mHealth

Mobile Application for Senior Citizens and Family Members to assist in the regular doctor visits of the patient.

From my personal experience, our elderly relatives and senior citizens have a higher risk to loose documents and papers when they hold or keep them. A regular checkup with a medical doctor will, with the minimum, give instructions on when is the next visit. There will be other instructions like the possible medications, when and how long to take them. These things are usually listed down on prescription pad by the medical doctor. The use of this application is to transfer the data from the hard copy prescription pad into the soft copy on the mobile application. This will provide a soft copy of all the medical documentation of the patient regarding the last visit, medications and schedule of next visits. Family members will have an actual interface and data in their phones so as to monitor the medical data of their elderly members of the family. The data inputted can only be edited and updated by an assigned designated family member, authorized doctor or authorized nurse in updating the information. The senior cannot update the said information without the help of another individual to avoid accidentally removing important medical information given by the doctor or the healthcare provider. Interface will be provided with big fonts and easy to read. The data will be able to sync among the allowed devices connected to the primary device of the elderly or senior person. This application will work with either a mobile phone or tablet. This will also be available in both the Android and iOS operating system.

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#MSHI #HI201

Allons-y!

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Telehealth

How can telehealth support healthcare delivery in the Philippines?

To begin, we need to know the meaning of telehealth. As defined by Health Resources and Services Administration (HRSA), telehealth is “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.”

To relate telehealth in the Philippine setting, it is important to note that there are two pending bills involving telehealth. The first on is the proposed Telehealth Act of 2012 or House Bill No. 6336, which was introduced by then Congressman Joseph Abaya. As stated in the objectives and purpose of this bill, the Telehealth Act shall provide a policy framework and establish a National Telehealth System that will govern the practice and development of telehealth in the country. The National Telehealth System will shall be a comprehensive, integrative, sustainable and progressive system that will facilitate inter-agency and inter-sectoral coordination at various levels of governance covering both the public and private sectors.

The second is the proposed Telehealth Act of 2014 or House Bill No. 4199, which was introduced by then Congressman Rogelio Espina. The objectives and purpose of this bill is similar to the Telehealth Act of 2012 as stated above. The declaration of the policy has been improved from the original Telehealth Act of 2012 which is “it is the policy of the State to protect and promote the right to health of the people, especially for those in the medically unserved and underserved areas.” The proposed Telehealth Act of 2014 declaration of policy states “the State shall protect and promote the right to health of the people and instill health consciousness among them. Henceforth, it is the intent of the Legislature to recognize the practice of telehealth as a legitimate means by which an individual may receive health care services from a health provider without in-person contact with health provider.” Furthermore, it states that “Telehealth or Telemedicine shall not be construed to alter the scope of practice of medicine or any health care provider or authorize the delivery of health care services in a setting or in a manner not otherwise authorized by law.”

For this entry, I will focus on two sections to evaluate and will suggest some revisions.  I will refer to the proposed Telehealth Act of 2014 as this is the more recent House bill.

Under the proposed Telehealth Act of 2014, Section 9 states: “Databases – All telehealth centers and originating sites shall coordinate with DOH for consolidation of pertinent databases. DOH shall maintain and manage a national database for consults on clinical cases as well as health and medical education exchanges.”

This section is lacking in such that the definition on how databases shall be managed and maintained is not clear. Databases in the medical field are much valued as the data gathered therein can help decision makers create paths and policies for the improvement of health, while health care providers can use such data to improve the delivery of health care to patients. The contents of such databases usually cannot be replicated anymore, thus it is important that such contents be handled properly and safely. The proposed Telehealth Act of 2012, Section 12, states that all telehealth centers and originating sites shall coordinate with the National Telehealth Reference Center (NTRC) for the consolidation of patient databases. The NTRC shall maintain and manage a national database for clinical cases as well as health and medical education exchanges made through the National Telehealth System. Specifying an actual agency that will handle and secure the medical databases is better than just handling it to DOH. The DOH is already a very big and busy agency such that this section might be overlooked. Another important feature that was lacking in the proposed Telehealth Act of 2014 is the need for the NTRC to submit annual reports both to the National Telehealth Board and DOH on the status of and relevant health information derived from the database. Lastly, under the earlier bill, it was provided that a plan for a long-term outcome evaluation of telehealth service utilizing cases registries shall be developed within two years of the passage of the Telehealth Act. This means that there will be continuity in the program and the continuous improvement of the databases ensures that there will be medical information that can be used to improve the decision making and healthcare of the people.

Another section of the proposed Telehealth Act of 2014 that I want to discuss is Section 12, “Privacy – Any medical records generated, including records maintained via video, audio, electronic, or other means due to telehealth examination, consultation or monitoring must conform to the laws regarding the confidentiality of healthcare information of the patient, his/her rights to medical information and recordkeeping requirements. Violation thereof shall constitute unprofessional conduct and would be liable to a fine not exceeding five (5) thousand pesos without prejudice to administrative, civil or criminal liability. Telehealth technology used by health care provider must be encrypted and must use a record keeping program to record each interaction.” The general content of this section is comprehensive as regards the thrust to protect the privacy of the medical records of the patient and is aligned with the Data Privacy Act of 2012 which ensures that human right of privacy is protected while ensuring the free flow of information. This was discussed in the previous blogs on the Data Privacy Act of 2012. What I would suggest is to increase in the penalties for such violation of this section or to make a reference to Chapter VIII of the Data Privacy Act of 2012, wherein substantial penalties are imposed. The proposed penalty of five thousand pesos is paltry compared to the breach of privacy of the patient. A bigger penalty, jail time and the risk of losing the license to practice in the medical field will be a greater deterrent against the breach of privacy and will ensure that healthcare providers and personnel will handle the medical records of each patient with importance and security.

 

References:

https://www.healthit.gov/providers-professionals/faqs/what-telehealth-how-telehealth-different-telemedicine

http://www.congress.gov.ph/legisdocs/basic_16/HB04199.pdf

http://www.congress.gov.ph/legisdocs/basic_15/HB06336.pdf

Marcelo. Telehealth in the Philippines. http://bit.ly/telehealthinthephilippines

 

#MSHI #HI201

Allons-y!

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Legal and Regulatory Issues in eHealth

In order to answer the driving questions for Week 13: Privacy, Confidentiality, Security and Trust and Week 14: Legal and Regulatory Issues in eHealth, it will help to combine these two as the subject matter are intertwined.

Week 13 Driving Question: What policies are in place to protect the Filipino patient’s privacy and confidentiality of health information?

Yes, we have a law in place to protect the Filipino patient’s privacy and confidentiality of health information. This law is the Data Privacy Act of 2012 or Republic Act No. 10173 “An act protecting individual personal information in information and communications systems in the government and the private sector, creating for this purpose a national privacy commission, and for other purposes”. This was passed by the Senate and the House of Representative on June 6, 2012 and approved by the President on Aug 15, 2012.

Week 14 Driving Question: Is the Data Privacy Act adequate to protect confidential health information?

Yes. I think that the newly created Data Privacy Act of 2012 is adequate to protect confidential health information of the patient. We will tackle some pertinent sections to support this statement.

“SEC. 2. Declaration of Policy. – It is the policy of the State to protect the fundamental human right of privacy, of communication while ensuring free flow of information to promote innovation and growth. The State recognizes the vital role of information and communications technology in nation-building and its inherent obligation to ensure that personal information in information and communications systems in the government and in the private sector are secured and protected.”

The last sentence in Section 2, specifically mentions that “…its inherent obligation to ensure that personal information in information and communications systems in the government and in the private sector are secured and protected.” Health information of a patient is owned by the patient; thus it is covered within the “personal information” of that patient that is mentioned in Section 2. This is further supported under Section 3, Definition of Terms, (g) which states that “Personal information refers to any information whether recorded in a material form or not, from which the identity of an individual is apparent or can be reasonably and directly ascertained by the entity holding the information, or when put together with other information would directly and certainly identify an individual.” A medical record is considered a confidential health information that can easily identify an individual based on the recorded information. This is why the confidential health information in a medical record falls under the definition of this particular section.

“SEC. 13. Sensitive Personal Information and Privileged Information. – The processing of sensitive personal information and privileged information shall be prohibited, except in the following cases:

(a) The data subject has given his or her consent, specific to the purpose prior to the processing, or in the case of privileged information, all parties to the exchange have given their consent prior to processing;

(b) The processing of the same is provided for by existing laws and regulations: Provided, That such regulatory enactments guarantee the protection of the sensitive personal information and the privileged information: Provided, further, That the consent of the data subjects are not required by law or regulation permitting the processing of the sensitive personal information or the privileged information;

(c) The processing is necessary to protect the life and health of the data subject or another person, and the data subject is not legally or physically able to express his or her consent prior to the processing;

(d) The processing is necessary to achieve the lawful and noncommercial objectives of public organizations and their associations: Provided, That such processing is only confined and related to the bona fide members of these organizations or their associations: Provided, further, That the sensitive personal information are not transferred to third parties: Provided, finally, That consent of the data subject was obtained prior to processing;

(e) The processing is necessary for purposes of medical treatment, is carried out by a medical practitioner or a medical treatment institution, and an adequate level of protection of personal information is ensured; or

(f) The processing concerns such personal information as is necessary for the protection of lawful rights and interests of natural or legal persons in court proceedings, or the establishment, exercise or defense of legal claims, or when provided to government or public authority.”

From this section, we can see that the general rule is that processing of personal information and privileged information is prohibited, except for the following cases as listed from (a) to (f) in this section. Sub-section (a) is commonly used and is generally applicable in medical practice. A patient will need to freely sign his consent before any medical procedure is done to him/her. This will be in writing to ensure that the patient already gave the health care providers the consent needed before the start of the procedure or treatment. Without this consent, the health care providers can choose not to push through with any procedure on the patient, for the protection of the health care provider as well as that of the patient. This sub-section clearly states that the data subject has to give his or her consent specific to the purpose prior to the processing and use of his data.

Another sub-section that is applicable to medical related data is sub-section (e). This states that the processing of data is necessary and important for purposes of medical treatment and is carried out by a medical practitioner or medical treatment institution. This sub-section relates to medical emergencies wherein a medical treatment must be done to the patient, such that gathering of his sensitive personal information is allowed in order to save his life. The last portion of that sub-section still states that there should be an adequate level of protection of personal information even if the purpose is for a medical treatment. We can see that the framers of the law still prioritized the need to ensure the protection of personal information, even if this is for use of a medical treatment. This means that even if the medical personel are there to save the life of the patient, the medical personnel still need to provide adequate level of protection of the sensivite personal information of the patient.

These two subsections are indicative of how the framers of the law intended to protect sensitive health information of a patient. The primary consideration is that medical personnel should provide adequate level of protection of the personal information of the patient under their care and supervision. The general rule is that the processing of sensitive personal information and privileged information shall be prohibited and any processing of sensitive personal information and privileged information should fall within the exceptions in order to be valid or allowed under the law. Chapter VIII of the Data Privacy Act imposes serious penalties, consisting of imprisonment and substantial fines, on those who violate the act such as those who conduct unauthorized processing of personal information.

Lastly I have come upon this images from DataPrivacyPH and talks about the Rights of the Data Subject under Section 16 of this law. These are useful in informing the public of their rights under this law.

1-sec-16-par-a-b2-sec-16-par-b3-sec-16-par-c4-sec-16-par-d5-sec-16-par-e6-sec-16-par-f

References:

http://www.gov.ph/2012/08/15/republic-act-no-10173/

Images owned by: https://www.facebook.com/pg/dataprivacyph/photos/?tab=album&album_id=1180862868641655

#MSHI #HI201

Allons-y!

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Privacy, Confidentiality, Security and Trust

In order to answer the driving questions for Week 13: Privacy, Confidentiality, Security and Trust and Week 14: Legal and Regulatory Issues in eHealth, it will help to combine these two as the subject matter are intertwined.

Week 13 Driving Question: What policies are in place to protect the Filipino patient’s privacy and confidentiality of health information?

Yes, we have a law in place to protect the Filipino patient’s privacy and confidentiality of health information. This law is the Data Privacy Act of 2012 or Republic Act No. 10173 “An act protecting individual personal information in information and communications systems in the government and the private sector, creating for this purpose a national privacy commission, and for other purposes”. This was passed by the Senate and the House of Representative on June 6, 2012 and approved by the President on Aug 15, 2012.

Week 14 Driving Question: Is the Data Privacy Act adequate to protect confidential health information?

Yes. I think that the newly created Data Privacy Act of 2012 is adequate to protect confidential health information of the patient. We will tackle some pertinent sections to support this statement.

“SEC. 2. Declaration of Policy. – It is the policy of the State to protect the fundamental human right of privacy, of communication while ensuring free flow of information to promote innovation and growth. The State recognizes the vital role of information and communications technology in nation-building and its inherent obligation to ensure that personal information in information and communications systems in the government and in the private sector are secured and protected.”

The last sentence in Section 2, specifically mentions that “…its inherent obligation to ensure that personal information in information and communications systems in the government and in the private sector are secured and protected.” Health information of a patient is owned by the patient; thus it is covered within the “personal information” of that patient that is mentioned in Section 2. This is further supported under Section 3, Definition of Terms, (g) which states that “Personal information refers to any information whether recorded in a material form or not, from which the identity of an individual is apparent or can be reasonably and directly ascertained by the entity holding the information, or when put together with other information would directly and certainly identify an individual.” A medical record is considered a confidential health information that can easily identify an individual based on the recorded information. This is why the confidential health information in a medical record falls under the definition of this particular section.

“SEC. 13. Sensitive Personal Information and Privileged Information. – The processing of sensitive personal information and privileged information shall be prohibited, except in the following cases:

(a) The data subject has given his or her consent, specific to the purpose prior to the processing, or in the case of privileged information, all parties to the exchange have given their consent prior to processing;

(b) The processing of the same is provided for by existing laws and regulations: Provided, That such regulatory enactments guarantee the protection of the sensitive personal information and the privileged information: Provided, further, That the consent of the data subjects are not required by law or regulation permitting the processing of the sensitive personal information or the privileged information;

(c) The processing is necessary to protect the life and health of the data subject or another person, and the data subject is not legally or physically able to express his or her consent prior to the processing;

(d) The processing is necessary to achieve the lawful and noncommercial objectives of public organizations and their associations: Provided, That such processing is only confined and related to the bona fide members of these organizations or their associations: Provided, further, That the sensitive personal information are not transferred to third parties: Provided, finally, That consent of the data subject was obtained prior to processing;

(e) The processing is necessary for purposes of medical treatment, is carried out by a medical practitioner or a medical treatment institution, and an adequate level of protection of personal information is ensured; or

(f) The processing concerns such personal information as is necessary for the protection of lawful rights and interests of natural or legal persons in court proceedings, or the establishment, exercise or defense of legal claims, or when provided to government or public authority.”

From this section, we can see that the general rule is that processing of personal information and privileged information is prohibited, except for the following cases as listed from (a) to (f) in this section. Sub-section (a) is commonly used and is generally applicable in medical practice. A patient will need to freely sign his consent before any medical procedure is done to him/her. This will be in writing to ensure that the patient already gave the health care providers the consent needed before the start of the procedure or treatment. Without this consent, the health care providers can choose not to push through with any procedure on the patient, for the protection of the health care provider as well as that of the patient. This sub-section clearly states that the data subject has to give his or her consent specific to the purpose prior to the processing and use of his data.

Another sub-section that is applicable to medical related data is sub-section (e). This states that the processing of data is necessary and important for purposes of medical treatment and is carried out by a medical practitioner or medical treatment institution. This sub-section relates to medical emergencies wherein a medical treatment must be done to the patient, such that gathering of his sensitive personal information is allowed in order to save his life. The last portion of that sub-section still states that there should be an adequate level of protection of personal information even if the purpose is for a medical treatment. We can see that the framers of the law still prioritized the need to ensure the protection of personal information, even if this is for use of a medical treatment. This means that even if the medical personel are there to save the life of the patient, the medical personnel still need to provide adequate level of protection of the sensivite personal information of the patient.

These two subsections are indicative of how the framers of the law intended to protect sensitive health information of a patient. The primary consideration is that medical personnel should provide adequate level of protection of the personal information of the patient under their care and supervision. The general rule is that the processing of sensitive personal information and privileged information shall be prohibited and any processing of sensitive personal information and privileged information should fall within the exceptions in order to be valid or allowed under the law. Chapter VIII of the Data Privacy Act imposes serious penalties, consisting of imprisonment and substantial fines, on those who violate the act such as those who conduct unauthorized processing of personal information.

Lastly I have come upon this images from DataPrivacyPH and talks about the Rights of the Data Subject under Section 16 of this law. These are useful in informing the public of their rights under this law.

1-sec-16-par-a-b2-sec-16-par-b3-sec-16-par-c4-sec-16-par-d5-sec-16-par-e6-sec-16-par-f

 

References:

http://www.gov.ph/2012/08/15/republic-act-no-10173/

Images owned by: https://www.facebook.com/pg/dataprivacyph/photos/?tab=album&album_id=1180862868641655

 

#MSHI #HI201

Allons-y!

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Knowledge Management and Information Retrieval

Knowledge management is defined as “the systematic process of identifying, capturing, and transferring information and knowledge people can use to create, compete, and improve” (1) while information retrieval is defined as “the activity of obtaining information resources relevant to an information need from a collection of information resources.” (2)

Knowledge translation is “the process of putting knowledge into action”. (3) The Canadian Institutes of Health Research (CHIR) defines knowledge translation as “a dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, to provide more effective health services and products and strengthen the healthcare system.” (4)

From the definitions above, we can see that there is a correlation between knowledge management and information retrieval to knowledge translation and that they are similar in how they work. Knowledge management can be as simple as the transfer of knowledge from one person to another or can be as complex as the transfer of information from different organizations to another. For purposes of this week’s entry, we will focus on the simpler portion in addressing a local public health problem.

The local public health problem I have in mind is the vaccination scheduling of children below 1-year-old. As medical professionals, we know the importance of vaccination of children as this prevents multiple disease and sickness of a child. An important factor in vaccination is the completeness of the schedule of vaccinations. A complete set of vaccinations will be an effective deterrent to possible disease and sickness. Someone who is not able to complete the whole dose of vaccinations to be given will have a greater probability of exposure to these diseases. A problem arises when parents are not aware of the importance of having a complete dosage of vaccinations for their children. This is where knowledge translation will step in.

A proper and effective knowledge translation happens when parents of children to be vaccinated are made to understand the gravity and importance of the complete vaccination dosage to be given to their children. Proper dissemination of information and explanation to parents of the risks and benefits of such vaccinations will ensure that the parents are aware of the usefulness and effectiveness of the vaccination. Parents can also be made to understand the consequences and dangers of not having their children vaccinated. In the real world, it is likely that there will be lapses in completing the dosages. The use of knowledge translation from the health provider to the patient will ensure that these lapses will be reduced or minimized.

The knowledge translation occurs not just from healthcare providers to the patients, but from healthcare providers to the decision makers such as local health officers and public officers in the department of health. Knowledge management and translation woud be useful in providing these decision makers with up-to-date information on the patients. The decision makers then can use this information to allocate resources, and if necessary, adjust their policies so as to provide the best cost efficient way of delivering the healthcare services to the patients who need them the most. In the given scenario regarding vaccinations, good knowledge management and translation can assist decision makers in determining whether there is a need to increase their programs in order to reach the communities wherein there is a low number of children being vaccinated properly. They can, for instance, decide whether to conduct a door to door campaign. Decision makers can also utilize the information to determine whether there is a need to divert some of the vaccines to communities with a higher turnout of children getting vaccinations but are lacking the supplies. Other solutions may be worked out from the information provided by the healthcare professional.

The end goal of knowledge translation is always the improvement of the healthcare system as a whole and not just on certain portions. The effective transfer of knowledge from the healthcare professional to their patients as well as from healthcare professional to the decision makers, works to ensure that the improvement of healthcare will affect everyone.

 

 

References:

  1. http://www.openclinical.org/knowledgemanagement.html
  2. https://en.wikipedia.org/wiki/Information_retrieval
  3. Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof 2006;26:13e24.
  4. Available at http://www.cihr-irsc.gc.ca/e/29418.html.Accessed February
  5. Straus et al. Knowledge translation is the use of knowledge in healthcare decision making. J Clinical Epidemiology 2011;64:6-10. http://www.ebcp.com.br/simple/upfiles/readings/Straus%20KT%20Defined%20JCE%202011.pdf

 

#MSHI #HI201

Allons-y!

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Clinical Decision Support

What is Computerized Clinical Decision Support Systems? Computerized Clinical Decision Support Systems (CCDSS) for primary preventive care is defined as the computerized matching of an individual patient’s characteristics with a knowledge base that would then provide patient-specific recommendations to healthcare providers about primary preventive care (PPC). Despite their promise and expense, definitive evidence of CCDSS effectiveness for process of care (e.g., performance and satisfaction of healthcare providers), patient outcomes (e.g. functional status, disability, major clinical events, quality of life, and death), costs, and safety remain to be established. (1-3)

What is CHITS-EMR? Community Health Information Tracking System-Electronic Medical Records or CHITS-EMR is an open source electronic medical record designed to run in public health centers and rural health units. CHITS-EMR has built-in modules for general patient consultations, consultation scheduling, maternal care services, child care, family planning and reporting features for the DOH Field Health Service Information System. CHITS-EMR runs over a local area network (LAN) installed inside the health center and accessible to computers installed within the health center. (2)

 

Source: https://telehealth.ph/wp-content/uploads/2011/07/CHITS-TM.png

We can safely say that CHITS is an example of CCDSS. A medical scenario that always happens in a regional or municipal health unit is vaccination. For this exercise, we shall limit this for all new borns until 1 year of age only. The Department of Health provides the updated Childhood Immunization Schedule under the National Immunization Program (NIP). The antigens are the following:

  • BCG Vaccine
  • Hepatitis B Vaccine
  • Pentavalent Vaccine (DPT-Hep B-Hi B)
  • Oral Polio Vaccine (OPV)
  • Inactivated Polio Vaccine (IPV)
  • Pneumococcal Conjugate Vaccine (PCV)
  • Measles, Mumps, Rubella Vaccine (MMR)

These are the antigens given to children from birth until 1-year-old. These antigens are also given on with the proper schedule as follows:

  • BCG vaccine, single dose given at birth
  • Monovalent Hepatitis B vaccine given at birth
  • DPT-Hib-Hep B vaccine, 3 doses given at 6-10-14 weeks of age
  • Oral Polio vaccine (OPV), 3 doses given at 6-10-14 weeks of age, a single dose of Inactivated Polio vaccine (IPV) is given with the 3rd dose of OPV at 14 weeks
  • Pneumococcal conjugate vaccine (PCV), 3 doses given at 6-10-14 weeks of age
  • Rotavirus vaccine given at a minimum age of 6 weeks with a minimum interval of 4 weeks between doses. The last dose should be administered not later than 32 weeks of age.
  • Measles –containing vaccine (either monovalent measles vaccine or MMR) given at 9 months of age
  • Measles-Mumps-Rubella (MMR) vaccine given at 12 months of age

From the foregoing, parents will have to monitor the schedule of vaccinations so as to have a complete and proper dosage for prevention of the certain diseases. As CHITS-EMR has built-in modules for general patient consultations, consultation scheduling, the application of such  lessens the chances of missing a scheduled vaccination of a child. Parents visiting the regional or municipal health centers will always have an updated record of their vaccination in the health center. This ensures that the possible exposure to certain disease of vaccinated children will be minimized, thus there is health improvement as characterized by CCDSS. The primary preventive care may be achieved using the systems of CHITS in the health centers. In a non-CHITS health center, there is a greater chance that the records of the patient might be misplaced or even lost. This can cause the improper giving of dosage of the vaccines which in turn could lead to lack or overdose of the required antigens given to children.

 

References:

  1. Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, Sam J, Haynes RB: Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 2005, 293(10):1223-1238.
  2. Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG: Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006, 144(10):742-752.
  3. Starfield B: Toward international primary care reform. CMAJ 2009, 180(11):1091-1092.
  4. http://www.athenahealth.com/knowledge-hub/icd-10/what-is-icd-10

 

#MSHI #HI201

Allons-y!

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