scholarly journals Blockchain-Enabled iWellChain Framework Integration With the National Medical Referral System: Development and Usability Study (Preprint)

2019 ◽  
Author(s):  
Yu-Sheng Lo ◽  
Cheng-Yi Yang ◽  
Hsiung-Fei Chien ◽  
Shy-Shin Chang ◽  
Chung-Ying Lu ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
National Health ◽  
Health Care Facilities ◽  
Health Record ◽  
National Medical ◽  
Referral Service ◽  
Care Facilities ◽  
Access Logs ◽  
Medical Referral

BACKGROUND Medical referral is the transfer of a patient’s care from one physician to another upon request. This process involves multiple steps that require provider-to-provider and provider-to-patient communication. In Taiwan, the National Health Insurance Administration (NHIA) has implemented a national medical referral (NMR) system, which encourages physicians to refer their patients to different health care facilities to reduce unnecessary hospital visits and the financial stress on the national health insurance. However, the NHIA’s NMR system is a government-based electronic medical referral service, and its referral data access and exchange are limited to authorized clinical professionals using their national health smart cards over the NHIA virtual private network. Therefore, this system lacks scalability and flexibility and cannot establish trusting relationships among patients, family doctors, and specialists. OBJECTIVE To eliminate the existing restrictions of the NHIA’s NMR system, this study developed a scalable, flexible, and blockchain-enabled framework that leverages the NHIA’s NMR referral data to build an alliance-based medical referral service connecting health care facilities. METHODS We developed a blockchain-enabled framework that can integrate patient referral data from the NHIA’s NMR system with electronic medical record (EMR) and electronic health record (EHR) data of hospitals and community-based clinics to establish an alliance-based medical referral service serving patients, clinics, and hospitals and improve the trust in relationships and transaction security. We also developed a blockchain-enabled personal health record decentralized app (DApp) based on our blockchain-enabled framework for patients to acquire their EMR and EHR data; DApp access logs were collected to assess patients’ behavior and investigate the acceptance of our personal authorization-controlled framework. RESULTS The constructed iWellChain Framework was installed in an affiliated teaching hospital and four collaborative clinics. The framework renders all medical referral processes automatic and paperless and facilitates efficient NHIA reimbursements. In addition, the blockchain-enabled iWellChain DApp was distributed for patients to access and control their EMR and EHR data. Analysis of 3 months (September to December 2018) of access logs revealed that patients were highly interested in acquiring health data, especially those of laboratory test reports. CONCLUSIONS This study is a pioneer of blockchain applications for medical referral services, and the constructed framework and DApp have been applied practically in clinical settings. The iWellChain Framework has the scalability to deploy a blockchain environment effectively for health care facilities; the iWellChain DApp has potential for use with more patient-centered applications to collaborate with the industry and facilitate its adoption.

scholarly journals Blockchain-Enabled iWellChain Framework Integration With the National Medical Referral System: Development and Usability Study

10.2196/13563 ◽  
2019 ◽  
Vol 21 (12) ◽  
pp. e13563 ◽  
Author(s):  
Yu-Sheng Lo ◽  
Cheng-Yi Yang ◽  
Hsiung-Fei Chien ◽  
Shy-Shin Chang ◽  
Chung-Ying Lu ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
National Health ◽  
Health Care Facilities ◽  
Health Record ◽  
National Medical ◽  
Referral Service ◽  
Care Facilities ◽  
Access Logs ◽  
Medical Referral

Background Medical referral is the transfer of a patient’s care from one physician to another upon request. This process involves multiple steps that require provider-to-provider and provider-to-patient communication. In Taiwan, the National Health Insurance Administration (NHIA) has implemented a national medical referral (NMR) system, which encourages physicians to refer their patients to different health care facilities to reduce unnecessary hospital visits and the financial stress on the national health insurance. However, the NHIA’s NMR system is a government-based electronic medical referral service, and its referral data access and exchange are limited to authorized clinical professionals using their national health smart cards over the NHIA virtual private network. Therefore, this system lacks scalability and flexibility and cannot establish trusting relationships among patients, family doctors, and specialists. Objective To eliminate the existing restrictions of the NHIA’s NMR system, this study developed a scalable, flexible, and blockchain-enabled framework that leverages the NHIA’s NMR referral data to build an alliance-based medical referral service connecting health care facilities. Methods We developed a blockchain-enabled framework that can integrate patient referral data from the NHIA’s NMR system with electronic medical record (EMR) and electronic health record (EHR) data of hospitals and community-based clinics to establish an alliance-based medical referral service serving patients, clinics, and hospitals and improve the trust in relationships and transaction security. We also developed a blockchain-enabled personal health record decentralized app (DApp) based on our blockchain-enabled framework for patients to acquire their EMR and EHR data; DApp access logs were collected to assess patients’ behavior and investigate the acceptance of our personal authorization-controlled framework. Results The constructed iWellChain Framework was installed in an affiliated teaching hospital and four collaborative clinics. The framework renders all medical referral processes automatic and paperless and facilitates efficient NHIA reimbursements. In addition, the blockchain-enabled iWellChain DApp was distributed for patients to access and control their EMR and EHR data. Analysis of 3 months (September to December 2018) of access logs revealed that patients were highly interested in acquiring health data, especially those of laboratory test reports. Conclusions This study is a pioneer of blockchain applications for medical referral services, and the constructed framework and DApp have been applied practically in clinical settings. The iWellChain Framework has the scalability to deploy a blockchain environment effectively for health care facilities; the iWellChain DApp has potential for use with more patient-centered applications to collaborate with the industry and facilitate its adoption.

scholarly journals Targeting and Impact of National Health Insurance Program in Indonesia

2020 ◽  
Vol 9 (4) ◽  
pp. 468-481
Author(s):  
Galih Putri Yunistria
Keyword(s):  
Health Care ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Health Insurance ◽  
National Health Insurance ◽  
Logistic Regression Analysis ◽  
National Health ◽  
Health Care Facilities ◽  
National Health Insurance System ◽  
Care Facilities

National Health Insurance System (NHIS) program in Indonesia has been launched since 2014,and government spending to support the program has allocated nearly 40% of MoH budget,especially for the NHIS subsidies. This study examined the distribution of NHIS subsidizedbeneficiaries which associated with the household income distribution, and also studied about theutilization rate of health care facilities among the residents since the NHIS program has introducedto change citizens’ health seeking behaviour from traditional services to health facilities. Using the2016 Susenas data, this study employed the benefit incidence analysis method to measure thedistribution of NHIS-subsidized group, and logistic regression analysis to determine the health careseeking behavior. The result shows that households in higher income (quantile III-V) get benefitfrom government subsidy on NHIS program. It indicated there was a leakage on governmentbudget that not belong to the target (quantile I and II). Then, logistic regression analysis found thatpeople with higher income and having health insurance tend to visit health care facilities morefrequently than lower income group and uninsured people. This can be concluded that healthinsurance ownership is one of the important factors to influence people visiting health carefacilities.

Kajian Kebijakan Jaminan Kesehatan Masyarakat

2010 ◽  
Vol 13 (2) ◽  
pp. 98-104
Author(s):  
Imami Nur Rachmawati
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Public Service ◽  
Living Environment ◽  
Health Care Facilities ◽  
The State ◽  
Human Right ◽  
Care Facilities ◽  
Community Health Insurance ◽  
Good Living

AbstrakKesehatan adalah hak asasi manusia. Sesuai dengan Pancasila dan amanat UUD 1945 yaitu pasal 28H ayat (1) yang mengatakan bahwa setiap orang berhak hidup sejahtera lahir dan batin, bertempat tinggal, dan mendapatkan lingkungan hidup yang baik dan sehat serta berhak memperoleh pelayanan kesehatan dan pasal 34 ayat (1) yang mengatakan bahwa Negara mengembangkan sistem jaminan sosial bagi seluruh rakyat dan memberdayakan masyarakat yang lemah dan tidak mampu sesuai dengan martabat kemanusiaan dan ayat (2) yang menetapkan bahwa Negara bertanggung jawab atas penyediaan fasilitas pelayanan kesehatan dan fasilitas pelayanan umum yang layak, maka sudah merupakan kewajiban negara untuk menjamin kesehatan warganya. Berbagai program telah dikembangkan oleh Negara termasuk Jaminan Kesehatan Masyarakat (Jamkesmas). Akan tetapi pada pelaksanaannya, Jamkesmas ini masih banyak menemui kendala. Makalah ini akan menjabarkan informasi terkait dengan pelaksanaan program Jamkesmas dan memberikan berbagai pemecahan masalah tersebut. AbstractHealth is a human right. In accordance with Pancasila and 1945 Constitution, namely Article 28H paragraph (1) which says that every person is entitled to live in prosperity and spiritual, living, and earn a good living environment and healthy and receive medical care and article 34 paragraph (1) the said that the State develop a system of social security for all citizens and to empower the weak and unable to human dignity and in accordance with paragraph (2) which provides that the State is responsible for the provision of health care facilities and public service facilities are decent, then it is the obligation of the state to ensure the health of its citizens. Various programs have been developed by the State including Community Health Insurance (Jamkesmas). However, in practice, this is still a lot of obstacles. This paper will describe the information related to the implementation of the program Jamkesmas and provide a variety of problem solving.

scholarly journals Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study (Preprint)

2017 ◽  
Author(s):  
Naomi Muinga ◽  
Steve Magare ◽  
Jonathan Monda ◽  
Onesmus Kamau ◽  
Stuart Houston ◽  
...  
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
Open Source ◽  
Health Information ◽  
Health Care Facilities ◽  
Health Record ◽  
Record System ◽  
Care Facilities ◽  
Electronic Health

BACKGROUND The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. OBJECTIVE We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. METHODS We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. RESULTS This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. CONCLUSIONS Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa.

scholarly journals Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study

2018 ◽  
Vol 6 (2) ◽  
pp. e22 ◽  
Author(s):  
Naomi Muinga ◽  
Steve Magare ◽  
Jonathan Monda ◽  
Onesmus Kamau ◽  
Stuart Houston ◽  
...  
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
Open Source ◽  
Health Care Facilities ◽  
Electronic Health Record System ◽  
Health Record ◽  
Record System ◽  
Care Facilities ◽  
Electronic Health

scholarly journals Practices of waste management in health care facilities in Nepal's Biratnagar metropolitan city

2021 ◽  
Vol 12 (3) ◽  
pp. 398-404
Author(s):  
Nawa Raj Subba
Keyword(s):  
Public Health ◽  
Health Care ◽  
Waste Management ◽  
Health Care Facilities ◽  
Household Waste ◽  
Care Facilities ◽  
Public Health Office ◽  
Medical Referral ◽  
Health Care Waste ◽  
The City

Biratnagar is a medical referral centre with tertiary health care in Eastern Nepal. The city population is 202,061, according to the 2011 census. There are 35 Health Care Facilities (HCFs) in the city as of 2014. There are 7 HCFs, 2 non-governmental HCFs, and 26 private HCFs. In 2014, the District Public Health Office Morang, the Biratnagar municipality, and the private sector collaborated to check Biratnagar's health care waste management. Investigators performed a semi-structured questionnaire and checklists while visiting health care sites. According to the survey results, 10% of HCFs use incinerators. 80% of HCFs separate their garbage, 60% use needle destroyer machines, and 50% use coloured dustbins to separate different sorts of medical waste. The bed occupancy rate is 78%. Every day, one sweeper looks for 6.66 beds. Even 10% of HCFs let their waste out in the open. HCFs do not have enough capacity for waste disposal facilities. Thus, HCFs pay the municipality Rs. 1500- 15000 a month to have the facility's waste removed. In the municipality tractor, they are hauling medical garbage and home rubbish. As a result, the city discharges health care waste with household waste in the Singhiaya River. These actions endanger public health. Biratnagar city generates 118 Kgs of hazardous health care waste daily, necessitating immediate treatment. Biratnagar Municipality should collaborate with partners to develop a short and long-term strategy.

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