An efficient and provably secure key agreement scheme for satellite communication systems.

Satellite communication has played an important part in many different industries because of its advantages of wide coverage, strong disaster tolerance and high flexibility. The security of satellite communication systems has always been the concern of many scholars. Without authentication, user should not obtain his/her required services. Beyond that, the anonymity also needs to be protected during communications. In this study, we design an efficient and provably secure key agreement scheme for satellite communication systems. In each session, we replace user's true identity by a temporary identity, which will be updated for each session, to guarantee the anonymity. Because the only use of lightweight algorithms, our proposed scheme has high performance. Furthermore, the security of the proposed scheme is proved in the real-or-random model and the performance analysis shows that the proposed scheme is more efficient than some other schemes for satellite communication systems.

Information System Maturity Models in Healthcare.

The use of information systems in healthcare (HIS) has been recognised as having crucial importance in improving the efficiency, cost-effectiveness, quality, and safety of medical care delivery. HIS has the potential to improve individuals' health and providers' performance by producing better quality, cost savings, and greater patient involvement in their own health. There have been two major drivers for the HIS investments in healthcare: The ever-increasing burden from chronic disease with costs growing significantly faster and the recognition of the need for greatly improved quality and safety in health delivery. Maturity models (MM) are based on the premises that people, organizations, functional areas and processes evolve through a process of development or growth towards a more advanced maturity, going through a distinct number of levels. Through a state-of-the-art review of HIS, focused on their maturity state, we identify and characterize a set of critical factors recognized as determinants in the context of HIS maturity. The article identifies a broad spectrum of MM applied to the health sector and its characteristics and reinforces the belief that the maturity of HIS can contribute to the quality of information and knowledge management in the sector.

ICT and the future of healthcare: Aspects of pervasive health monitoring.

Along with the digital revolution, information and communication technology applications are currently transforming the delivery of health and social care services. This paper investigates prevailing opinions toward future technology-based healthcare solutions among Austrian healthcare professionals. During a biphasic online Delphi survey, panelists rated expected outcomes of two future scenarios describing pervasive health monitoring applications. Experts perceived that the scenarios were highly innovative, but only moderately desirable, and that their implementation could especially improve patients' knowledge, quality of healthcare, and living standard. Contrarily, monetary aspects, technical prerequisites, and data security were identified as key obstacles. We further compared the impact of professional affiliation. Clearly, opinions toward pervasive healthcare differed between the interest groups, medical professionals, patient advocates, and administrative personnel. These data suggest closer collaborations between stakeholder groups to harmonize differences in expectations regarding pervasive health monitoring.

Increased Burden of Pediatric Acute Pancreatitis on the Health Care System.

OBJECTIVES: The incidence of pediatric acute pancreatitis (AP) increased over the past 2 decades and is estimated to be 3 to 13 per 100,000. The impact of rising AP incidence on health care costs is unknown. Our aim was to examine pediatric AP admissions and associated hospital costs in the United States between years 2004 and 2014. METHODS: Acute pancreatitis admission and cost data were extracted from the Pediatric Health Information System. We determined AP admission and cost percentages each year, as well as the ratio of AP cost to admission percentages to estimate AP "burden." Length of stay, costs of hospitalization, and the effect of intensive care unit care on these estimates were examined. RESULTS: Between 2004 and 2014, AP admission percentages increased (P = 0.002). Length of stay decreased over time (P < 0.0001) and was longer for those requiring intensive care unit care (P < 0.0001). Acute pancreatitis admissions cost per day significantly increased over time (P < 0.0001). Median AP cost percentage remained 1.2 to 1.7 times higher than AP admission percentage. CONCLUSIONS: Acute pancreatitis admissions constitute an expensive burden on the health care system relative to the percentage of all admissions. If AP admissions continue to increase, the cost of AP admissions may pose a substantial financial health care burden.

"What Goes Around Comes Around": Lessons Learned from Economic Evaluations of Personalized Medicine Applied to Digital Medicine.

BACKGROUND: The growth of "big data" and the emphasis on patient-centered health care have led to the increasing use of two key technologies: personalized medicine and digital medicine. For these technologies to move into mainstream health care and be reimbursed by insurers, it will be essential to have evidence that their benefits provide reasonable value relative to their costs. These technologies, however, have complex characteristics that present challenges to the assessment of their economic value. Previous studies have identified the challenges for personalized medicine and thus this work informs the more nascent topic of digital medicine. OBJECTIVES: To examine the methodological challenges and future opportunities for assessing the economic value of digital medicine, using personalized medicine as a comparison. METHODS: We focused specifically on digital biomarker technologies and multigene tests. We identified similarities in these technologies that can present challenges to economic evaluation: multiple results, results with different types of utilities, secondary findings, downstream impact (including on family members), and interactive effects. RESULTS: Using a structured review, we found that there are few economic evaluations of digital biomarker technologies, with limited results. CONCLUSIONS: We conclude that more evidence on the effectiveness of digital medicine will be needed but that the experiences with personalized medicine can inform what data will be needed and how such analyses can be conducted. Our study points out the critical need for typologies and terminology for digital medicine technologies that would enable them to be classified in ways that will facilitate research on their effectiveness and value.

Effects of a computerized provider order entry and a clinical decision support system to improve cefazolin use in surgical prophylaxis: a cost saving analysis

Background: Computerized Provider Order Entry (CPOE) and Clinical Decision Support System (CDSS) help practitioners to choose evidence-based decisions, regarding patients’ needs. Despite its use in developed countries, in Brazil, the impact of a CPOE/CDSS to improve cefazolin use in surgical prophylaxis was not assessed yet. Objective: We aimed to evaluate the impact of a CDSS to improve the use of prophylactic cefazolin and to assess the cost savings associated to inappropriate prescribing. Methods: This is a cross-sectional study that compared two different scenarios: one prior CPOE/CDSS versus after software implementation. We conducted twelve years of data analysis (3 years prior and 9 years after CDSS implementation), where main outcomes from this study included: cefazolin Defined Daily Doses/100 bed-days (DDD), crude costs and product of costs-DDD (cost-DDD/100 bed-days). We applied a Spearman rho non-parametric test to assess the reduction of cefazolin consumption through the years. Results: In twelve years, 84,383 vials of cefazolin were dispensed and represented 38.89 DDD/100 bed-days or USD 44,722.99. Surgical wards were the largest drug prescribers and comprised >95% of our studied sample. While in 2002, there were 6.31 DDD/100 bed-days, 9 years later there was a reduction to 2.15 (p<0.05). In a scenario without CDSS, the hospital would have consumed 75.72 DDD/100 bed-days, which is equivalent to USD 116 998.07. It is estimated that CDSS provided USD 50,433.39 of cost savings. Conclusion: The implementation of a CPOE/CDSS helped to improve prophylactic cefazolin use by reducing its consumption and estimated direct costs (AU)

No disponible

Software Quality Evaluation Models Applicable in Health Information and Communications Technologies. A Review of the Literature.

Information and Communications Technologies in healthcare has increased the need to consider quality criteria through standardised processes. The aim of this study was to analyse the software quality evaluation models applicable to healthcare from the perspective of ICT-purchasers. Through a systematic literature review with the keywords software, product, quality, evaluation and health, we selected and analysed 20 original research papers published from 2005-2016 in health science and technology databases. The results showed four main topics: non-ISO models, software quality evaluation models based on ISO/IEC standards, studies analysing software quality evaluation models, and studies analysing ISO standards for software quality evaluation. The models provide cost-efficiency criteria for specific software, and improve use outcomes. The ISO/IEC25000 standard is shown as the most suitable for evaluating the quality of ICTs for healthcare use from the perspective of institutional acquisition.

Keeping IT fair: how to avoid a stacked deck when dealing with IT vendors.

Small and midsize healthcare organizations may not have the IT capabilities to properly evaluate software offerings. Organizations can avoid choosing inappropriate software by asking questions, reading reviews, and vetting the software. If an IT installation fails to work properly, hospitals can respond by seeking a settlement or filing suit.

Understanding and valuing the broader health system benefits of Uganda's national Human Resources for Health Information System investment.

BACKGROUND: To address the need for timely and comprehensive human resources for health (HRH) information, governments and organizations have been actively investing in electronic health information interventions, including in low-resource settings. The economics of human resources information systems (HRISs) in low-resource settings are not well understood, however, and warrant investigation and validation. CASE DESCRIPTION: This case study describes Uganda's Human Resources for Health Information System (HRHIS), implemented with support from the US Agency for International Development, and documents perceptions of its impact on the health labour market against the backdrop of the costs of implementation. Through interviews with end users and implementers in six different settings, we document pre-implementation data challenges and consider how the HRHIS has been perceived to affect human resources decision-making and the healthcare employment environment. DISCUSSION AND EVALUATION: This multisite case study documented a range of perceived benefits of Uganda's HRHIS through interviews with end users that sought to capture the baseline (or pre-implementation) state of affairs, the perceived impact of the HRHIS and the monetary value associated with each benefit. In general, the system appears to be strengthening both demand for health workers (through improved awareness of staffing patterns) and supply (by improving licensing, recruitment and competency of the health workforce). This heightened ability to identify high-value employees makes the health sector more competitive for high-quality workers, and this elevation of the health workforce also has broader implications for health system performance and population health. CONCLUSIONS: Overall, it is clear that HRHIS end users in Uganda perceived the system to have significantly improved day-to-day operations as well as longer term institutional mandates. A more efficient and responsive approach to HRH allows the health sector to recruit the best candidates, train employees in needed skills and deploy trained personnel to facilities where there is real demand. This cascade of benefits can extend the impact and rewards of working in the health sector, which elevates the health system as a whole.

mHealth in Low- and Middle-Income Countries: Status, Requirements and Strategies.

Recent studies demonstrate the potential of Mobile Health (mHealth) to improve quality of care and efficiency in low- and middle- income countries (LMIC). However, strong evidence of their impact, especially in large scale projects is still missing. The objective of this paper is to provide an overview about the current status of mHealth in LMIC, and to identify Requirements and possible Strategies to strength their health systems. A search in Pubmed was performed, which resulted in 427 articles. Restricting the search to review papers published during the last 5 years, 72 publications were identified and characterized, and the more relevant articles analyzing mHealth use, impact and/or adoption in LMIC from a more generic perspective were analyzed in detail. Finally, based on the literature, and complemented with the authors own reflections and experience, mHealth challenges and strategies were identified and presented according to the WHO Health Systems Framework which identifies six main lines of action to improve the performance of health systems: service delivery, health workforce, health information systems, essential medical products and technologies, health financing and governance.

Economic review of immunization information systems to increase vaccination rates: a community guide systematic review.

CONTEXT: A recent systematic review found that use of an immunization information system (IIS) is an effective intervention to increase vaccination rates. The purpose of this review was to evaluate costs and benefits associated with implementing, operating, and participating with an IIS. The speed of technology change has had an effect on costs and benefits of IIS and is considered in this review. EVIDENCE ACQUISITION: An economic evaluation for IIS was conducted using methods developed for Community Guide systematic reviews. The literature search covered the period from January 1994 to March 2012 and identified 12 published articles and 2 government reports. EVIDENCE SYNTHESIS: Most studies involving cost data evaluated (1) system costs of building an IIS and (2) cost of exchanging immunization data; most economic benefits focused on administrative efficiency. CONCLUSIONS: A major challenge to evaluating a technology-based intervention is the evolution that comes with technology improvements and advancements. Although the cost and benefit data may be less applicable today due to changes in system technology, data exchange methods, availability of vendor support, system functionalities, and scope of IIS, it is likely that more up-to-date estimates and comprehensive estimates of benefits would support the findings of cost savings in this review. More research is needed to update and address limitations in the available evidence and to enable assessment of economic costs and benefits of present-day IIS.

Energy saving in data processing and communication systems.

The power management of ICT systems, that is, data processing (Dp) and telecommunication (Tlc) systems, is becoming a relevant problem in economical terms. Dp systems totalize millions of servers and associated subsystems (processors, monitors, storage devices, etc.) all over the world that need to be electrically powered. Dp systems are also used in the government of Tlc systems, which, besides requiring Dp electrical power, also require Tlc-specific power, both for mobile networks (with their cell-phone towers and associated subsystems: base stations, subscriber stations, switching nodes, etc.) and for wired networks (with their routers, gateways, switches, etc.). ICT research is thus expected to investigate into methods to reduce Dp- and Tlc-specific power consumption. However, saving power may turn into waste of performance, in other words, into waste of ICT quality of service (QoS). This paper investigates the Dp and Tlc power management policies that look at compromises between power saving and QoS.

Tying supply chain costs to patient care.

In September 2014, the FDA will establish a unique device identification (UDI) system to aid hospitals in better tracking and managing medical devices and analyzing their effectiveness. When these identifiers become part of patient medical records, the UDI system will provide a much-needed link between supply cost and patient outcomes. Hospitals should invest in technology and processes that can enable them to trace supply usage patterns directly to patients and analyze how these usage patterns affect cost and quality.

The impact of IT over five decades - towards the Ambient organization.

This contribution to the Ken D. Eason special issue is an illustration of the value of socio-technical analysis applied at an organizational level. We provide a brief historical overview of socio-technical IS research and review studies investigating the impact of IT on organizational structures in the last five decades, identifying a dominating (new) research theme in each decade. A key overall impact of IT in all decades has been a dramatic decrease in transaction costs making it increasingly easier for organizations to source from external providers. A five level taxonomy of sourcing arrangement is developed together with a framework of organizational activities, and a number of significant cases are offered of how organizations are sourcing practically all types of business processes, including innovation. We argue that future IT will further accelerate the movement towards more sourcing, eventually leading to a new type of organization that we call the Ambient organization.