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.

'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.

Anesthesia information management systems: past, present, and future of anesthesia records.

Documenting a patient's anesthetic in the medical record is quite different from summarizing an office visit, writing a surgical procedure note, or recording other clinical encounters. Some of the biggest differences are the frequent sampling of physiologic data, volume of data, and diversity of data collected. The goal of the anesthesia record is to accurately and comprehensively capture a patient's anesthetic experience in a succinct format. Having ready access to physiologic trends is essential to allowing anesthesiologists to make proper diagnoses and treatment decisions. Although the value provided by anesthesia information management systems and their functions may be different than other electronic health records, the real benefits of an anesthesia information management system depend on having it fully integrated with the other health information technologies. An anesthesia information management system is built around the electronic anesthesia record and incorporates anesthesia-relevant data pulled from disparate systems such as laboratory, billing, imaging, communication, pharmacy, and scheduling. The ability of an anesthesia information management system to collect data automatically enables anesthesiologists to reliably create an accurate record at all times, regardless of other concurrent demands. These systems also have the potential to convert large volumes of data into actionable information for outcomes research and quality-improvement initiatives. Developing a system to validate the data is crucial in conducting outcomes research using large datasets. Technology innovations outside of healthcare, such as multitouch interfaces, near-instant software response times, powerful but simple search capabilities, and intuitive designs, have raised the bar for users' expectations of health information technology.

Progress and delivery of health care in Bhutan, the Land of the Thunder Dragon and Gross National Happiness.

The Himalayan Kingdom of Bhutan is rapidly changing, but it remains relatively isolated, and it tenaciously embraces its rich cultural heritage. Despite very limited resources, Bhutan is making a concerted effort to update its health care and deliver it to all of its citizens. Healthcare services are delivered through 31 hospitals, 178 basic health unit clinics and 654 outreach clinics that provide maternal and child health services in remote communities in the mountains. Physical access to primary health care is now well sustained for more than 90% of the population. Bhutan has made progress in key health indicators. In the past 50 years, life expectancy increased by 18 years and infant mortality dropped from 102.8 to 49.3 per 1000 live births between 1984 and 2008. Bhutan has a rich medical history. One of the ancient names for Bhutan was 'Land of Medicinal Herbs' because of the diverse medicinal plants it exported to neighbouring countries. In 1967, traditional medicine was included in the National Health System, and in 1971, formal training for Drungtshos (traditional doctors) and sMenpas (traditional compounders) began. In 1982, Bhutan established the Pharmaceutical and Research Unit, which manufactures, develops and researches traditional herbal medicines. Despite commendable achievements, considerable challenges lie ahead, but the advances of the past few decades bode well for the future.

The role of information technology in the development of community pharmacy services: visions and strategic views of international experts.

BACKGROUND: Community pharmacy's strategic vision has been to extend practice responsibilities beyond dispensing and provide patient care services. Few studies have evaluated the strategic and long-term development of information technology (IT) systems to support this vision. OBJECTIVE: The objective of this study was to explore international experts' visions and strategic views on IT development needs in relation to service provision in community pharmacies. METHOD: Semistructured interviews were conducted with a purposive sample of 14 experts from 8 countries in 2007-2008. These experts had expertise in the development of community pharmacy services and IT. The interviews were content analyzed using a constant comparison approach and a SWOT (strengths, weaknesses, opportunities, threats) analysis was undertaken. RESULTS: Most of the experts shared the vision for community pharmacy adopting a patient care orientation; supported by IT-based documentation, new technological solutions, access to information, and shared patient data. Opportunities to achieve this vision included IT solutions, professional skills, and interprofessional collaboration. Threats included costs, pharmacists' attitude, and the absence of IT solutions. CONCLUSIONS: Those responsible for IT development in community pharmacy sector should create long-term IT development strategies that are in line with community pharmacy service development strategies.

Health Management Information System utilization in Pakistan: challenges, pitfalls and the way forward.

Use of data generated through the Health Management Information System (HMIS) in decision making has been facing various challenges ever since its inception in Pakistan. This descriptive qualitative study attempts to explore the perceptions of health managers to identify the status and issues in use of HMIS. Overall 26 managers (all men, ages ranging from 26 to 49 years; selected from federal level (2), provincial (4) and seven selected districts (20) from all four provinces) were interviewed face to face. The respondents identified a number of hurdles resulting in non-use, misuse and disuse of data. These included limited scope of HMIS, dubious data quality, political motives behind demand of data and an element of corruption in data reporting etc. A great deal of political and administrative will is required to institutionalize transparency in decision making in health management and HMIS is an important tool for doing so. Appropriate legislation and regulations are needed to create a conducive policy environment that would help in changing the existing decision making culture. The effective use of information requires that besides capacity development of district health managers in understanding and use of data, the higher level decision makers are provided with relevant data timely and in an easily understandable form along with the recommended actions pertinent to this data.

Cloud computing in pharmaceutical R&D: business risks and mitigations.

Cloud computing provides information processing power and business services, delivering these services over the Internet from centrally hosted locations. Major technology corporations aim to supply these services to every sector of the economy. Deploying business processes 'in the cloud' requires special attention to the regulatory and business risks assumed when running on both hardware and software that are outside the direct control of a company. The identification of risks at the correct service level allows a good mitigation strategy to be selected. The pharmaceutical industry can take advantage of existing risk management strategies that have already been tested in the finance and electronic commerce sectors. In this review, the business risks associated with the use of cloud computing are discussed, and mitigations achieved through knowledge from securing services for electronic commerce and from good IT practice are highlighted.

[Progress of childhood immunization information management system in China in 2008].

OBJECTIVE: To evaluate the coverage of childhood immunization information management system (CIIMS) in China (not include HongKong, Macao, and Taiwan) in 2008. METHODS: Analyzing immunization cases and users' file record archives in CIIMS for china in 2008. RESULTS: These data indicated that 87.10% (27/31) of provinces and 30.36% (891/2935) of county level and 26.63% (11,512/43,231) of vaccination points of township level submitted immunization data to an CIIMS in 2008. The rate of implementation of the county > or = 90% are Fujian and Hubei. The rate of implementation of the township > or = 90% are Hubei, Fujian and Hebei. Coverage of eastern areas, middle areas and western areas were 28.91%, 43.20%, and 18.41% by county, 26.15%, 37.69%, and 16.44% by township respectively. The upload permissions against cases is in a total of 15,014 units, and the client software collect a total of 42,956,214 cases of immunization. 44.46% chinese children aged < 6 years old participated in an CIIMS in 2008. The vaccination point of township level submitted 8,793,334 cases to CIIMS, it accounted for 20.47% of client collection cases. CONCLUSION: To achieve the national CIIMS objectives for 2010, the extensive implementation must be promoted, the funding for system-building should be increased, an independent platform of CIIMS must be established, and admission of the issue of data exchange with the local information systems must be accelerated.

[Informational cooperation of the complex of software and hardware tools in automatization of state disease control management].

Nowadays, taking into account new tasks, that should be resolved by the medical service, could be marked enlargement of informational cooperation at the expense of perspective program-technical solutions, put in the complex of program-technical means of automatization of administration of state disease control CPTMADC during it's creating. It's planed to elaborate an additional programmatic module for the purpose of using in CPTMADC the methodology of valuation of risk for resolving of tasks of socially-hygienic monitoring. Before it's elaborating, there was examined a capacity to conversion of patterns of weekly reports about the sanitarian condition of objects and it's following using for informational transporting using electronic means of connection of the complex CPTMADC by the way of including in patterns the data about the staff under the influence of adverse factor, and following rangering the objects by the level of risk for staff.

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.

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.

Evaluation and management documentation and coding technology adoption.

This study determines the relative effect of financial incentives, practice characteristics, and regulatory guidelines on the utilization of documentation and coding technology among physician practices employing HIM professionals. A total of 442 HIM professionals, 9.78 percent of the surveyed population, completed a Web-based survey regarding their practices and E/M documentation and coding methods used. More physician practices use the traditional documentation and coding methods than use automated methods. Less than half of the practices using automated documentation technology also utilized automated coding technology. Financial incentives and regulatory guidelines were not related to documentation or coding method used. Organization size and type were highly related to documentation or coding method used. Practices using coding technology were more likely to perform coding validation. The reasons for low levels of coding technology adoption, which requires little additional physician effort, suggest the potential presence of unique factors inhibiting the adoption of this technology.