La historia clínica compartida y el ejercicio de la autonomía de las personas en sanidad / Shared Electronic Health Record and the exercise of personal autonomy in Health

En este artículo se exponen los elementos principales que configuran la relación entre los usuarios de la sanidad y la gestión de sus datos personales de salud en el marco de la implementación de la historia clínica compartida, poniendo el énfasis en los riesgos que para la privacidad de las personas y para la debida confidencialidad pueden ocasionar la compartición de estos datos sensibles (AU)

This article set out the main elements that structure the relationship between Health Service users and the management of their personal health data, in the frame of implementation of Shared Electronic Health Record, emphasizing the risks that sharing this sensitive data can produce to personal privacy and confidentiality (AU)

Definición y estabilización de los procesos I. Procesos de gestión y soporte en un Servicio de Urología / Definition and stabilization of processes I. Management processes and support in a Urology Department

La implantación de modelos de gestión de calidad total en servicios clínicos se adapta mejor al modelo ISO 9004:2009. Una parte esencial en la implantación de estos modelos de gestión es la creación de procesos y su estabilización. Existen cuatro tipos de procesos: claves, gestión, soporte y operativos (clínicos). Los procesos de gestión constan de cuatro partes: el formulario de estabilización del proceso, el formulario de procedimientos del proceso, el formulario de estimación de coste de actividades médicas y el diagrama de flujo del proceso. En este trabajo vamos a detallar la creación de un proceso esencial dentro de un servicio quirúrgico, como es el proceso de gestión de la lista de espera quirúrgica

The implantation of total quality management models in clinical departments can better adapt to the 2009 ISO 9004 model. An essential part of implantation of these models is the establishment of processes and their stabilization. There are four types of processes: key, management, support and operative (clinical). Management processes have four parts: process stabilization form, process procedures form, medical activities cost estimation form and, process flow chart. In this paper we will detail the creation of an essential process in a surgical department, such as the process of management of the surgery waiting list

Use of administrative data to identify colorectal liver metastasis.

BACKGROUND: The ability to identify patients with colorectal cancer (CRC) liver metastasis (LM) using administrative data is unknown. The goals of this study were to evaluate whether administrative data can accurately identify patients with CRCLM and to develop a diagnostic algorithm capable of identifying such patients. MATERIALS AND METHODS: A retrospective cohort study was conducted to validate the diagnostic and procedural codes found in administrative databases of the Veterans Administration (VA) system. CRC patients evaluated at a major VA center were identified (1997-2008, n = 1671) and classified as having liver-specific ICD-9 and/or CPT codes. The presence of CRCLM was verified by primary chart abstraction in the study sample. Contingency tables were created and the positive predictive value (PPV) for CRCLM was calculated for each candidate administrative code. A multivariate logistic-regression model was used to identify independent predictors (codes) of CRCLM, which were used to develop a diagnostic algorithm. Validity of the algorithm was determined by discrimination (c-statistic) of the model and PPV of the algorithm. RESULTS: Multivariate logistic regression identified ICD-9 diagnosis codes 155.2 (OR 9.7 [95% CI 2.5-38.4]) and 197.7 (84.6 [52.9-135.3]), and procedure code 50.22 (5.9 [1.3-25.5]) as independent predictors of CRCLM diagnosis. The model's discrimination was 0.89. The diagnostic algorithm, defined as the presence of any of these codes, had a PPV of 87%. CONCLUSIONS: VA administrative databases reliably identify patients with CRCLM. This diagnostic algorithm is highly predictive of CRCLM diagnosis and can be used for research studies evaluating population-level features of this disease within the VA system.

Defining the "Health Benefit Basket" in nine European countries. Evidence from the European Union Health BASKET Project.

This article identifies and analyses a framework for "health baskets," the taxonomy of benefit catalogues for curative services, and the criteria for the in- or exclusion of benefits in nine EU member states (Denmark, England, France, Germany, Hungary, Italy, The Netherlands, Poland and Spain). Focusing on services of curative care, it is found that the explicitness of benefit catalogues varies largely between the countries. In the absence of explicitly defined benefit catalogues, in- and outpatient remuneration schemes have the character of benefit catalogues. The criteria for the in- or exclusion into benefit catalogues are often not transparent and (cost-)effectiveness is applied only for certain sectors. An EU-wide harmonization of benefit baskets does not seem realistic in the short or medium term as the variation in criteria and the taxonomies of benefit catalogues are large but not insurmountable. There may be scope for a European core basket.

Definition and scope of health services administration.

The definition and scope of health services administration are important to public policy, educational programs, new entrants to the field, and practitioners. Formal definition of the field of health services administration has not received concerted attention since 1975. Significant changes in the field have occurred since that time, widening opportunities for graduates of educational programs and increasing interdependencies between health services organizations and public policy organizations, supplier organizations, insurers, and other businesses that are not involved directly in health services delivery. Stakeholders in the field of health services administration should consider a broadened definition of the field that would institutionalize and build on those increased opportunities and interdependencies.

A theory for classification of health care organizations in the new economy.

Most of the available studies into information technology (IT) have been limited to investigating specific issues, such as how IT can support decision makers distributing the information throughout health care organization, or how technology impacts organizational performance. In this study, for use in the planning of information system development projects, a theoretical model for the classification of health care organizations is proposed. We try to reflect the development in the contemporary digital economy by theoretically classifying health care organizations into three types, namely traditional, developing, and flexible. We describe traditional health care organizations as organizations with a centralized system for management and control. In developing health care organizations, IT is spread over the horizontal dimension and is used for coordinating the different parties throughout the organization. Finally, flexible health care organizations are those which work actively with the design of new health care organizational structure while they are designing the information system.