An authentication framework for e-health systems

The high-level sensitivity of medical information mandates stronger authentication and authorization mechanisms to be used in e-Health systems. This paper describes the design and implementation of certificate-based e-Health authentication and authorization architecture. This architecture was developed to authenticate e-Health professionals accessing shared clinical data among a set of affiliated health institutions based on peer-to- peer networks. The architecture had to accommodate specific medical data sharing and handling requirements, namely the security of professionals' credentials.

Improving access to evidence-based acute stroke services: development and evaluation of a health systems model to address equity of access issues

Level 1 evidence for management of patients with stroke in a dedicated Stroke Care Unit (SCU) demonstrates improved outcomes by about 20%. It has been estimated that 21% of Australian hospitals provide an SCU and that these SCUs are mainly located in either metropolitan sites and/or in hospitals with more than 300 beds. To address equity issues related to access to SCUs, the National Stroke Foundation and the Australian Government undertook the National Stroke Units Program. One program outcome was the development of a conceptual model of acute stroke service delivery. The development process and initial evaluation of the model are described. Use of the model to increase capacity within the health care system to treat stroke is discussed.

Challenges in health services and health systems research

The relationship between emerging trends in healthcare systems and the consequent research priorities will be explored.

Governments and policy makers in developed countries are increasingly focused on the management of chronic disease, reflecting demographic changes and shifts in the burden of disease. Systems of quality improvement and reward are increasingly based on performance in chronic disease management. There is some evidence that countries with well-developed systems of primary care, such as Australia, achieve better health outcomes at less cost. In the past 15 years, almost all developed countries have undergone some type of health care reform. There has been a major focus on reducing costs; often involving shifting services from secondary to primary care. While there are few international comparisons, most suggest a complex relationship between the strength of primary care within the overall health services system and good performance, particularly with regard to lower costs of care and particularly relevant measures of health.

Aims for 21st century health systems
What, then, are the issues which are shaping contemporary general practice in developed countries? There are several imperatives: Safety, effectiveness, patient-centredness, timeliness, efficiency and equity. A study by the Nuffield Trust (Dargie, 1999) projected the shape of healthcare for the first fifteen years of this century. The study identified six issues that need to be addressed in the process of formulating health systems policies:

• Peoples’ expectations and financial sustainability
• Demography and ageing
• Information and knowledge management
• Scientific advance and new technology
• Workforce education and training
• Systems performance and quality (efficiency, effectiveness, economy
and equity)

Each of these six issues requires innovative thinking and priority setting on the part of the health sector, such as the delivery of health services in new and creative ways. Furthermore, there is a clear need for a finely tuned research, development and evaluation strategies to match these goals.

Information needs and the implications for monitoring health systems : the Australian experience

This paper outlines the information needs underlying the health information system in Australia and the implications these have for the ability to monitor the performance of the health system. We discuss the use of indicators in performance monitoring and the role of information frameworks in providing a basis for their development. The major Australian data sources to support the development of performance indicators are outlined, and their current and likely futures uses for performance monitoring discussed.

HealthPathways: creating a pathway for health systems reform

Inefficiencies in the co-ordination and integration of primary and secondary care services in Australia, have led to increases in waiting times, unnecessary presentations to emergency departments and issues around poor discharge of patients. HealthPathways is a program developed in Canterbury, New Zealand, that builds relationships between General Practitioners and Specialists and uses information technology so that efficiency is maximised and the right patient is given the right care at the right time. Healthpathways is being implemented by a number of Medicare Locals across Australia however, little is known about the impact HealthPathways may have in Australia. This article provides a short description of HealthPathways and considers what it may offer in the Australian context and some of the barriers and facilitators to implementation. What is known about the topic? Early evidence on HealthPathways suggests that the program does seem to be strengthening relationships between GPs and secondary care specialists. In New Zealand advances in efficiency and system integration have been noted. However, there is limited evidence on the effectiveness of HealthPathways in Australia. What does this paper add? It is one of the first published papers to provide a perspective around HealthPathways and draws existing evidence and research to explore some of the barriers and facilitators to the development and implementation of HealthPathways in Australia. What are the implications for practitioners'? Early evidence suggests HealthPathways could help GPs and other practitioners' in the delivery of health services, it could also help to strengthen practitioner relationships.

Health systems and social transition in Asia

 This study examines the intersection of political and health policy history in selected countries of the Asian region including Cambodia, Myanmar and North Korea. The main finding is that political and social history sets the parameters for health policy making. The thesis then considers the implications this main finding has for the approach to health policy making in the region.

Health literacy toolkit for low and middle-income countries: a series of information sheets to empower communities and strengthen health systems

This series of information sheets introduces health literacy, its relevance to public policy, and the ways it can be used to inform the promotion of good health, the prevention and management of communicable and noncommunicable diseases, and the reduction of health inequities. It provides information and links to further resources to assist organizations and governments to incorporate health literacy responses into practice, service delivery systems, and policy.

Welcome from the policies, socio-economic aspects, and health systems research section

At BMC Obesity, the Policies, Socio-economic Aspects, and Health Systems Research Section provides an opportunity to submit research focussed on what we need to know to support implementation of obesity policies most likely to achieve substantial, sustainable and equitable reductions in the prevalence of obesity globally. Here, we present the aims and objectives of this section, hearing from each of the Associate Editors in turn. The ambition of the Policies, Socio-economic Aspects, and Health Systems Research Section is to foster innovative research combining scientific quality with real world experience. We envisage this will include research addressing the structural drivers of obesity, solution oriented research, research addressing socio-economic inequalities in obesity and obesity prevention in low and middle income countries. We look forward to stimulating research to advance both the methods and substance required to drive uptake of effective and equitable obesity reduction policies globally.

Application of information and communication technologies for health systems in Belgium, Denmark, Spain, the United Kingdom and Sweden

Incluye Bibliografía

PROJECTION OF HEALTH DEMAND IN TERMS OF HOSPITAL ADMISSIONS FOR SELECTED DIAGNOSES IN HEALTH SYSTEMS AGENCY SERVICE AREAS

The National Health Planning and Resources Development Act of 1974 (Public Law 93-641) requires that health systems agencies (HSAs) plan for their health service areas by the use of existing data to the maximum extent practicable. Health planning is based on the identificaton of health needs; however, HSAs are, at present, identifying health needs in their service areas in some approximate terms. This lack of specificity has greatly reduced the effectiveness of health planning. The intent of this study is, therefore, to explore the feasibility of predicting community levels of hospitalized morbidity by diagnosis by the use of existing data so as to allow health planners to plan for the services associated with specific diagnoses.^ The specific objectives of this study are (a) to obtain by means of multiple regression analysis a prediction equation for hospital admission by diagnosis, i.e., select the variables that are related to demand for hospital admissions; (b) to examine how pertinent the variables selected are; and (c) to see if each equation obtained predicts well for health service areas.^ The existing data on hospital admissions by diagnosis are those collected from the National Hospital Discharge Surveys, and are available in a form aggregated to the nine census divisions. When the equations established with such data are applied to local health service areas for prediction, the application is subject to the criticism of the theory of ecological fallacy. Since HSAs have to rely on the availability of existing data, it is imperative to examine whether or not the theory of ecological fallacy holds true in this case.^ The results of the study show that the equations established are highly significant and the independent variables in the equations explain the variation in the demand for hospital admission well. The predictability of these equations is good when they are applied to areas at the same ecological level but become poor, predominantly due to ecological fallacy, when they are applied to health service areas.^ It is concluded that HSAs can not predict hospital admissions by diagnosis without primary data collection as discouraged by Public Law 93-641. ^

Safe abortion: technical and policy guidance for health systems

Esta 2da edición de la Guía recoge la última evidencia disponible no sólo respecto de la atención del aborto seguro sino también de cómo deben organizarse los recursos humanos, los insumos y las instituciones de salud para garantizar los derechos humanos, incluyendo los derechos sexuales y reproductivos de las mujeres.

Moving from medical to health systems classifications of deaths : extending verbal autopsy to collect information on the circumstances of mortality

Funding A Health Systems Research Initiative Development Grant from the UK Department for International Development (DFID), Economic and Social Research Council (ESRC), Medical Research Council (MRC (and the Wellcome Trust (MR/N005597/1) funds the research presented in this paper. Support for the Agincourt HDSS including verbal autopsies was provided by The Wellcome Trust, UK (grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z), and the University of the Witwatersrand and Medical Research Council, South Africa.