Pediatric Emergency Telehealth

Pediatric Emergency Telehealth (PET) has enormous potential to help address the health care needs of children and families. In some regions, health care is particularly fragmented or difficult to access for the pediatric patient. Telehealth may bridge those gaps, improve continuity of care, and enhance communication between children’s hospitals and general pediatricians practicing in both rural and urban communities. Launching a PET service requires careful preparation with community health networks and stakeholders to ensure that the model is providing adjunct services as opposed to on-demand primary care services. General pediatricians’ offices that lack the capability to implement a virtual care system may seek consultation from the PET service in terms of triage, recommendations, or direct patient care. A substantial effort is required at initiation of a PET program but is useful in mitigating disease exposure such as Covid-19, as well as improving emergency department metrics such as patient satisfaction, length of stay, wait times, and revenue capture.

The Rhône-Alpes Health Platform

Summary Objectives: The purpose of this workis to develop a health information platform connecting most health facilities in the Rhône-Alpes region. The health platform called SIS-RA is used through a Web interface. An iconic interface is dedicated to the platform and presents information in a unique way for all users. Methods: Newtechniques have been used to develop this platform which will be used by a great number of Rhône-Alpes doctors in the future. We chose a user-centered design which takes into account doctors’ requirements (hospital and GP). We also consider that no system has to be rebuilt, but a direct connection to the legacysystems should be provided. Results: The platform permits fast and more appropriate medical decisions than those made without this information system. The iconic interface presents all medical documents in a uniform way. Currently, 11 healthcare facilities and 15 community health networks are connected to SIS-RA sharing more than 60,000 records with 1.2 million indexed items. 3200 doctors use the system. Conclusion: The platform is approved by French supervision authorities (regional hospitals association (ARH)), regional practitioners union (URML) and Rhônes-Alpes region administration and is known as the official shared health record.

Editorial

How should we organise community health services? This is the question posed by Swerissen in his paper in the Forum section of this issue. Within the context of reforms to the health system with an increased focus on improving efficiency, he argues that the organisation of community services should be driven by the functional relations between general care, acute care and co-ordinated care. The efficiency of vertical and horizontal integration and the creation of community health networks is considered in relation to a number of issues including distributional equity. He concludes that community health networks offer the most efficient model for the delivery of community based public health and general, acute and coordinated care services. It is hoped that this paper and the arguments presented will give rise to debate within the primary health care sector.

How Should We Organise Community Health Services?

This paper reviews the organisation of Victorian community health services in the context of the general direction of reform for the Australian and Victorian health systems. It notes that the emphasis has shifted to a greater focus on improving the efficiency of the relationship between needs, resources, services and outcomes. Within this context, in addition to public health measures, national reforms have advocated the creation of funding and organisational arrangements around three service functions: general care, acute care and co-ordinated care. It is argued that the organisation of community services should be driven by these functional relations, not vice versa. The efficiency of vertical and horizontal integration and the creation of community health networks is considered in relation to transaction costs, organisational scale, transition costs and distributional equity. It is concluded that community health networks offer the most efficient model for the delivery of community based public health and general, acute and co-ordinated care services.