Business model for healthcare interoperability services

En la situación actual donde los sistemas TI sanitarios son diversos con modelos que van desde soluciones predominantes, adoptadas y creadas por grandes organizaciones, hasta soluciones a medida desarrolladas por cualquier empresa de la competencia para satisfacer necesidades concretas. Todos estos sistemas se encuentran bajo similares presiones financieras, no sólo de las condiciones económicas mundiales actuales y el aumento de los costes sanitarios, sino también bajo las presiones de una población que ha adoptado los avances tecnológicos actuales, y demanda una atención sanitaria más personalizable a la altura de esos avances tecnológicos que disfruta en otros ámbitos. El objeto es desarrollar un modelo de negocio orientado al soporte del intercambio de información en el ámbito clínico. El objetivo de este modelo de negocio es aumentar la competitividad dentro de este sector sin la necesidad de recurrir a expertos en estándares, proporcionando perfiles técnicos cualificados menos costosos con la ayuda de herramientas que simplifiquen el uso de los estándares de interoperabilidad. Se hará uso de especificaciones abiertas ya existentes como FHIR, que publica documentación y tutoriales bajo licencias abiertas. La principal ventaja que nos encontramos es que ésta especificación presenta un giro en la concepción actual de la disposición de información clínica, vista hasta ahora como especial por el requerimiento de estándares más complejos que solucionen cualquier caso por específico que sea. Ésta especificación permite hacer uso de la información clínica a través de tecnologías web actuales (HTTP, HTML, OAuth2, JSON, XML) que todo el mundo puede usar sin un entrenamiento particular para crear y consumir esta información. Partiendo por tanto de un mercado con una integración de la información casi inexistente, comparada con otros entornos actuales, hará que el gasto en integración clínica aumente dramáticamente, dejando atrás los desafíos técnicos cuyo gasto retrocederá a un segundo plano. El gasto se centrará en las expectativas de lo que se puede obtener en la tendencia actual de la personalización de los datos clínicos de los pacientes, con acceso a los registros de instituciones junto con datos ‘sociales/móviles/big data’.---ABSTRACT---In the current situation IT health systems are diverse, with models varying from predominant solutions adopted and created by large organizations, to ad-hoc solutions developed by any company to meet specific needs. However, all these systems are under similar financial pressures, not only from current global economic conditions and increased health care costs, but also under pressure from a population that has embraced the current technological advances, and demand a more personalized health care, up to those enjoyed by technological advances in other areas. The purpose of this thesis is to develop a business model aimed at the provision of information exchange within the clinical domain. It is intended to increase competitiveness in the health IT sector without the need for experts in standards, providing qualified technical profiles less expensively with the help of tools that simplify the use of interoperability standards. Open specifications, like FHIR, will be used in order to enable interoperability between systems. The main advantage found within FHIR is that introduces a shift in the current conception of available clinical information. So far seen, the clinical information domain IT systems, as a special requirement for more complex standards that address any specific case. This specification allows the use of clinical information through existing web technologies (HTTP, HTML, OAuth2, JSON and XML), which everyone can use with no particular training to create and consume this information. The current situation in the sector is that the integration of information is almost nonexistent, compared to current trends. Spending in IT health systems will increase dramatically within clinical integration for the next years, leaving the technical challenges whose costs will recede into the background. The investment on this area will focus on the expectations of what can be obtained in the current trend of personalization of clinical data of patients with access to records of institutions with ‘social /mobile /big data’.

A rural virtual health sciences library project: research findings with implications for next generation library services*

Purpose: The Shared Hospital Electronic Library of Southern Indiana (SHELSI) research project was designed to determine whether access to a virtual health sciences library and training in its use would support medical decision making in rural southern Indiana and achieve the same level of impact seen by targeted information services provided by health sciences librarians in urban hospitals.

Secularism, Sharia, and the Turkish Financial Markets

The financial markets in Turkey provide a laboratory to help resolve these competing views. Islamic law or Sharia contains a number of proscriptions that directly affect financial practices. The payment and receipt of interest is prohibited; so are most kinds of commercial insurance. These interpretations provided the impetus in the Islamic world for the creation of a class of banks that sought to offer Sharia compliant services. The first Islamic Banks in Turkey began operations in the 1980s. Their entry was initially tepid, in no small part because of secularist principles. Islamic financial institutions could not overtly advertise their religious orientation. The country had no “Islamic” banks, only finance houses. They were not Sharia compliant but “interest-free.” Moreover, the government left them in an uncertain regulatory status and subjected them to restrictions on growth. In this environment, the Islamic banks remained a peripheral part of the financial system. With the election of the AKP in 2002, however, the environment for Islamic banks in Turkey changed. Limitations on branch networks and capital raising were lifted. The government removed restrictions on the issuance of Sharia compliant bonds. Officials from the Islamic banks were appointed to the highest levels of government. This Article does several things. First, it examines principles of Islam that affect banking practices, with a particular emphasis on deposit insurance and credit cards. Second, the Article discusses the emergence of secularism in Turkey and the introduction of Islamic banks into the Turkish financial markets. The Article then examine their evolution, with particular emphasis on the changes implemented by the AKP. Finally, the Article examines the impact of these reforms, and what that impact says about Islamic influence in Turkey.

Changes in Access to Health Services of the Immigrant and Native-Born Population in Spain in the Context of Economic Crisis

Aim: To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis. Methods: Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012). Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1) to compare outcome variables in each group between years, (2) to compare outcome variables between both groups within each year, and (3) to determine the factors associated with health service use for each group and year. Results: unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012. Conclusion: Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012.

O registro do patrimônio cultural imaterial: as práticas do IPHAN e do IEPHA/MG

Patrimônio cultural é tudo aquilo que possui significado social e representa identidades, sendo dividido em duas principais categorias: material e imaterial. O reconhecimento deste último foi construído ao longo de um processo de maturação, ampliação de debates, legislação e ação de órgãos públicos nacionais e internacionais. No Brasil, a Constituição Federal de 1988 incorporou, ao lado do patrimônio material, as diversas formas de expressão e os modos de criar, fazer e viver, como patrimônio imaterial, adotando novos instrumentos de proteção aos bens culturais: o registro e o inventário. Entretanto, somente pelo Decreto 3.551/2000 é que o registro do imaterial foi definitivamente normatizado. Paulatinamente, ocorreu a descentralização da legislação e das políticas públicas, que passaram a ser compartilhadas por União, Estados e Municípios e, nesse sentido, um caso peculiar na gestão do patrimônio cultural ocorreu no estado de Minas Gerais, no qual o Instituto Estadual do Patrimônio Histórico e Artístico de Minas Gerais (IEPHA/MG) assumiu um valioso papel na preservação do patrimônio cultural, onde as ações municipais voltadas ao patrimônio cultural no Estado contam com repasses financeiros, via distribuição do Imposto Sobre Mercadorias e Serviços (ICMS). Esse cenário propiciou um campo para a reflexão e debate sobre o papel e a função desse órgão estadual frente às práticas de identificação, valorização e promoção do patrimônio imaterial de Minas Gerais.

The neglected side of banking union: reshaping Europe’s financial system. Bruegel Policy Contribution, 14 September 2013

This Policy Contribution...discusses how Europe's financial system could and should be reshaped. It starts from two basic points: First, the banking system needs to be credibly de-linked from the sovereigns and banks should operate across borders. Europe needs fewer national champions. Second, other forms of financial intermediation need to be developed. Both steps require a significant stepping up of the policy system, including a single resolution mechanism. Together, this will render Europe’s financial system more stable, more efficient and more conducive to growth.

Fiscal policy, banks and the financial crisis. National Bank of Belgium Working Paper No. 234, October 2012

This paper studies the effectiveness of Euro Area (EA) fiscal policy, during the recent financial crisis, using an estimated New Keynesian model with a bank. A key dimension of policy in the crisis was massive government support for banks—that dimension has so far received little attention in the macroeconomics literature. We use the estimated model to analyze the effects of bank asset losses, of government support for banks, and other fiscal stimulus measures, in the EA. Our results suggest that support for banks had a stabilizing effect on EA output, consumption and investment. Increased government purchases helped to stabilize output, but crowded out consumption. Higher transfers to households had a positive impact on private consumption, but a negligible effect on output and investment. Banking shocks and increased government spending explain half of the rise in the public debt/GDP ratio since the onset of the crisis.

Legal Aspects in Establishing the Internal Market for services. Research Papers in Law, 6/2007

Introduction. The internal market for services is one of the objectives set by the founding fathers of the EC back in 1957. It is only in the last ten-fifteen years, however, that this aspect of the internal market has seriously attracted the attention of the EC legislature and judiciary.1 With the exception of some sector-specific directives dating back in the late ‘80s, it is only with the deregulation of network industries, the development of electronic communications and the spread of financial services, in the ‘90s that substantial bits of legislation got adopted in the field of services. Similarly, the European Court of Justice (ECJ, the Court) left the principles established in Van Binsbergen back in 1973, hibernate for a long time before fully applying them in Säger and constantly thereafter.2 Ever since, the Court’s case law in this field has grown so important that it has become the compulsory starting point for any study concerning the (horizontal) regulation of the internal market in services. The limits inherent to negative integration and to the casuistic approach pursued by judiciary decisions have prompted the need for a general legislative text to be adopted for services in the internal market. This text, however, hotly debated both at the political and at the legal level, has ended up in little more than a complex restatement of the Court’s case law. It may be, however, that this ‘little more’ is not that little. In view of the ever expanding application of the Treaty rules on services, promoted by the ECJ (para. 1),3 the Directive certainly appears to be a limited regulatory attempt (para. 2). This, however, does not mean that the Directive is a toothless, or useless regulatory instrument (conclusion: para. 3).

The Single Supervisory Mechanism: A Sound First Step in Europe’s Banking Union? Egmont European Affairs Paper, March 2013

The financial and economic crisis has hit Europe in its core. While the crisis may not have originated in the European Union, it has laid bare structural weaknesses in the EU’s policy framework. Both public finances and the banking sector have been heavily affected. For a long time, the EU failed to take into account sufficiently the perverse link that existed between the two. Negative evolutions in one field of the crisis often dragged along the other in its downward spiral. In June 2012, in the early hours of a yet another EU Summit, the leaders of the eurozone finally decided to address the link between the banking and sovereign debt crises. Faced with soaring public borrowing costs in Spain and Italy, they decided to allow for the direct European recapitalisation of banks when the Member State itself would no longer be in a position to do so. In exchange, supervision of the banking sector would be lifted to the European level by means of a Single Supervisory Mechanism. The Single Supervisory Mechanism, or SSM in the EU jargon, is a first step in the broader revision of policies towards banks in Europe. The eventual goal is the creation of a Banking Union, which is to carry out effective surveillance and – if needed – crisis management of the banking sector. The SSM is to rely on national supervisors and the ECB, with the ECB having final authority on the matter. The involvement of the latter made it clear that the SSM would be centred on the eurozone – while it is to remain open to other Member States willing to join. Due to the ongoing problems and the link between the creation of the SSM and the recapitalisation of banks, the SSM became one of the key legislative priorities of the EU. In December 2012, Member States reached an agreement on the design of the SSM. After discussions with the European Parliament (which were still ongoing at the time of writing), the process towards making the SSM operational can be initiated. The goal is to have the SSM fully up and running in the first half of 2014. The decisions that were taken in June 2012 are likely to have had a bigger impact than the eurozone’s Heads of State and Government could have realised at the time for two important reasons. On the one hand, creating the SSM necessitates a full Banking Union and therefore shared risk. On the other hand, the decisions improved the ECB’s perception of the willingness of governments to take far-reaching measures. This undoubtedly played a significant role in the creation of the Outright Monetary Transactions programme by the ECB, which has led to a substantial easing of the crisis in the short-term. 1 These short-term gains should now be matched with a stable long-term framework for bank supervision and crisis management. The agreement on the SSM should be the first step in the direction of this goal. This paper provides an analysis of the SSM and its role in the creation of a Banking Union. The paper starts with a reminder of why the EU decided to put in place the SSM (§1) and the state of play of the ongoing negotiations on the SSM (§2). Subsequently, the supervisory responsibilities of the SSM are detailed, including its scope and the division of labour between the national supervisors and the ECB (§3). The internal functioning of the SSM (§4) and its relation to the other supervisors are discussed afterwards (§5). As mentioned earlier, the SSM is part of a wider move towards a Banking Union. Therefore, this paper sheds light on the other building blocks of this ambitious project (§6). The transition towards the Banking Union is important and will prove to be a bumpy ride. Before formulating a number of conclusions, this Working Paper therefore provides an overview of the planned road ahead (§7).