The Patient Researcher

2017 ◽  
Author(s):  
Barbara Prainsack
Keyword(s):  
Health Care ◽  
Personalized Medicine ◽  
Health Risks ◽  
Digital Health ◽  
Health Care Systems ◽  
Policy Makers ◽  
Care Systems

Policy makers and practitioners alike emphasize that the realization of personalized medicine requires “activated patients,” and some go as far as saying that the survival of our health care systems will depend on it. This chapter shows that in the era of digital health, “activated patients” are not merely expected to obtain information on their health and manage their own health risks but are also supposed to contribute data and information. This expectation is built into the very infrastructures of digital health and medicine, which turns patients into contributors to the personalization of their own health care, and to research, by default. Do those patients who cannot or will not participate miss out on the benefit of personalization, or can it be a blessing to be below the digital health radar? And what new practices and patterns of exclusion emerge in the context of these developments?

Machines and Medicines: A Projection of Analogies between Electric Power Systems and Health Care Systems

1986 ◽  
Vol 2 (2) ◽  
pp. 285-295
Author(s):  
Thomas P. Hughes
Keyword(s):  
Health Care ◽  
Power Systems ◽  
Policy Making ◽  
Health Care Systems ◽  
Electric Power Systems ◽  
Policy Makers ◽  
Care Systems ◽  
History Of ◽  
Large Systems ◽  
Capital Intensive

If medicine is becoming mechanized, as many indications suggest, then those interested in policy making for medical matters have much to learn from the history of technology. The mechanization of medicine, as in the case of the mechanization of production, will accelerate the transfer of skill and knowledge from people to machines and the transition of health care to a capital intensive industry (19, 196–226). Furthermore, mechanization and increasing capital intensification may bring the increased systematization of health care. If the development of mechanized medicine follows the precedent of the mechanization of production, then our society must deal with the evolution of another set of extremely large systems, systems that will become virtually impervious to social control. Historians of technology are currently providing a better understanding of the evolution of large systems of production (3;9;10); there are lessons to be learned from this history by policy makers in health care.

Health of Newcomers

2017 ◽  
Author(s):  
Patricia Illingworth ◽  
Wendy E. Parmet
Keyword(s):  
Health Care ◽  
Global Climate ◽  
Health Care Systems ◽  
Vital Role ◽  
Health Policies ◽  
Global Public Good ◽  
Policy Makers ◽  
Native Populations ◽  
Care Systems ◽  
The Right

Immigration and health are two of the most contentious issues facing policy makers today. Policies that relate to both issues—to the health of newcomers—often reflect misimpressions about immigrants, their health, and their impact on health care systems. Although immigrants are typically younger and healthier than natives, and many newcomers play a vital role in providing care in their new lands, natives are often reluctant to extend basic health care to immigrants. Likewise, many nations turn against immigrants when epidemics strike, falsely believing that native populations can be kept well by keeping immigrants out. This book demonstrates how such reactions thwart attempts to create efficient and effective health policies and efforts to promote public health. The book argues that because health is a global public good and people benefit from the health of neighbor and stranger alike, it is in everyone’s interest to ensure the health of all. Reviewing issues as diverse as medical repatriation, epidemic controls, the right to health, the medical brain drain, organ tourism, and global climate change, the book shows why solidarity between natives and newcomers is ethically required and in the service of health for all.

scholarly journals Trends and Visibility of “Digital Health” as a Keyword in Articles by JMIR Publications in the New Millennium: Bibliographic-Bibliometric Analysis

10.2196/10477 ◽  
2019 ◽  
Vol 21 (12) ◽  
pp. e10477 ◽  
Author(s):  
Alireza Ahmadvand ◽  
David Kavanagh ◽  
Michele Clark ◽  
Judy Drennan ◽  
Lisa Nissen
Keyword(s):  
Health Care ◽  
Bibliometric Analysis ◽  
Digital Health ◽  
Health Care Systems ◽  
Internet Research ◽  
Translational Science ◽  
Science Center ◽  
The Past ◽  
Care Systems ◽  
Research Networking

Background Digital health has become an advancing phenomenon in the health care systems of modern societies. Over the past two decades, various digital health options, technologies, and innovations have been introduced; many of them are still being investigated and evaluated by researchers all around the globe. However, the actual trends and visibility of peer-reviewed publications using “digital health” as a keyword to reflect the topic, published by major relevant journals, still remain to be quantified. Objective This study aimed to conduct a bibliographic-bibliometric analysis on articles published in JMIR Publications journals that used “digital health” as a keyword. We evaluated the trends, topics, and citations of these research publications to identify the important share and contribution of JMIR Publications journals in publishing articles on digital health. Methods All JMIR Publications journals were searched to find articles in English, published between January 2000 and August 2019, in which the authors focused on, utilized, or discussed digital health in their study and used “digital health” as a keyword. In addition, a bibliographic-bibliometric analysis was conducted using the freely available Profiles Research Networking Software by the Harvard Clinical and Translational Science Center. Results Out of 1797 articles having “digital health” as a keyword, published mostly between 2016 and 2019, 277 articles (32.3%) were published by JMIR Publications journals, mainly in the Journal of Medical Internet Research. The most frequently used keyword for the topic was “mHealth.” The average number of times an article had been cited, including self-citations, was above 2.8. Conclusions The reflection of “digital health” as a keyword in JMIR Publications journals has increased noticeably over the past few years. To maintain this momentum, more regular bibliographic and bibliometric analyses will be needed. This would encourage authors to consider publishing their articles in relevant, high-visibility journals and help these journals expand their supportive publication policies and become more inclusive of digital health.

scholarly journals Harnessing Digital Health Technologies During and After the COVID-19 Pandemic: Context Matters (Preprint)

2020 ◽  
Author(s):  
Francesco Petracca ◽  
Oriana Ciani ◽  
Maria Cucciniello ◽  
Rosanna Tarricone
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Health Care Services ◽  
Organizational Context ◽  
Digital Health ◽  
Health Care Systems ◽  
Health Technologies ◽  
Digital Reconstruction ◽  
Depth Analysis ◽  
Care Systems

UNSTRUCTURED A common development observed during the COVID-19 pandemic is the renewed reliance on digital health technologies. Prior to the pandemic, the uptake of digital health technologies to directly strengthen public health systems had been unsatisfactory; however, a relentless acceleration took place within health care systems during the COVID-19 pandemic. Therefore, digital health technologies could not be prescinded from the organizational and institutional merits of the systems in which they were introduced. The Italian National Health Service is strongly decentralized, with the national government exercising general stewardship and regions responsible for the delivery of health care services. Together with the substantial lack of digital efforts previously, these institutional characteristics resulted in delays in the uptake of appropriate solutions, territorial differences, and issues in engaging the appropriate health care professionals during the pandemic. An in-depth analysis of the organizational context is instrumental in fully interpreting the contribution of digital health during the pandemic and providing the foundation for the digital reconstruction of what is to come after.

scholarly journals The Development of Complex Digital Health Solutions: Formative Evaluation Combining Different Methodologies (Preprint)

2017 ◽  
Author(s):  
Anne Lee ◽  
Marianne Sandvei ◽  
Hans Christian Asmussen ◽  
Marie Skougaard ◽  
Joanne Macdonald ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Participatory Design ◽  
Formative Evaluation ◽  
Digital Health ◽  
Health Care Systems ◽  
Real Life ◽  
Evaluation Process ◽  
Stakeholder Groups ◽  
Care Systems

BACKGROUND The development of digital health solutions for current health care settings requires an understanding of the complexities of the health care system, organizational setting, and stakeholder groups and of the underlying interplay between stakeholders and the technology. The digital health solution was founded on the basis of an information and communication technology platform and point-of-care devices enabling home-based monitoring of disease progression and treatment outcome for patients with rheumatoid arthritis (RA). OBJECTIVE The aim of this paper is to describe and discuss the applicability of an iterative evaluation process in guiding the development of a digital health solution as a technical and organizational entity in three different health care systems. METHODS The formative evaluation comprised the methodologies of contextual understanding, participatory design, and feasibility studies and included patients, healthcare professionals, and hardware and software developers. In total, the evaluation involved 45 patients and 25 health care professionals at 3 clinical sites in Europe. RESULTS The formative evaluation served as ongoing and relevant input to the development process of the digital health solution. Through initial field studies key stakeholder groups were identified and knowledge obtained about the different health care systems, the professional competencies involved in routine RA treatment, the clinics’ working procedures, and the use of communication technologies. A theory-based stakeholder evaluation achieved a multifaceted picture of the ideas and assumptions held by stakeholder groups at the three clinical sites, which also represented the diversity of three different language zones and cultures. Experiences and suggestions from the patients and health care professionals were sought through participatory design processes and real-life testing and actively used for adjusting the visual, conceptual, and practical design of the solution. The learnings captured through these activities aided in forming the solution and in developing a common understanding of the overall vision and aim of this solution. During this process, the 3 participating sites learned from each other’s feed-back with the ensuing multicultural inspiration. Moreover, these efforts also enabled the consortium to identify a ‘tipping point’ during a pilot study, revealing serious challenges and a need for further development of the solution. We achieved valuable learning during the evaluation activities, and the remaining challenges have been clarified more extensively than a single-site development would have discovered. The further obstacles have been defined as has the need to resolve these before designing and conducting a real-life clinical test to assess the outcome from a digital health solution for RA treatment. CONCLUSIONS A formative evaluation process with ongoing involvement of stakeholder groups from 3 different cultures and countries have helped to inform and influence the development of a novel digital health solution, and provided constructive input and feedback enabling the consortium to control the development process.

Medical Necessity, Benefit and Resource Allocation in Health Care

1997 ◽  
Vol 2 (4) ◽  
pp. 223-230 ◽  
Author(s):  
Jeremiah Hurley ◽  
Stephen Birch ◽  
Greg Stoddart ◽  
George Torrance
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Operational Definition ◽  
Management Tool ◽  
Allocation Of Resources ◽  
Medical Necessity ◽  
Policy Makers ◽  
Guiding Principle ◽  
Care Systems ◽  
Definition Of

Many health care systems espouse medical necessity, or need, as a guiding principle for the allocation of resources. Yet, logic and experience suggest that it is likely impossible to develop a concise, explicit, operational definition of medical necessity that would allow it to be used as an administrative or management tool. Even if such a definition could be developed, it would likely do little to solve the fundamental challenges facing policy-makers attempting to reform health care systems. This implies that we should refrain from further efforts to define medical necessity operationally. But does it follow that medical necessity is an empty concept? No. Even if it cannot be defined precisely, it can still serve as a guiding principle for health policy. Given that ability-to-benefit is a core concept underlying necessity, we develop a conceptual framework that encompasses alternative notions of benefit and then illustrate some selected implications of alternative benefit notions for processes required to use medical necessity as a guiding principle and for the types of services that would be deemed to produce a benefit.

scholarly journals Why Are Digital Health Care Systems Still Poorly Designed, and Why Is Health Care Practice Not Asking for More? Three Paths Toward a Sustainable Digital Work Environment

10.2196/26694 ◽  
2021 ◽  
Vol 23 (6) ◽  
pp. e26694
Author(s):  
Johanna Persson ◽  
Christofer Rydenfält
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Work Environment ◽  
Digital Health ◽  
Health Care Systems ◽  
Digital Systems ◽  
User Context ◽  
Care Systems ◽  
Digital Work ◽  
And Task

Knowledge of how to design digital systems that are ergonomically sound, high in usability, and optimized for the user, context, and task has existed for some time. Despite this, there are still too many examples of new digital health care systems that are poorly designed and that could negatively affect both the work environment of health care staff and patient safety. This could be because of a gap between the theoretical knowledge of design and ergonomics and the practical implementation of this knowledge in procuring and developing digital health care systems. Furthermore, discussions of digitalization are often at a general level and risk neglecting the nature of direct interaction with the digital system. This is problematic since it is at this detailed level that work environment and patient safety issues materialize in practice. In this paper, we illustrate such issues with two scenarios concerned with contemporary electronic health care records, based on field studies in two health care settings. We argue that current methods and tools for designing and evaluating digital systems in health care must cater both to the holistic level and to the details of interaction and ergonomics. It must also be acknowledged that health care professionals are neither designers nor engineers, so expectations of them during the development of digital systems must be realistic. We suggest three paths toward a more sustainable digital work environment in health care: (1) better tools for evaluating the digital work environment in the field; (2) generic formulations of qualitative requirements related to usability and for adaptation to the user, context, and task, to be used in procurement; and (3) the introduction of digital ergonomics as an embracing concept capturing several of the ergonomic challenges (including physical, cognitive, and organizational aspects) involved in implementing and using digital systems.

scholarly journals Harnessing Digital Health Technologies During and After the COVID-19 Pandemic: Context Matters

10.2196/21815 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e21815
Author(s):  
Francesco Petracca ◽  
Oriana Ciani ◽  
Maria Cucciniello ◽  
Rosanna Tarricone
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Health Care Services ◽  
Organizational Context ◽  
Digital Health ◽  
Health Care Systems ◽  
Health Technologies ◽  
Digital Reconstruction ◽  
Depth Analysis ◽  
Care Systems

A common development observed during the COVID-19 pandemic is the renewed reliance on digital health technologies. Prior to the pandemic, the uptake of digital health technologies to directly strengthen public health systems had been unsatisfactory; however, a relentless acceleration took place within health care systems during the COVID-19 pandemic. Therefore, digital health technologies could not be prescinded from the organizational and institutional merits of the systems in which they were introduced. The Italian National Health Service is strongly decentralized, with the national government exercising general stewardship and regions responsible for the delivery of health care services. Together with the substantial lack of digital efforts previously, these institutional characteristics resulted in delays in the uptake of appropriate solutions, territorial differences, and issues in engaging the appropriate health care professionals during the pandemic. An in-depth analysis of the organizational context is instrumental in fully interpreting the contribution of digital health during the pandemic and providing the foundation for the digital reconstruction of what is to come after.

Commentary to Special Issue on Health Discrepancies: Expanding the Frame of Understanding Health Disparities: From a Focus on Health Systems to Social and Economic Systems

2006 ◽  
Vol 33 (4) ◽  
pp. 538-541 ◽  
Author(s):  
Brian D. Smedley
Keyword(s):  
Health Care ◽  
Health Disparities ◽  
Health Systems ◽  
Access To Health Care ◽  
Health Care Systems ◽  
Ethnic Disparities ◽  
Policy Makers ◽  
Psychosocial Risks ◽  
Inequality In Health ◽  
Care Systems

Policy makers are increasingly attending to the problem of racial and ethnic health disparities, but much of this focus has been on evidence of inequality in health care systems. This attention is important and laudable, but eliminating inequality in the health care system would be insufficient to eliminate racial and ethnic disparities and improve the health of all Americans. Social and economic factors, such as disadvantaged socioeconomic status, racism, discrimination, and geographic inequality shape virtually all risks for poor health. Interventions that focus solely on improving access to health care, or on reducing individual behavioral and psychosocial risks, therefore have limited potential to reduce racial and ethnic health disparities. The elimination of health disparities requires comprehensive, intensive strategies that address inequality in many sectors, including housing, education, employment, and health systems. These interventions must be targeted at many levels, including individuals and families, workplaces, schools, and communities

Re-establishment of medical and healthcare systems for nuclear emergency workers based on the lessons learned from the 2011 Fukushima nuclear accident

2019 ◽  
Vol 54 (4) ◽  
pp. 283-288
Author(s):  
S. Yasui
Keyword(s):  
Health Care ◽  
Health Risks ◽  
Health Care Systems ◽  
Healthcare Systems ◽  
Lessons Learned ◽  
Nuclear Accident ◽  
Fukushima Nuclear Accident ◽  
Emergency Workers ◽  
Care Systems ◽  
Medical And Healthcare

In response to the Fukushima nuclear accident in 2011, the Ministry of Health, Labour and Welfare (MHLW) temporarily increased emergency dose limits from 100 to 250 mSv from March 14 to December 16, 2011, but there were many problems in medical and health care systems. Based on the lessons learned, in 2015, the MHLW deliberated for radiation protection and medical and health care systems to prepare for future nuclear emergencies. The paper aims to describe and share the experience gained in the process of setting medical and healthcare systems. The paper outlines the issues of: (a) on-site medical and health care systems; (b) health care during emergency work and; (c) long-term health care. For the deliberation, the MHLW had to find the way to keep a balance between the protection of the emergency workers and the prompt implementation of crisis response. The MHLW built a consensus among stakeholders by providing lifetime healthcare systems as compensation for the radiation health risks and by enhancing preparedness to eliminate confusion and disorder and improve the level of protection against health risks. The experience gained shows that acceptance of the health risks due to radiation exposure needs not only a scientific basis, but also social acceptance.

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