amount of penalty relative to none was associated with higher exposures (meta-OR = 1.54, 95% CI: 1.40-1.71; meta-RIE = 1.18, 95% CI: 1.13-1.23). CONCLUSIONS: The relationships observed between exposure levels and ancillary variables across a vast majority of agents suggest that certain elements of OSHA's process of selecting worksites for inspection influence the exposure levels that OSHA inspectors encounter. Nonetheless, given the paucity of other sources of exposure data and the lack of a more demonstrably representative data source, our study considers the use of IMIS data for the estimation of exposures in the broader universe of worksites in the USA.

[The current state-of-the-art of the expert evaluation of medical documentation pertaining to the cases of death from an injury inflicted in a healthcare facility in the late; post-traumatic period].

This article presents a concise review of the literature data concerning the modern methods for the expert evaluation of medical documentation as an object of forensic medical examination. The authors lay special emphasis on the practical significance of this issue for the scientifically sound substantiation of the results of forensic medical expertise carried out for the elucidation of the causes of death and the relationship between the injury and the outcome of the medical aid provided for its treatment. The expert evaluation of medical documentation is equally important for the assessment of the harm to health and the cause of death as a consequence of a thermal and/or mechanical injury inflicted during the hospital stay and in the late post-traumatic period.

Medicaid Program; Mechanized Claims Processing and Information Retrieval Systems (90/10). Final rule.

This final rule will extend enhanced funding for Medicaid eligibility systems as part of a state's mechanized claims processing system, and will update conditions and standards for such systems, including adding to and updating current Medicaid Management Information Systems (MMIS) conditions and standards. These changes will allow states to improve customer service and support the dynamic nature of Medicaid eligibility, enrollment, and delivery systems.

Technical solution for data collection, data safety and data privacy legislation: experiences from the SWEET study.

BACKGROUND: One of the most important tasks of the SWEET study is benchmarking the data collected. Information on the occurrence of the disease of diabetes, the treatment, and their outcomes in children from the different member states of European Union (EU) is crucial. How the collection of data is realized is essential, concerning both the technical issues and the results. The creation of SWEET Centers of Reference (CoR), all over Europe will be facilitated by the access to safe data collection, where legal aspects and privacy are ascertained. OBJECTIVE: To describe the rationale for- and the technical procedure in the data collection implementation, in the SWEET study. SUBJECTS: Selected data on all patients treated at SWEET CoR are collected. METHODS: The SWEET project data collection and management system, consists of modular components for data collection, online data interchange, and a database for statistical analysis. CONCLUSION: The SWEET study and the organization of CoR aims for the goal of offering an updated, secure, and continuous evaluation of diabetes treatment regimens for all children with diabetes in Europe. To support this goal, an appropriate and secure data management system as described in this paper has been created.

Coordinated computerized systems aimed at management, control, and quality assurance of medical processes and informatics.

PURPOSE: As part of the routine work of the medical committees in the Israel Defense Forces, a unique nationwide computerized control system is being implemented to assess and manage medical processes. The purpose of this paper is to report on that implementation. DESIGN/METHODOLOGY/APPROACH: The computerized system consists of three main components: a specific status indicating the processes in each file, an appointment system, and an internal computerized system that uses a magnetic card for the regulation of the local waiting lists. FINDINGS: The combined computerized system improves the control and management of the medical processes and informatics from the point-of-view of both the patients and system operators. Different parameters of quality control regarding the medical and administrative processes are assessed (such as efficiency), and solutions are sought. Computerized system-based design and re-allocation of human and medical resources were implemented according to the capacities and limitations of the medical system. A reduction in the daily number of invited recruits improved the quality of the medical encounters. Specific combined status codes were introduced for the efficient planning of the medical encounters. Implementation and automation of medical regulations and procedures within the computerized system make the latter play a key role and serve as a control tool during the decision-making process. ORIGINALITY/VALUE: The computerized system allows efficient follow-up and management of medical processes and informatics, led to a better utilization of human and medical resources, and becomes a component of the decision making by the system operators and the administrative staff. Such a system could be used with success in clinics, hospitals, and other medical facilities.

Enhancing the routine health information system in rural southern Tanzania: successes, challenges and lessons learned.

OBJECTIVE: To describe and evaluate the use of handheld computers for the management of Health Management Information System data. METHODS: Electronic data capture took place in 11 sentinel health centres in rural southern Tanzania. Information from children attending the outpatient department (OPD) and the Expanded Program on Immunization vaccination clinic was captured by trained local school-leavers, supported by monthly supervision visits. Clinical data included malaria blood slides and haemoglobin colour scale results. Quality of captured data was assessed using double data entry. Malaria blood slide results from health centre laboratories were compared to those from the study's quality control laboratory. RESULTS: The system took 5 months to implement, and few staffings or logistical problems were encountered. Over the following 12 months (April 2006-March 2007), 7056 attendances were recorded in 9880 infants aged 2-11 months, 50% with clinical malaria. Monthly supervision visits highlighted incomplete recording of information between OPD and laboratory records, where on average 40% of laboratory visits were missing the record of their corresponding OPD visit. Quality of microscopy from health facility laboratories was lower overall than that from the quality assurance laboratory. CONCLUSIONS: Electronic capture of HMIS data was rapidly and successfully implemented in this resource-poor setting. Electronic capture alone did not resolve issues of data completeness, accuracy and reliability, which are essential for management, monitoring and evaluation; suggestions to monitor and improve data quality are made.

Manual editing of automatically recorded data in an anesthesia information management system.

BACKGROUND: Anesthesia information management systems allow automatic recording of physiologic and anesthetic data. The authors investigated the prevalence of such data modification in an academic medical center. METHODS: The authors queried their anesthesia information management system database of anesthetics performed in 2006 and tabulated the counts of data points for automatically recorded physiologic and anesthetic parameters as well as the subset of those data that were manually invalidated by clinicians (both with and without alternate values manually appended). Patient, practitioner, data source, and timing characteristics of recorded values were also extracted to determine their associations with editing of various parameters in the anesthesia information management system record. RESULTS: A total of 29,491 cases were analyzed, 19% of which had one or more data points manually invalidated. Among 58 attending anesthesiologists, each invalidated data in a median of 7% of their cases when working as a sole practitioner. A minority of invalidated values were manually appended with alternate values. Pulse rate, blood pressure, and pulse oximetry were the most commonly invalidated parameters. Data invalidation usually resulted in a decrease in parameter variance. Factors independently associated with invalidation included extreme physiologic values, American Society of Anesthesiologists physical status classification, emergency status, timing (phase of the procedure/anesthetic), presence of an intraarterial catheter, resident or certified registered nurse anesthetist involvement, and procedure duration. CONCLUSIONS: Editing of physiologic data automatically recorded in an anesthesia information management system is a common practice and results in decreased variability of intraoperative data. Further investigation may clarify the reasons for and consequences of this behavior.

Anesthesia information management system implementation: a practical guide.

Anesthesia Information Management Systems (AIMS) display and archive perioperative physiological data and patient information. Although currently in limited use, the potential benefits of an AIMS with regard to enhancement of patient safety, clinical effectiveness and quality improvement, charge capture and professional fee billing, regulatory compliance, and anesthesia outcomes research are great. The processes and precautions appropriate for AIMS selection, installation, and implementation are complex, however, and have been learned at each site by trial and error. This collaborative effort summarizes essential considerations for successful AIMS implementation, including product evaluation, assessment of information technology needs, resource availability, leadership roles, and training.

Risk assessment: where security meets compliance.

In this article, the authors provide a guide on how to structure and manage the annual physical security risk assessment now required under a recent Joint Commission standard.

Characterization of the Selective Recording of Workplace Exposure Measurements into OSHA's IMIS Databank.

Objectives: The Integrated Management Information System (IMIS) is the largest multi-industry source of exposure results available in North America. In 2010, the Occupational Safety and Health Administration (OSHA) released the Chemical Exposure Health Data (CEHD) that contains analytical results of samples collected by OSHA inspectors. However, the two databanks only partially overlap, raising suspicion of bias in IMIS data. We investigated the factors associated with selective recording of CEHD results into the IMIS databank. Methods: This analysis was based on personal exposure measurements of 24 agents from 1984 to 2009. The association between nine variables (level of exposure coded as detected versus non-detected (ND), whether a sampling result was part of a panel of chemicals, duration of sampling, issuance of a citation, presence of other detected levels during the same inspection, year, OSHA region, amount of penalty, and establishment size) and a CEHD sampling result being reported in IMIS was analyzed using modified Poisson regression. Results: A total of 461900 CEHD sampling results were examined. The proportion of CEHD sampling results recorded into IMIS was 38% (51% for detected and 28% for ND measurements). In the models, the detected sampling results were associated with a higher probability of recording into IMIS than ND sampling results, and this difference was similar for panel versus non-panel samples. Probability of recording remained constant from 1984 to 2009 for sampling results measured on panels but increased for sampling results of single determinations of an agent. Some OSHA regions had probability of recording two times higher than others. No other variables that we examined were associated with a CEHD sampling result being reported in IMIS. Conclusions: Our results indicate that the under-reporting of sampling results in IMIS is differential: ND results (especially those determined from the panels) seem less likely to be recorded in IMIS than other results. It is important to consider both IMIS and CEHD data in order to reduce bias in evaluation of exposures in workplaces inspected by OSHA.

Anesthesia information management systems: a survey of current implementation policies and practices.

BACKGROUND: Anesthesia information management systems (AIMS) implementation is increasing, but there are no published recommendations from anesthesia professional societies to guide configuration and policy decisions that affect billing, security, medical-legal, and compliance issues. METHODS: A 45-question structured survey was developed by a committee of the Society for Technology in Anesthesia and was sent to the clinical administrator at 18 separate institutions, comprising six different installed AIMS systems. The primary goal of the survey was to establish a baseline of current policies and practices. RESULTS: There was more than two-third agreement among respondents for only 25% of questions. A number of configurations reported may increase exposure to billing denial, Medicare and Medicaid noncompliance, security breeches, and medical-legal defense difficulties. CONCLUSIONS: Developing guidelines by anesthesia professional organizations such as Society for Technology in Anesthesia to assist in the configuration of AIMS is recommended to help anesthesia departments avoid problems that may result in significant financial and legal risk.

An observational study of anesthesia record completeness using an anesthesia information management system.

BACKGROUND: Studies of the accuracy and completeness of handwritten anesthesia records demonstrate deficiencies in documentation, suggesting that the quality of anesthesia records can be improved. METHODS: We reviewed all electronic anesthesia records generated during a 1-month period at our institution to ascertain completion rates for six clinical documentation elements: allergies, IV access, electrocardiogram rhythm, ease of mask ventilation, laryngoscopic grade of view, and insertion depth of the endotracheal tube. RESULTS: Of 2838 records, 64% had the necessary free text remark in the allergy element. The free text required to complete endotracheal tube depth documentation appeared in 538 of 918 cases in which the patient was tracheally intubated (59%). Free text documentation of the electrocardiogram rhythm diagnosis appeared at least once in 86% of records. Documentation of mask ventilation characteristics was entered by touch screen from a pick list and was expected in 781 records but appeared in 664 records (85%). Laryngoscopic grade of view documentation was also selected by touch screen and expected in 883 records but present in 811 cases (92%). Any notation of IV access appeared in 84% of records. CONCLUSIONS: We found that electronic clinical anesthesia documentation was often incomplete. Dependence on free text remarks and the record keeping system's inability to automatically present entries in logical sequences consistent with workflow were associated with incomplete data entry. Our results suggest that the user interface for data entry, and the logic that an electronic system uses for preventing omissions and inconsistencies, merit further study and development in order to facilitate clinically useful documentation.

Web Validation Service for Ensuring Adherence to the DICOM Standard.

The DICOM Standard has been fundamental for ensuring the interoperability of Picture Archive and Communications Systems (PACS). By compiling rigorously to the standard, medical imaging equipment and applications from different vendors can share their data, and create integrated workflows which contributes to better quality healthcare services. However, DICOM is a complex, flexible and very extensive standard. Thus, it is difficult to attest the conformity of data structures produced by DICOM applications resulting in unexpected behaviors, errors and malfunctions. Those situations may be critical for regular PACS operation, resulting in serious losses to the healthcare enterprise. Therefore, it is of paramount importance that application vendors and PACS administrators are confident that their applications follow the standard correctly. In this regard, we propose a method for validating the compliance of PACS application with the DICOM Standard. It can capture the intricate dependency structure of DICOM modules and data elements using a relatively simple description language. The modular nature of our method allows describing each DICOM module, their attributes, and dependencies on a re-usable basis. As a result, our validator is able to encompass the numerous modules present in DICOM, as well as keep up with the emergence of new ones.