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Yemelyan Romanov
Yemelyan Romanov

Advanced System Care 9 Serial Key 2017


This analysis is the latest in a series of Commonwealth Fund cross-national comparisons that uses health data from the Organisation for Economic Co-operation and Development (OECD) to assess U.S. health care system spending, outcomes, risk factors and prevention, utilization, and quality, relative to 10 other high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom. We also compare U.S. performance to that of the OECD average, comprising 36 high-income member countries.




Advanced System Care 9 Serial Key 2017



While the United States spends more on health care than any other country, we are not achieving comparable performance. We have poor health outcomes, including low life expectancy and high suicide rates, compared to our peer nations. A relatively higher chronic disease burden and incidence of obesity contribute to the problem, but the U.S. health care system is also not doing its part. Our analysis shows that the U.S. has the highest rates of avoidable mortality because of people not receiving timely, high-quality care. The findings from this analysis point to key policy implications, as well as opportunities to learn from other countries.


In sum, the U.S. health care system is the most expensive in the world, but Americans continue to live relatively unhealthier and shorter lives than peers in other high-income countries. Efforts to rein in costs, improve affordability and access to needed care, coupled with greater efforts to address risk factors, are required to alleviate the problem.


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As electronic medical records (EMRs) have propagated through the US health care system, they have brought both great promise and great problems [1,2]. One unintended consequence of increasing EMR adoption that has been recently characterized is physician burnout associated with EMR-associated clerical tasks [3]. The high clerical burden of these tasks may be a consequence of variable attention given to usability and user-centered design by vendors [4,5]. Health information technology interfaces that are not well adapted to clinician workflow can both increase clerical workload and potentially pose safety risks to patients [6-8]. As in other industries, medicine has sought to overcome task-related inefficiencies through automation [9].


In past years, policies and regulations required hospitals to implement advanced capabilities of certified electronic health records (EHRs) in order to receive financial incentives. This has led to accelerated implementation of health information technologies (HIT) in health care settings. However, measures commonly used to evaluate the success of HIT implementation, such as HIT adoption, technology acceptance, and clinical quality, fail to account for complex sociotechnical variability across contexts and the different trajectories within organizations because of different implementation plans and timelines. We propose a new focus, HIT adaptation, to illuminate factors that facilitate or hinder the connection between use of the EHR and improved quality of care as well as to explore the trajectory of changes in the HIT implementation journey as it is impacted by frequent system upgrades and optimizations. Future research should develop instruments to evaluate the progress of HIT adaptation in both its longitudinal design and its focus on adaptation progress rather than on one cross-sectional outcome, allowing for more generalizability and knowledge transfer.


Hospitals have been rapidly responding to these new policies and incentives with large-scale implementations of EHRs during the past few years. Adopting new technology requires the redesign of individual and collective workflows and results in changes in both organizational structure and process [9-13]. Yet rapid adoption may hinder the interoperability of the EHR system [14,15]. To facilitate appropriate adoption and use, upgrades, redesign, and optimization are needed, including both minor and major changes in EHR infrastructures, functions, interfaces, and workflows. Further, recent studies have shown that there is a close relationship between the speed of adoption and patient safety concerns of clinicians, both across facilities and within different units [16-18]. EHR implementation could be a distraction from patient care with negative impact on patient outcomes [19] and has mixed association with quality improvement [20,21].


Given MU regulations, MU requirements have commonly been used as a means to assess HIT implementation success in order to promote essential HIT functionalities [4]. For example, MU stage 2 requires providers to have certain HIT functionalities (eg, computerized provider order entry, personal health record, medication reconciliation) in order to continue to participate in the EHR incentive programs [25]. However, this approach also creates a ceiling effect, hindering the advancement of innovative utilities. While the MU program may accelerate development and implementation of certain key functions, it also slows down other functionalities [26,27]. By focusing on achieving MU, we risk missing the big picture of health care system changes. Therefore, we propose that there is a need to improve our understanding of how to appropriately assess the performance and success of HIT implementation over time to allow us to generalize to other HIT implementation contexts.


Current sociotechnical evaluations involve assessing both the technology and the social contexts where the technology is implemented. A systematic review conducted on EHR implementations revealed that sociotechnical factors complicate HIT deployments [46]. Technical features of HIT interact with the social features of a health care work environment. Further, it has been demonstrated that the quality of the implementation process is just as important as the features and capabilities of the system being implemented [47-49].


Implementing a new technology into a complex environment is often disruptive, particularly in health care. Sociotechnical evaluations of HIT implementations are supported in both theory and empirically; however, little guidance exists in terms of how to conduct a sociotechnical evaluation [65]. Challenges in conducting sociotechnical evaluations include a lack of agreement on the components of the sociotechnical system, possible study designs, and data analysis strategies which may give light to both practical and conceptual challenges [65].


Evaluating practice patterns and current health system capacity to deliver kidney healthcare is also critically important. The Global Kidney Health Atlas provides important information on CKD risk factors (biological, behavioural and sociodemographic including obesity and diabetes), the burden and consequences of CKD, and gaps in specific kidney care areas in different countries around the world based on the six health system building blocks.5 9 11 12 It also provides the foundation for a global CKD surveillance network to facilitate the development and evaluation of implementation strategies for including CKD in the global health agenda. For the first time, the Atlas clearly details the significant inter-regional and intraregional variability and gaps in kidney care across countries and regions, which are summarised in tables 1 and 2.


The data contained within the Atlas have significant policy implications. Particularly across low-income and middle-income countries, the Atlas provides both evidence and opportunities for advocacy: improving access to affordable essential medications, and establishing health information systems (eg, renal registries) to capture reliable information on the burden of CKD, and to promote more investment and a targeted research agenda to improve understanding of kidney disease burden, process of care, outcomes monitoring and testing of novel interventions.5 12 It provides advocacy organisations and health workforces with the data to engage key government and non-government stakeholders to support countries in improving the quality of kidney care and to hold countries to account by measuring country and region progress over time. 076b4e4f54


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