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State health departments have placed a tremendous amount of information, data, and services online in recent years. With the significant increase in online resources at official health sites, though, have come questions concerning equity of access and the confidentiality of electronic medical materials. This paper reports on an examination of public health department websites maintained by the 50 state governments. Using a content analysis of health department sites undertaken each year from 2000 to 2005, we investigate several dimensions of accessibility and privacy: readability levels, disability access, non-English accessibility, and the presence of privacy and security statements. We argue that although progress has been made at improving the accessibility and confidentiality of health department electronic resources, there remains much work to be done to ensure quality access for all Americans in the area of public e-health.
Defined-contribution health insurance products have received considerable recent attention, stimulated by double-digit increases in health plan premiums and employers' desire to get their employees more involved in health care purchasing decisions. Existing products typically feature a consumer health spending account, a major medical or other insurance policy, and the use of the Internet to support consumer decision making. They vary in their use of provider networks, provider payment approaches, the specific design of spending accounts, marketing strategies, and infrastructure investment. The companies producing these products are now at a critical juncture. They could grow rapidly over the next few years, be acquired by existing health plans, or fail if they do not deliver on their promises.
State governments are influential purchasers of health benefits but have not been studied extensively. In a recent survey of senior benefit managers, we examine the extent to which states have followed the private-sector approach to purchasing health care. We found that states have adopted "industrial purchasing" practices similar to those of large private employers but offer greater choice of carriers and pay a higher percentage of premiums. Unions continue to influence health care purchasing in both the public and private sectors. Double-digit increases in health costs and the current budget crisis may force states to align their purchasing practices with the private sector to cut costs.
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Speed, control, accountability, cost containment, and customer satisfaction are the first-level benefits of digitization. We'll see these benefits grow, and we'll see much more in the new century.
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The present state of the art and the state of practice regarding legal aspects of medical informatics are reported. Examples are taken from networking, archiving, and virtual reality. It is derived that the data protection concepts of the seventies are covering only some legal aspects of the application scene today and in the future. Thus a far wider legal approach is necessary. It can only be mastered if engineers and lawyers discuss future trends and derive together a new legal framework for medical computer systems in the late nineties. As computers will be everywhere from childhood to death the key issue is not to just protect an individual but to positively frame an information society.
In support of its institutional mission of community service, the Medical College of Wisconsin created a digital library of health information. This Internet-based resource, named MCW HealthLink, provides health news and information geared to patients, their family members, and the community at large. Information is delivered through a World Wide Web site and an e-mail newsletter. The web and e-mail components are integrated to maximize their utility to readers. This article describes the philosophy, design and implementation of the resource. Ongoing efforts include development of a health information resource tailored to the needs of individual readers.
This Data Bulletin is based on data from the Milliman USA Health Cost Index ($0 deductible), which is designed to reflect claims increases faced by private insurers; the Kaiser Family Foundation/Health Research and Educational Trust survey of employer-based health plans for 1999- 2002; the KPMG survey of employer-based plans for 1991-98; and the U.S. Bureau of Labor Statistics Employment, Hours and Earnings series to track payroll costs and Hospital Producer Price Index to track hospital prices.
PURPOSE: To assess possible digit preference in self-reported year at natural menopause, and to determine whether equal proportions is an appropriate reference distribution.METHODS: Data are from the cross-sectional telephone interview from the Study of Women's Health Across the Nation (SWAN), a multi-site, multi-ethnic study of women aged 40-55. Analyses included 2151 naturally menopausal respondents, who were asked the year their periods stopped. Using a chi-square test, we compared the distribution of the terminal digit for year of final menstrual period (FMP) to an equal proportions (EP) distribution assigning 10% probability of each of the 10 digits. Departures from EP, however, may be accurate and may reflect the observed age distribution of subjects rather than digit preference. Thus, we stratified by year of interview to determine if the distribution was the same across years-suggesting digit preference-or if it varied systematically. We then estimated an expected distribution of terminal digit for year of FMP, using prospectively collected data (not subject to digit preference or recall bias) from the Massachusetts Women's Health Study, applied to the SWAN age distribution. The SWAN terminal digit distribution was compared with this expected distribution.RESULTS: Terminal digit for year at FMP exhibited a strong departure from EP (chi(2) = 841.60, p < 0.001), with highest frequencies for digits 4 and 5. Stratifying by year of interview, the distribution was shifted one digit in 1997 compared with 1996, consistent with unbiased reporting. Using the expected distribution as the reference reduced the chi-square statistic by a factor of 7 (chi(2) = 119.51, p < 0.001).CONCLUSIONS: The distribution of terminal digits for reported year at FMP was far from uniform, but departures from EP were consistent with results expected from an independent prospective study. These results suggest that EP may not be an appropriate reference for studies of digit preference, particularly those with a restricted age range.
The issues of the digital divide and of accessing health information in areas of greatest need has been addressed by many. It has been a key component of the discussion of the World Summit for the Information Society and also the focus of an important new initiative, the Global Review for Health Information. Only approximately 1 in 700 people in Africa have internet access compared to a rate worldwide of approximately 10%. Access to essential health information and knowledge management for health care has been deemed a priority for the development of health systems and for the care of patients in areas with limited resources, prompting recent efforts by international organisations and by both governmental and non-governmental agencies (see Godlee et al, 2004 and McConnell, 2004). Health care in developing countries can be limited by many different resources: lack of health care workers with sufficient training, lack of diagnostic equipment, lack of treatment facilities or essential pharmaceuticals; and lack of education or expertise in many relevant areas. Much of the health care done in developing countries is by local lay persons or practitioners or by volunteers working with a variety of NGOs. These volunteers are often very dedicated young people with a vision of health-for-all that is often frustrated in the limited time they are able to spend in these areas and further constrained by meager resources (including availability of appropriate information). The availability of medical expertise and consultation depends largely on the geographical location of the health practitioner and of the patient as well as the level of integration with local practitioners and extent of outside agency involvement. Futhermore, there are often many NGOs working simultaneously on similar projects in the same region without knowledge of each other's activities. Often this occurs simply because a lack of communication exists between organisations, resulting in unnecessary duplication of effort. The availability of medical expertise and consultation depends largely on the geographical location of the health practitioner and of the patient as well as the level of integration with local practitioners and extent of outside agency involvement. The health care worker in developing countries is frequently faced with a paucity of information appropriate to the clinical situations on hand as well as a lack of locally available expertise. The lack of access to health care and other vital resources is one factor in the much lower (by approximately 1/3) life expectancy in the least developed countries campared to industrialised nations. In many developing countries there is only one doctor for 5-10,00 people, compared to a ratio of 1:200 in many developed countries. Textbooks, if they exist, may be 10-20 years out of date and are often directed more at the needs of developed countries. There is thus a growing need for wider availability of training and information on health care in developing countries and support for health care workers. There is also a need for increased communication and collaboration between governmental and non-governmental organisations working in international health to share education, resources and to coordinate efforts in areas supporting improved health care delivery. In recognition of this, the Institute for Sustainable Health Education and Development (www.ished.org) is launching the World Health Channel (WHC) in the spring of 2005 in collaboration with WorldSpace. This will allow access to critical health information in developing countries and place the emphasis on issues important for clinical care for front line health workers in these areas.
Drawing on the results of a national survey of 1,907 firms with three or more workers, this paper reports on several facets of job-based health insurance, including the cost to employers and workers; plan offerings and enrollments; patient cost sharing and benefits; eligibility, coverage, and take-up rates; and results from questions about employers' knowledge of market trends and health policy initiatives. Premiums increased 11 percent from spring 2000 to spring 2001, and the percentage of Americans in health maintenance organizations (HMOs) fell six percentage points to its lowest level since 1993, while preferred provider organization (PPO) enrollment rose to 48 percent. Despite premium increases, the percentage of firms offering coverage remained statistically unchanged, and a relatively strong labor market has continued to shield workers from the higher cost of coverage.
Increasing number of individuals are using the internet to meet their health information needs; however, little is known about the characteristics of online health information seekers and whether they differ from individuals who search for health information from offline sources. Researchers must examine the primary characteristics of online and offline health information seekers in order to better recognize their needs, highlight improvements that may be made in the arena of internet health information quality and availability, and understand factors that discriminate between those who seek online vs. offline health information. This study examines factors that differentiate between online and offline health information seekers in the United States. Data for this study are from a subsample (n = 385) of individuals from the 2000 General Social Survey. The subsample includes those respondents who were asked Internet and health seeking module questions. Similar to prior research, results of this study show that the majority of both online and offline health information seekers report reliance upon health care professionals as a source of health information. This study is unique in that the results illustrate that there are several key factors (age, income, and education) that discriminate between US online and offline health information seekers; this suggests that general "digital divide" characteristics influence where health information is sought. In addition to traditional digital divide factors, those who are healthier and happier are less likely to look exclusively offline for health information. Implications of these findings are discussed in terms of the digital divide and the patient-provider relationship.
BACKGROUND: The North Carolina (NC) Area Health Education Center's (AHEC) Digital Library (ADL) is a web portal designed to meet the information needs of health professionals across the state by pulling together a set of resources from numerous different sources and linking a pool of users to only the resources for which they have eligibility. Although the ADL was designed with the primary purpose of linking health care professionals to a set of licensed resources, the ADL also contains a significant number of links to free resources. These resources are available to any ADL member logging into their ADL account and to guest visitors to the ADL. While there are regular assessments of the subscription resources in the ADL as to utility and frequency of use, up until this point there has been no systematic analysis of the use of the overall set of free resources. It was decided to undertake an examination of the usage of ADL free resources over a 6-month period to analyze the utility of these resources to both ADL members and guests. METHODS: Each time a resource is accessed through the ADL, it is logged in a table. This study used a SQL query to pull every free resource accessed between November 1, 2005 and April 30, 2006. An additional query also pulled the user information for each free resource accessed. Once the queries of the database were complete, the results were imported into an Excel spreadsheet and analyzed using basic descriptive statistics. RESULTS: The vast majority of resource use through the ADL is to licensed resources. There are 2056 free resource URLs in the ADL, to which 1351 were linked out, meaning there was at least one link out to 65% of the free resources. The single most popular free resource was PubMed with 4803 link outs or nearly 20% of the total link outs to free resources. The breakdown of free resource use by different use groups indicates that the highest percentage of use of free resources was by guests followed by institutional affiliates and AHEC Faculty/Staff. The next 3 highest user groups accessing free resources are: paid members, preceptors, and residents. CONCLUSION: The only free resource capturing a significant number of link outs is the free link to PubMed. This reflects the importance placed on traditional medical literature searching by the ADL clinical user base. Institutional affiliates access free resources through the ADL with the second highest frequency of all the user groups. Finally, in analyzing use of free resources, it is important to note the overall limitations of this survey. While link outs are excellent indicators of frequency of use they do not provide any information about the ultimate usefulness of the resource being accessed. Further studies would need to examine not only the quantitative use of resources, but also their qualitative importance to the user.
Responding to the challenge for efficient and high quality health care, the shared care paradigm must be established in health. In that context, information systems such as electronic patient records (EPR) have to meet this paradigm supporting communication and interoperation between the health care establishments (HCE) and health professionals (HP) involved. Due to the sensitivity of personal medical information, this co-operation must be provided in a trustworthy way. To enable different views of HCE and HP ranging from management, doctors, nurses up to systems administrators and IT professionals, a set of models for analysis, design and implementation of secure distributed EPR has been developed and introduced. The approach is based on the popular UML methodology and the component paradigm for open, interoperable systems. Easy to use tool kits deal with both application security services and communication security services but also with the security infrastructure needed. Regarding the requirements for distributed multi-user EPRs, modelling and implementation of policy agreements, authorisation and access control are especially considered. Current developments for a security infrastructure in health care based on cryptographic algorithms as health professional cards (HPC), security services employing digital signatures, and health-related TTP services are discussed. CEN and ISO initiatives for health informatics standards in the context of secure and communicable EPR are especially mentioned.
An increased prevalence of the digit sucking habit among Nigerian children has been reported. Certain factors are believed to influence its occurrence. This study was carried out to assess these factors and determine possible correlation with the onset and persistence of the habit. The sample population consisted of 81 children--52 females and 29 males aged 3-16 years who were still actively digit sucking. Findings in this group were compared with a control group made up of 80 children aged 2-16 years who were not digit suckers and had no history of the habit. Results showed no correlation between mode of infant feeding and the digit sucking habit. The duration of breast-feeding was found to have a significant effect on the habit. About 79% of non-suckers had been breast-fed for more than 6 months while only 43.2% of digit suckers were breast-fed for the same duration. The digit sucking habit was observed more frequently in children with mothers in high cadre occupations (53.1%) compared to non-suckers (23.8%). More digit suckers (22.2%) than non-suckers (12.5%) were reported to have a history of pacifier use. Neither family size nor position of the child in the family had a significant effect on the occurrence of the habit. In addition, 48.1% of the sample population had siblings with the same habit compared to 16.2% of the controls. The identification of significant factors may be useful in targeting interventions in order to prevent consequences of the prolonged habit.