Evaluation of Health IT in Low-Income Countries.

Low and middle income countries (LMICs) bear a disproportionate burden of major global health challenges. Health IT could be a promising solution in these settings but LMICs have the weakest evidence of application of health IT to enhance quality of care. Various systematic reviews show significant challenges in the implementation and evaluation of health IT. Key barriers to implementation include lack of adequate infrastructure, inadequate and poorly trained health workers, lack of appropriate legislation and policies and inadequate financial 333indicating the early state of generation of evidence to demonstrate the effectiveness of health IT in improving health outcomes and processes. The implementation challenges need to be addressed. The introduction of new guidelines such as GEP-HI and STARE-HI, as well as models for evaluation such as SEIPS, and the prioritization of evaluations in eHealth strategies of LMICs provide an opportunity to focus on strategic concepts that transform the demands of a modern integrated health care system into solutions that are secure, efficient and sustainable.

The roles of federal legislation and evolving health care systems in promoting medical-dental collaboration.

Recent federal health care legislation contains explicit and implicit drivers for medical-dental collaboration. These laws implicitly promote health care evolution through value-based financing, "big data" and health information technology, increased number of care providers and a more holistic approach. Additional changes--practice aggregation, consumerism and population health perspectives--may also influence dental care. While dentistry will likely lag behind medicine toward value-based and accountable care organizations, dentists will be affected by changing consumer expectations.

Progress and challenge in meeting meaningful use at an integrated delivery network.

Intermountain Healthcare hospitals and providers are eligible for approximately $95 million in incentives from the Health Information Technology for Economic and Clinical Health Act (HITECH), which requires that hospitals and providers use a certified electronic health record (EHR) in a meaningful way. This paper describes the our progress in readying legacy systems for certification, including measuring, and filling gaps in (EHR) functionality. Also addressed are some of the challenges and successes in meeting meaningful use. Methods for measuring and tracking levels of clinician meaningful use behaviors, and our most recent results impacting meaningful use behaviors in a large integrated delivery network are described. We identified 20 EHR requirements we can certify now, 16 requirements with minor issues to resolve, and 38 requirements which are still in some state of development. We also identified 6 meaningful use workflows that will require significant work to bring all of our hospitals and providers above the measure requirement.

Ethics and electronic health information technology: challenges for evidence-based medicine and the physician-patient relationship.

OBJECTIVES: The National Health Insurance Scheme (NHIS), and the National Identification Authority (NIA), pose ethical challenges to the physician-patient relationship due to interoperability. This paper explores (1) the national legislation on Electronic Health Information Technology (EHIT), (2) the ethics of information technology and public health and (3) the effect on the Physician-patient relationship. METHOD: This study consisted of systematic literature and internet review of the legislation, information technology, the national health insurance program, and the physician-patient relationship. RESULT: The result shows that (1) EHIT have eroded a big part of the confidentiality between the physician and patient; (2) The encroachment on privacy is an inevitable outcome of EHIT; (3) Legislation on privacy, the collection, storage and uses of electronic health information is needed and; (4) the nexus between EHIT, NHIS, NHA, Ethics, the physician-patient relationship and privacy. CONCLUSION: The study highlights the lack of protection for physician-patient relationship as medical practice transitions from the conventional to the modern, information technology driven domain.

Health care reform and care at the behavioral health--primary care interface.

The historic passage of the Patient Protection and Affordable Care Act in March 2010 offers the potential to address long-standing deficits in quality and integration of services at the interface between behavioral health and primary care. Many of the efforts to reform the care delivery system will come in the form of demonstration projects, which, if successful, will become models for the broader health system. This article reviews two of the programs that might have a particular impact on care on the two sides of that interface: Medicaid and Medicare patient-centered medical home demonstration projects and expansion of a Substance Abuse and Mental Health Services Administration program that colocates primary care services in community mental health settings. The authors provide an overview of key supporting factors, including new financing mechanisms, quality assessment metrics, information technology infrastructure, and technical support, that will be important for ensuring that initiatives achieve their potential for improving care.

Government's public policy in regards to the National Health Information Infrastructure: two approaches.

Public policy conducted whether by government institutions or by legislators has a definitive impact on society as whole. This presentation analyses these two approaches: (1) describing relevant activities conducted by the National Library of Medicine (NLM) and (2) analyzing legislation that makes direct reference to the National Health Information Infrastructure (NHII).

eHealth in Latin America and the Caribbean: development and policy issues.

This paper reviews trends and issues in health and in the information and communication technologies (ICT) market as they relate to the deployment of eHealth solutions in Latin America and the Caribbean. Heretofore designed for industrialized countries and large organizations, eHealth solutions are being proposed as an answer to a variety of health-system management problems and health care demands faced by all health organizations including those in developing societies. Particularly, eHealth is seen as especially useful in the operational support of the new health care models being implemented in many countries. The authors examine those developments vis-à-vis the characteristics of the Latin American and the Caribbean health-sector organizational preparedness and technological infrastructure, and propose policy and organizational actions to foster the development of eHealth solutions in the region.