eHealth-as-a-Service (eHaaS) : the industrialisation of health informatics, a practical approach

With the introduction of the Personally Controlled Health Record (PCEHR), the Australian public is being asked to accept greater responsibility for their healthcare. Although well designed, constructed and intentioned, policy and privacy concerns have resulted in an eHealth model that may impact future health information sharing requirements. Thus an opportunity to transform the beleaguered Australian PCEHR into a sustainable on-demand technology consumption model for patient safety must be explored further. Moreover, the current clerical focus of healthcare practitioners must be renegotiated to establish a shared knowledge creation landscape of action for safer patient interventions. To achieve this potential however requires a platform that will facilitate efficient and trusted unification of all health information available in real-time across the continuum of care. As a conceptual paper, the goal of the authors is to deliver insights into the antecedents of usage influencing superior patient outcomes within an eHealth-as-a-Service framework. To achieve this, the paper attempts to distil key concepts and identify common themes drawn from a preliminary literature review of eHealth and cloud computing concepts, specifically cloud service orchestration to establish a conceptual framework and a research agenda. Initial findings support the authors’ view that an eHealth-as-a-Service (eHaaS) construct will serve as a disruptive paradigm shift in the aggregation and transformation of health information for use as real-world knowledge in patient care scenarios. Moreover, the strategic value of extending the community Health Record Bank (HRB) model lies in the ability to automatically draw on a multitude of relevant data repositories and sources to create a single source of practice based evidence and to engage market forces to create financial sustainability.

Quantifying uncertainty in parameter estimates for stochastic models of collective cell spreading using approximate Bayesian computation

Wound healing and tumour growth involve collective cell spreading, which is driven by individual motility and proliferation events within a population of cells. Mathematical models are often used to interpret experimental data and to estimate the parameters so that predictions can be made. Existing methods for parameter estimation typically assume that these parameters are constants and often ignore any uncertainty in the estimated values. We use approximate Bayesian computation (ABC) to estimate the cell diffusivity, D, and the cell proliferation rate, λ, from a discrete model of collective cell spreading, and we quantify the uncertainty associated with these estimates using Bayesian inference. We use a detailed experimental data set describing the collective cell spreading of 3T3 fibroblast cells. The ABC analysis is conducted for different combinations of initial cell densities and experimental times in two separate scenarios: (i) where collective cell spreading is driven by cell motility alone, and (ii) where collective cell spreading is driven by combined cell motility and cell proliferation. We find that D can be estimated precisely, with a small coefficient of variation (CV) of 2–6%. Our results indicate that D appears to depend on the experimental time, which is a feature that has been previously overlooked. Assuming that the values of D are the same in both experimental scenarios, we use the information about D from the first experimental scenario to obtain reasonably precise estimates of λ, with a CV between 4 and 12%. Our estimates of D and λ are consistent with previously reported values; however, our method is based on a straightforward measurement of the position of the leading edge whereas previous approaches have involved expensive cell counting techniques. Additional insights gained using a fully Bayesian approach justify the computational cost, especially since it allows us to accommodate information from different experiments in a principled way.

Collective futures: How projections about the future of society are related to actions and attitudes supporting social change

We identified the active ingredients in people’s visions of society’s future (“collective futures”) that could drive political behavior in the present. In eight studies (N = 595), people imagined society in 2050 where climate change was mitigated (Study 1), abortion laws relaxed (Study 2), marijuana legalized (Study 3), or the power of different religious groups had increased (Studies 4-8). Participants rated how this future society would differ from today in terms of societal-level dysfunction and development (e.g., crime, inequality, education, technology), people’s character (warmth, competence, morality), and their values (e.g., conservation, self-transcendence). These measures were related to present-day attitudes/intentions that would promote/prevent this future (e.g., act on climate change, vote for a Muslim politician). A projection about benevolence in society (i.e., warmth/morality of people’s character) was the only dimension consistently and uniquely associated with present-day attitudes and intentions across contexts. Implications for social change theories, political communication, and policy design are discussed.

The Global Protection of Personal Health Data

The workshop is an activity of the IMIA Working Group ‘Security in Health Information Systems’ (SiHIS). It is focused to the growing global problem: how to protect personal health data in today’s global eHealth and digital health environment. It will review available trust building mechanisms, security measures and privacy policies. Technology alone does not solve this complex problem and current protection policies and legislation are considered woefully inadequate. Among other trust building tools, certification and accreditation mechanisms are dis-cussed in detail and the workshop will determine their acceptance and quality. The need for further research and international collective action are discussed. This workshop provides an opportunity to address a critical growing problem and make pragmatic proposals for sustainable and effective solutions for global eHealth and digital health.

Mathematical models for collective cell spreading

Collective cell spreading is frequently observed in development, tissue repair and disease progression. Mathematical modelling used in conjunction with experimental investigation can provide key insights into the mechanisms driving the spread of cell populations. In this study, we investigated how experimental and modelling frameworks can be used to identify several key features underlying collective cell spreading. In particular, we were able to independently quantify the roles of cell motility and cell proliferation in a spreading cell population, and investigate how these roles are influenced by factors such as the initial cell density, type of cell population and the assay geometry.

Information accountability and health big data analytics: A consent-based model

With the ever increasing amount of eHealth data available from various eHealth systems and sources, Health Big Data Analytics promises enticing benefits such as enabling the discovery of new treatment options and improved decision making. However, concerns over the privacy of information have hindered the aggregation of this information. To address these concerns, we propose the use of Information Accountability protocols to provide patients with the ability to decide how and when their data can be shared and aggregated for use in big data research. In this paper, we discuss the issues surrounding Health Big Data Analytics and propose a consent-based model to address privacy concerns to aid in achieving the promised benefits of Big Data in eHealth.

Managing and sharing health data through information accountability protocols

Concerns over the security and privacy of patient information are one of the biggest hindrances to sharing health information and the wide adoption of eHealth systems. At present, there are competing requirements between healthcare consumers' (i.e. patients) requirements and healthcare professionals' (HCP) requirements. While consumers want control over their information, healthcare professionals want access to as much information as required in order to make well-informed decisions and provide quality care. In order to balance these requirements, the use of an Information Accountability Framework devised for eHealth systems has been proposed. In this paper, we take a step closer to the adoption of the Information Accountability protocols and demonstrate their functionality through an implementation in FluxMED, a customisable EHR system.

Nuclear power and Japan's collective future: Understanding beliefs about how nuclear policies will affect society

Despite ongoing controversies regarding possible directions for the nuclear plants program throughout Japan since the Fukushima disaster, little has been researched about people's belief structure about future society and what may affect their attitudes toward different policy options. Beyond policy debates, the present study focused on how people see a future society according to the assumptions of different policy options. A total of 125 students at Japanese universities were asked to compare a future society with society today in which one of alternative policies was adopted (i.e., shutdown or expansion of nuclear reactors) in terms of characteristics of individuals and society in general. While perceived dangerousness of nuclear power predicted attitudes and behavioural intentions to make personal sacrifices for nuclear power policies, beliefs about the social consequences of the policies, especially on economic development and dysfunction, appeared to play stronger roles in predicting those measures. The importance of sociological dimensions in understanding how people perceive the future of society regarding alternative nuclear power policies, and the subtle discrepancies between attitudes and behavioural intentions, are discussed.

Personal health records as sources of productivity evidence

Capturing data from various data repositories and integrating them for productivity improvements is common in modern business organisations. With the well-accepted concept of achieving positive gains through investment in employee health and wellness, organisations have started to capture both employee health and non-health data as Employer Sponsored electronic Personal Health Records (ESPHRs). However, non-health related data in ESPHRs has hardly been taken into consideration with outcomes such as employee productivity potentially being suited for further validation and stimulation of ESPHR usage. Here we analyse selected employee demographic information (age, gender, marital status, and job grade) and health-related outcomes (absenteeism and presenteeism) of employees for evidence-based decision making. Our study considered demographic and health-related outcomes of 700 employees. Surprisingly, the analysis shows that employees with high sick leave rates are also high performers. A factor analysis shows 92% of the variance in the data can be explained by three factors, with the job grade capable of explaining 62% of the variance. Work responsibilities may drive employees to maintain high work performance despite signs of sickness, so ESPHRs should focus attention on high performers. This finding suggests new ways of extracting value from ESPHRs to support organisational health and wellness management to help assure sustainability in organisational productivity.

An eroding social justice agenda: The case of physical education and health edu-business in schools

In this paper we draw on current research to explore notions of a socially just Health and Physical Education (HPE), in light of claims that a neoliberal globalisation promotes markets over the states, and a new individualism that privileges self-interest over the collective good. We also invite readers to consider United Nations Educational, Scientific and Cultural Organization’s ambition for PE in light of preliminary findings from an Australian led research project exploring national and international patterns of outsourcing HPE curricula. Data were sourced from this international research project through a mixed method approach. Each external provider engaged in four phases of research activity: (a) Web-audits, (b) Interviews with external providers, (c) Network diagrams, and (d) School partner interviews and observations. Results We use these data to pose what we believe to be three emerging lines of inquiry and challenge for a socially just school HPE within neoliberal times. In particular our data indicates that the marketization of school HPE is strengthening an emphasis on individual responsibility for personal health, elevating expectations that schools and teachers will “fill the welfare gap” and finally, influencing the nature and purchase of educative HPE programs in schools. The apparent proliferation of external providers of health work, HPE resources and services reflects the rise and pervasiveness of neoliberalism in education. We conclude that this global HPE landscape warrants attention to investigate the extent to which external providers’ resources are compatible with schooling’s educative and inclusive mandates.

History and development of public health

This chapter and the others that follow have the study of population health as their focus, as opposed to a focus on individual care and treatment. Clearly, however, we are concerned with the way in which population health is influenced by biomedical theories and practices, and the way population health is funded, and is influenced by the importance placed on therapeutic medicine. The discussions that follow include a brief overview of the ancient history of public health, and the modern history of Western public health dating from 1850. This date signifies the beginnings of a more organised, collective effort to protect the public’s health. These discussions will help you further expand your definition of public health. You will have an entertaining journey through public health achievements, and less successful outcomes, by examining the historical developments that have led us to a modern understanding of public health. The ancient Greeks and Romans, for example, had public health measures to ensure the safety and health of their populations, for a range of social and economic reasons. Convicts arrived in Australia with many health problems, and were put to work to satisfy the needs of a fledgling colony. It is important to understand the historical journey of public health and the way it is critically analysed, as it provides a looking-glass onto the present and the future.

Unraveling the helix of change : An activity-theoretical study of health care change efforts and their consequences

M.A. (Educ.) Anu Kajamaa from the University of Helsinki, Center for Research on Activity, Development and Learning (CRADLE), examines change efforts and their consequences in health care in the public sector. The aim of her academic dissertation is, by providing a new conceptual framework, to widen our understanding of organizational change efforts and their consequences and managerial challenges. Despite the multiple change efforts, the results of health care development projects have not been very promising, and many developmental needs and managerial challenges exist. The study challenges the predominant, well-framed health care change paradigm and calls for an expanded view to explore the underlying issues and multiplicities of change efforts and their consequences. The study asks what kind of expanded conceptual framework is needed to better understand organizational change as transcending currently dominant oppositions in management thinking, specifically in the field of health care. The study includes five explorative case studies of health care change efforts and their consequences in Finland. Theory and practice are tightly interconnected in the study. The methodology of the study integrates the ethnography of organizational change, a narrative approach and cultural-historical activity theory. From the stance of activity theory, historicity, contradictions, locality and employee participation play significant roles in developing health care. The empirical data of the study has mainly been collected in two projects, funded by the Finnish Work Environment Fund. The data was collected in public sector health care organizations during the years 2004-2010. By exploring the oppositions between distinct views on organizational change and the multi-site, multi-level and multi-logic of organizational change, the study develops an expanded, multidimensional activity-theoretical framework on organizational change and management thinking. The findings of the study contribute to activity theory and organization studies, and provide information for health care management and practitioners. The study illuminates that continuous development efforts bridged to one another and anchored to collectively created new activity models can lead to significant improvements and organizational learning in health care. The study presents such expansive learning processes. The ways of conducting change efforts in organizations play a critical role in the creation of collective new practices and tools and in establishing ownership over them. Some of the studied change efforts were discontinuous or encapsulated, not benefiting the larger whole. The study shows that the stagnation and unexpected consequences of change efforts relate to the unconnectedness of the different organizational sites, levels and logics. If not dealt with, the unintended consequences such as obstacles, breaks and conflicts may stem promising change and learning processes.

Finding space to mental health : promoting mental health in adolescents (12 to 14 year olds): preliminary results of the intervention's effectiveness

Resumen: La salud mental y el bienestar son fundamentales para nuestra capacidad colectiva y individual como seres humanos de pensar, de exteriorizar los sentimientos, de establecer y mantener relaciones, para estudiar, para perseguir las actividades de ocio, para tomar decisiones diarias y para disfrutar de una vida plena. Una adolescencia saludable es un prerrequisito para una vida adulta saludable. Sin embargo, la realidad actual presenta un panorama preocupante. La formación del capital mental individual y colectivo - especialmente en las primeras etapas de la vida - está siendo retenida por una serie de riesgos evitables para la salud mental (World Health Organization [WHO], 2013). Los adolescentes del sur de Europa (región que ha sido más severamente afectada por la crisis financiera; e.g., Portugal) son señalados como un grupo extremadamente vulnerable, ya que su salud mental fácilmente podría ser influenciada por las dificultades económicas de sus padres y la escasez de solidaridad social (European Parliament, 2012). La promoción de la salud mental de los adolescentes es considerada como una preocupación fundamental (WHO, 2005a, 2013). En este ámbito, las intervenciones centradas en la promoción de la literacía de la salud mental han revelado importantes ventajas en la prevención, reconocimiento, intervención precoz y la reducción del estigma (Pinfold, Stuart, Thornicroft & Arboleda-Florez, 2005; Pinfold, Toulmin, Thornicroft, Huxley, Farmer & Graham, 2003; Schulze, Richter-Werling, Matschinger & Angermeyer, 2003; Stuart, 2006). En consonancia con los marcos de promoción de la salud mentales propuestos por la Organización Mundial de la Salud (2005a), tenemos que involucrar a jóvenes en los ambientes donde interactúan (Burns, 2011). Las escuelas son implícitamente uno de los locales más importantes para la promoción de la salud mental de los adolescentes (Barry, Clarke, Jenkins & Patel, 2013; WHO, 2001). El proyecto “Abrir Espacio para la Salud Mental – Promoción de la salud mental en adolescentes (12-14 años)” tiene como objetivo incrementar literacía de la salud mental en los jóvenes. En el primer año se ha desarrollado un instrumento de evaluación - Mental Health Literacy questionnaire (MHLq) - y la intervención para la promoción de la salud mental. La intervención consiste en 2 sesiones, 90 minutos cada una, implementadas con intervalo de una semana. Siguen una metodología interactiva, utilizando dinámicas de grupo, videos, música y discusión. El estudio de la eficacia de la intervención se lleva a cabo mediante un análisis pre y pos-test con el MHLq, utilizando un grupo experimental y un grupo de control. Este artículo presenta los resultados preliminares de la eficacia de la intervención de promoción de la salud mental en una muestra de 100 adolescentes portugueses (12-14 años). El pos-test mostró un incremento de los niveles de conocimientos de salud mental y estrategias de autoayuda. Los resultados sugieren que la intervención desarrollada parece ser adecuada al objetivo propuesto y refuerzan la creencia de que intervenciones escolares, sistemáticas y sostenibles, para la promoción de la salud mental con jóvenes, es un enfoque prometedor para la promoción de la literacía de la salud mental (Schulze et al., 2003; Rickwood et al., 2005; Corrigan et al., 2007; WHO, 2010).

Collaboration on procurement of e-content between the National Health Service and higher education in the UK

Urquhart, C. J., Cox, A. M.& Spink, S. (2007). Collaboration on procurement of e-content between the National Health Service and higher education in the UK. Interlending & Document Supply, 35(3), 164-170. Sponsorship: JISC, LKDN

The CLARITY modular ambient health and wellness measurement platform

Emerging healthcare applications can benefit enormously from recent advances in pervasive technology and computing. This paper introduces the CLARITY Modular Ambient Health and Wellness Measurement Platform:, which is a heterogeneous and robust pervasive healthcare solution currently under development at the CLARITY Center for Sensor Web Technologies. This intelligent and context-aware platform comprises the Tyndall Wireless Sensor Network prototyping system, augmented with an agent-based middleware and frontend computing architecture. The key contribution of this work is to highlight how interoperability, expandability, reusability and robustness can be manifested in the modular design of the constituent nodes and the inherently distributed nature of the controlling software architecture.Emerging healthcare applications can benefit enormously from recent advances in pervasive technology and computing. This paper introduces the CLARITY Modular Ambient Health and Wellness Measurement Platform:, which is a heterogeneous and robust pervasive healthcare solution currently under development at the CLARITY Center for Sensor Web Technologies. This intelligent and context-aware platform comprises the Tyndall Wireless Sensor Network prototyping system, augmented with an agent-based middleware and frontend computing architecture. The key contribution of this work is to highlight how interoperability, expandability, reusability and robustness can be manifested in the modular design of the constituent nodes and the inherently distributed nature of the controlling software architecture.