Home Telecare, Medical Implant, and Mobile Technology

With a rapidly expanding global aging population, alternatives must be developed to minimize the inevitable increase in acute and long-term care admissions to the health care system. This chapter explores the use of home telecare as an alternative medical approach to managing this growing trend, while also providing superior care to geriatric patients. To address some of the emergent disadvantages of home telecare concerning usability, self-management, and confinement to the home, the use of a cardiac implant in conjunction with a mobile device—to assist in the management of chronic heart failure in seniors—is proposed as a promising technological solution to overcoming these limitations. Ultimately, it seems that the growth of home telecare, as well as the great potential to enhance its services with the use of mobile wireless technology, stands to drastically improve clinical decision-making and management of health services in the future.

Towards Healthy Public Policy

As an issue that affects a significant portion of the Canadian population, food security must be addressed in public health policy and research. Decision-making for food security is a complex task that needs to take into account a diverse range of issues including production, processing, distribution, access, consumption, and waste management. This approach to policymaking for food security, known as food systems analysis, makes use of a large amount of geospatial data. Public health informatics can offer some potential answers to handling and using this large amount of information. The purpose of this chapter is to provide a brief introduction to Geographic Information Systems (GIS) and how they are used in public health, particularly for food systems analysis. A hypothetical scenario that envisions using a type of spatial analytic tool, called Spatial On-Line Analytic Processing (Spatial OLAP or SOLAP), for public health decision-making is also introduced. In describing both GIS and spatial OLAP, a case for incorporating food systems analysis into public health practices is made.

Investing in a “Rehabilitation Model” to Improve the Decision-Making Process in Long-Term Care

An aging population is a primary factor associated with escalating healthcare costs due to increased drug spending, chronic diseases and co-morbidities, physician visits, and hospital costs (TD Report, 2010). There has already been a marked increase in the number of Long-Term Care (LTC) residents with co-morbidities, and chronic diseases will be more prevalent in future years (Conference Board of Canada, 2011). The chapter explores the use of a rehabilitation model to improve the current decision-making processes that impact the health outcomes of seniors across the Ontario LTC continuum. Improved clinical management of this population through rehabilitation could result in not only enhanced quality of care but also significant cost savings for both the Long-Term Care (LTC) industry and the health system at large. The chapter highlights the need for the LTC sector to identify strategies for harnessing innovation to improve its own activities and outcomes and become a leader in health system transformation.

Normalizing Cross-Border Healthcare in Europe via New E-Prescription Paradigms

The 21st century started with some significant efforts globally in the e-health sector. This was mainly pushed as a generic strategy from many nations and international organizations in order to cope with issues such as ageing population, demographic shift, social security limitations, and financial instability. A second reason was the introduction of new technologies such as cloud computing, Web interoperability standards, mobile health, and social media that are steadily changing the way healthcare has been seen in the last decades. In addition to that, globalization, commuting, immigration, and increased mobility raised the issue of cross-border healthcare and the right to access normalized healthcare services anywhere, anytime. In that context, the authors analyze the technological offerings and result of the epSOS (European Patient Smart Open Services) framework and how it has affected strategic decisions in electronic prescription in Greece, thus creating a new useful e-health national application. They prove that by rethinking healthcare, reusing established standards such as HL7 CDA (Health Level Seven Clinical Document Architecture) and IHE (Integrating the Healthcare Enterprise) profiles, it is possible to propose a new innovative system that is in fact based upon new technological propositions such as REST (Representational State Transfer) architecture and cloud computing.

Caring for our Aging Population

An increasing senior population and national fiscal challenges affect the provision of healthcare in many ways. Keeping this in mind, the Ontario Ministry of Health and Long-Term Care’s recent release of the Ontario Action Plan for Health Care (2012) aims to manage scarce resources and healthcare dollars to improve the health of Ontarians while making care available to seniors closer to home. One highly viable approach to attaining such goals is through the adoption of various healthcare technologies. Computerized Physician Order Entry Systems and Telehomecare are two examples presented in this chapter that describes how health informatics can be used as a solution to policy concerns.

Implementation of Case Costing with Ontario Case Costing Initiative (OCCI)

Over the past decade there has been a tremendous spread of computerized systems in hospitals. The advancement provided an opportunity for hospitals to gain access to computerized clinical, financial, and statistical data. Case costing information is the integration of clinical, financial, and statistical data to provide costing information at the patient level. Ontario Case Costing Initiative (OCCI) is an undertaking of the Ontario Ministry of Health and Long-Term Care (MOHLTC). This chapter focuses on the implementation of case costing using OCCI as a guideline for a hospital. It addresses the process of implementation by discussing proposals for planning, implementing, transitioning, and evaluation of case costing. The adoption of the OCCI allows health care professionals to analyze integrated health information and further enables evidence-based decision making.

How Web 2.0 Shapes Patient Knowledge Sharing

Web 2.0 has totally changed the health communication world. In particular, it has reconfigured peer exchanges about health. These exchanges are important because they allow knowledge sharing and construction between patients, in particular chronic patients. Although their importance is well established, this field of study brings together a variety of theories not uniformly shared or understood. It is not clear how patients use Web for knowledge processes: what kind of knowledge processes happen in Web 2.0 between patients? How does Web 2.0 sustain or impede these processes? The aim of this research is to map virtual exchanges about diabetes in Italy by developing a systematic exploration of Web using the main search engines (Google, Yahoo) and analyzing the site that hosts posts and exchanges about diabetes. According to a psychosocial perspective, findings highlight the main features of online knowledge processes among patients.

The Administrative Policy Quandary in Canada’s Health Service Organizations

This chapter examines the process for administrative health service policy development with respect to information sharing and decision-making as well as the relationship of policy to decision making. The challenges experienced by health service managers are identified. The administrative health policy experience in Nova Scotia is described. There is a need for integrated policy at multiple levels (public, clinical, and administrative). The quandary is that while working to share health information systems, most Canadian health service organizations continue to individually develop administrative health policy, expending more resources on policy writing than on translation/education, monitoring, or evaluation. By exploring the importance and nature of administrative policy as a foundation for quality improvement in healthcare delivery, a case is made for greater use of health informatics tools and processes.

Using Case Costing Data and Case Mix for Funding and Benchmarking in Rehabilitation Hospitals

The concern for Ontario hospitals in Canada is that the funding model has recently changed from global- to activity-based funding, which will affect hospitals’ operational budget and cost management. Hospitals will be reimbursed based on a pre-set payment price for each patient type or case mix treated. Specifically, the purpose of this chapter is to describe how case costing data and case mix information are collected and used for funding. A framework is proposed for health administrators, policy makers, and researchers to understand the input variables for determining resource utilization and long stay trim point. A clinical decision-making tool is demonstrated to assist hospital administrators to define admission criteria and predict length of stay and volumes with clinical teams. The chapter highlights the importance of data quality and use of comparative data and concludes with 10 key success factors for better funding and benchmarking for rehabilitation hospitals.

Decision-Making and Decision Support in Acute Care

Clinical Decision Support Systems (CDSS) are information tools intended to optimize medical choice, promising better patient outcomes, faster care, reduced resource expenditure, or some combination of all three. Clinical trials of CDSS have provided only insipid evidence of benefit to date. This chapter reviews the theory of medical decision-decision making, identifying the different decision support needs of novices and experts, and demonstrates that discipline, objective and setting, and affect of the nature of support that is required. A discussion on categorization attempts to provide metrics by which systems can be compared and evaluated, in particular with regard to decision support mechanics and function. Throughout, the common theme is the placement of clinical decision makers at the center of the design or evaluation process.