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BMC Med ; 17(1): 68, 2019 03 27.
Artigo em Inglês | MEDLINE | ID: mdl-30914045


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.

Tecnologia Biomédica , Redes de Comunicação de Computadores , Assistência à Saúde/tendências , Sistemas de Informação Administrativa , Informática Médica , Tecnologia Biomédica/métodos , Tecnologia Biomédica/organização & administração , Tecnologia Biomédica/tendências , Redes de Comunicação de Computadores/organização & administração , Redes de Comunicação de Computadores/normas , Redes de Comunicação de Computadores/provisão & distribução , Redes de Comunicação de Computadores/tendências , Data Warehousing/métodos , Data Warehousing/tendências , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Processamento Eletrônico de Dados/métodos , Processamento Eletrônico de Dados/organização & administração , Processamento Eletrônico de Dados/tendências , Utilização de Equipamentos e Suprimentos/organização & administração , Utilização de Equipamentos e Suprimentos/tendências , Ensaios de Triagem em Larga Escala/normas , Humanos , Sistemas de Informação Administrativa/normas , Sistemas de Informação Administrativa/tendências , Informática Médica/métodos , Informática Médica/organização & administração , Informática Médica/tendências , Registros Médicos/normas
Ann Surg ; 267(2): 370-374, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-27906759


OBJECTIVE: The aim of this study was to assess the impact of developing a hernia program on mesh utilization. BACKGROUND: With the ongoing changes in healthcare, the value of all interventions will see increased scrutiny. Hernia mesh can be one of the most costly components of hernia repairs. A disease-based institutional hernia program that defines roles for mesh utilization and measures outcomes has the potential to add significant value to hospital systems. METHODS: In August 2014, a disease-based hernia program was initiated across a hospital system. In collaboration with hospital administration, surgical operations, and all surgeons involved in the care of hernia patients, general guidelines for mesh utilization based on CDC wound class were created. All hernia repairs performed between January 2013 and November 2015 were reviewed. RESULTS: Approximately, 13,937 hernias were repaired during the study period. Biologic mesh was used in 0.4% of clean, 7.1% of clean-contaminated, 38.5% of contaminated, and 58.8% of dirty cases. After initiation of the hernia program there was a reduction in biologic mesh utilization across the system (clean: 66% reduction; clean-contaminated: 63% reduction; contaminated: 55% reduction; dirty: 47% reduction). Surgeons who participated in the hernia program used significantly less biologic mesh in clean (P < 0.01), clean-contaminated (P = 0.01) and contaminated (P < 0.01) hernia repairs. CONCLUSIONS: The development of a system-wide hernia program based on collaboration with the hospital administration, operating room purchasing and clinicians resulted in a significant reduction in costly mesh utilization. This collaborative effort from all stakeholders involved in the care of a specific disease process could provide a reproducible model to improve the value equation through cost reduction strategies in today's healthcare environment.

Utilização de Equipamentos e Suprimentos/tendências , Fidelidade a Diretrizes/tendências , Herniorrafia/economia , Custos Hospitalares/tendências , Padrões de Prática Médica/tendências , Desenvolvimento de Programas/métodos , Telas Cirúrgicas/economia , Utilização de Equipamentos e Suprimentos/economia , Fidelidade a Diretrizes/economia , Herniorrafia/instrumentação , Herniorrafia/métodos , Herniorrafia/normas , Humanos , Ohio , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/economia , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos