Resultados en la prescripción electrónica de nutriciones parenterales tras la implantación de un programa informático. Análisis de costes y prescripción / Results in the parenteral nutritions electronic prescription following implementation of a computer program. Cost analysis and prescription

Introducción. Cada vez son más los hospitales que incorporan en su tecnología software informáticos capaces de elaborar una nutrición eficaz, segura y ajustada a las necesidades de los pacientes con el fin de minimizar errores. Sin embargo, estos programas no siempre disponen de un manejo intuitivo, lo que en ocasiones, pueden comportar diversas dificultades que los haga estar infrautilizados y en consecuencia, el número de prescripciones puede verse disminuido. Objetivo: Evaluar la reducción en la prescripción de nutriciones parenterales y el impacto económico que ha supuesto en nuestro centro, tras la implantación de un software informático de prescripción electrónica para nutriciones parenterales. Material y métodos. Se utilizó un software informático de Fresenius-Kabi España (v. 1.8/2011) como base de datos, para clasificar las NP prescritas durante los últimos 24 meses, teniendo en cuenta la implantación de la herramienta informática. Este procedimiento se usó para determinar la disminución en la prescripción de nutriciones. Resultados. Durante el año 2013 se prescribieron un total de 3.530 nutriciones parenterales, mientras que en el mismo periodo de 2014, las nutriciones prescritas fueron 2.622. Esta diferencia de 908 prescripciones, supuso un ahorro económico de 22.230,03 Euros

Introduction. Increasingly hospitals that incorporate in its software technology computer capable of developing a nutrition effective, safe and adjusted to the needs of patients in order to minimize errors. However, these programs do not always have an intuitive, sometimes, may lead to difficulties making them to be underused and as a result, the number of prescriptions will be decreased. Objective. To evaluate the reduction in prescription of parenteral nutritions and the economic impact that has been in our centre, the introduction of computer software for electronic prescription for parenteral nutritions. Material and method. A computer software of Fresenius-Kabi Spain (v. 1.8/2011) as the database, was used to classify the NP prescribed during the past 24 months, taking into account the implementation of the computer tool. This procedure was used to determine the reduction in prescription of nutritions. Results. During the year 2013 were prescribed a total of 3.530 parenteral nutritions, while in the same period in 2014, prescribed nutritions were 2.622. This difference of 908 prescriptions meant a savings of 22.230,03 Euros

What do women know about government services and benefits?

This article examines how much women know about government services and benefits and discusses why this type of knowledge matters. Using data from a survey as well as focus groups conducted in Montreal and Toronto, we show that the women who are most likely to need information about these programs are often the least likely to be aware of them. This is especially true of low-income women, older women, and women who came to Canada as immigrants. We end by suggesting some steps that could be taken to address these knowledge gaps.

A curious jumble: the Canadian approach to online consumer health information.

As part of a larger e-health strategy, Canadian governments have invested millions in online health information services for the lay public. These services are intended to reduce demands on the primary health care system by encouraging greater individual responsibility for health and are often promoted using the language of personal empowerment. In this paper, we describe how lay searchers generally look for online health information and discuss the disempowering challenges they are likely to face in (a) locating Canadian government-sponsored health information sites and (b) finding useful information on these sites to address everyday health concerns. We conclude with several recommendations for policy changes.

Mission-driven priorities: public health in health information exchange.

Developing state- and nationwide health information exchange (HIE) is one of the health priorities defined in the American Recovery and Reinvestment Act. States are expected to take leadership in statewide planning and implementation. To balance limited resources among mandated responsibilities and emerging HIE accountability, we maintain that state public health practitioners must integrate HIE into our mission-driven practice in five priority areas: 1) connecting real-time disease surveillance and notifiable case reporting through HIE to better protect citizens; 2) sharing public health-managed clinical information through HIE for preventive services, 3) conduct health education for targeted populations via HIE to promote healthy lifestyles; 4) leverage public health informatics with Medicaid information system to provide quality healthcare; and 5) serve as a regulator for standardized HIT to participate in healthcare reform. We summarize public health's broad practice into "Five P's" and link each domain's historical foundation, current and proposed practices to sustain success.

Legal foundations for a national public health agency in Canada.

This commentary addresses some of the key legal challenges associated with establishing a national public health agency in Canada. These include issues related to privacy and confidentiality of personal health information in the public health context, constraints on the jurisdiction and powers of a national agency, the need to respect individual rights and freedoms in an outbreak situation, and international cooperation in infectious disease control. The authors are part of a research initiative, comprised of experts in law, public health policy and medicine, that is currently analyzing legal considerations that may influence the mandate of a national public health agency in regard to infectious disease activities. This article discusses critical issues raised at a meeting in August 2004 that brought the research team together with key federal and provincial policy-makers and members of the public health community. The commentary emphasizes that law sets the foundation for public health activities, and the promise of a national public health agency will only be realized if significant legal issues are examined early on to ensure the agency is built on a robust legal and policy framework.

Learning from experience: privacy and the secondary use of data in health research.

Health services research must continually address the question: Under what conditions may data not collected specifically for research, such as primary medical data, be re-used for research without compromising the privacy of the data-subjects? For secondary use of data in research there are basically three options. Option A: Use personal data with consent or other assent from the data-subjects. To make this both fairer and more practical, in many circumstances broader construals of consent, or permission or approval, need to be explored and instituted. Option B: Anonymise the data, then use them. For many studies, this is the most practical and desirable option. The craft of anonymisation, including reversible anonymisation, or key-coding, needs to be developed and more fully supported under law. Option C: Use personal data without explicit consent, under a public interest mandate. Whether and how the data should be anonymised will depend on the situation. Public health mandates and protections deserve to be clarified, strengthened and extended for a variety of surveillance, registration, clinical audit, health services research and other types of investigation. Safeguards are an integral part of the research promise to the public, offer crucial reassurance and should be emphasised. For health services research, databases are core resources, and their stewardship must be cultivated.

Privacy and the secondary use of data in health research in Scotland.

In response to new data protection legislation for the UK and widespread concern about its implications, the Scottish Executive set up the Confidentiality and Security Advisory Group for Scotland (CSAGS) to place the use of personal health information in a modern setting. The group affirmed the principle of consent and, more broadly, the importance of involving patients and the public in decisions about their health information. It promoted methods of acceptable anonymisation of data, and the need for good stewardship and disclosure of data uses to the greatest extent possible, where explicit individual consent and anonymisation were not practicable. They did not recommend pursuit of legislation, preferring consensus, informed debate and widespread acceptance of the proposed arrangements. The Scottish Executive is now responding to the work of CSAGS to develop systems that command public and patient confidence, promote good practice for clinicians and researchers, and preserve important public health and research functions.

Health research and the Data Protection Act 1998.

The 1998 Data Protection Act in the UK largely restates existing good practice: individuals have a right to know what data are held about them and why; and those processing data have a duty to proceed with fairness and transparency, maintain high data quality and keep data secure. Some health researchers have criticised the Act, seeing it as a legal minefield, unnecessary bureaucracy and interference from the European Union. This is largely based on misconceptions. Recent guidance from the Information Commissioner aims to assist researchers by advising how legal requirements can be met through anonymisation of data, attention to data-processing methods and fair collection of data. The Act provides a clear framework of rights and responsibilities that should be embraced with enthusiasm rather than with the reluctance of a person forced to carry out a meaningless chore.

Statutory basis for public health reporting beyond specific diseases.

Statutory authority for public health surveillance is necessarily broad as previously uncharacterized diseases are regularly discovered. This article provides specific information about general disease reporting provisions in each state. The intent of these reporting laws and the Health Insurance Portability and Accountability Act Privacy Rule is to support this critical disease surveillance function for the benefit of the entire population.

The challenge and potential of childhood immunization registries.

Recent efforts to attain near-complete coverage of child populations by recommended vaccines have included initiatives by federal and state agencies, as well as private foundations, to develop and implement statewide or community-based childhood immunization registries. Plans for a single, national registry have been set aside in favor of a national network of local and state registries linked through the use of common definitions and unique child identifiers. However, both operational/technical and financing difficulties have slowed their development. The experience to date in selected areas has provided useful lessons for further development of a registry system and has underscored the potential of such systems to assure the success of childhood immunization initiatives.