Use of Cohesive Ties in Relation to the Quality of Compositions by ...

mochug - Don Detmer , Md , Ma , President And Chief Executive Officer And Elaine Steen , Policy Analyst , American Medical Informatics Association; Joyce Dubow , Project Manager , Aarp Public Policy Institute

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expression écrite - matière potentielle : l2
expression écrite - matière potentielle : prompt
expression écrite - matière potentielle : college students
expression écrite - matière potentielle : linguistic variables to l2
expression écrite
expression écrite - matière potentielle : rating scale

Volume 5, No. 2-3 78 Use of Cohesive Ties in Relation to the Quality of Compositions by Chinese College Students Aiping ZHANG Lanzhou University of Technology, China. Email: , Abstract: One hundred sample compositions were selected systematically from 4845 compositions written by college non-English majors who took part in the 2004 National Entrance Test of English for M.A./M.S. Candidates and applied for a postgraduate program in Lanzhou University in China.

personal reference
foreign language teaching
lexical synonymy
cohesive ties
reread sentence by sentence
multiple regression analysis
writing
cohesion

Sujets

Prompt

Student

Rating scale

Lanzhou

Tsinghua University

Pearson

People's Republic of China

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Publié par	mochug
Nombre de lectures	30
Langue	English

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#2006-10
March 2006

Learning from Abroad:
Lessons and Questions on Personal Health
Records for National Policy

by
Don Detmer, MD, MA, President and
Chief Executive Officer
Elaine Steen, MA, Policy Analyst
American Medical Informatics Association

The AARP Public Policy Institute, formed in 1985, is part of the
Policy and Strategy Group at AARP. One of the missions of the
Institute is to foster research and analysis on public policy issues
of importance to mid-life and older Americans. This publication
represents part of that effort.
The views expressed herein are for information, debate, and
discussion, and do not necessarily represent official policies of
AARP.
© 2006, AARP.
Reprinting with permission only.
AARP, 601 E Street, NW, Washington, DC 20049
http://www.aarp.org/ppi Acknowledgements

We would like to thank the health information technology experts from around the world
who participated in the interviews that provided the foundation for this study. We would
also like to thank Joyce Dubow and the anonymous reviewers for their helpful comments
on a previous draft of this manuscript.

Table of Contents
Acronyms ______________________________________________________________ i
Foreword _____________________________________________________________iii
Tables ________________________________________________________________ iv
Executive Summary ______________________________________________________v
Background ___________________________________________________________ 1
Study Purpose__________________________________________________________ 6
Study Methodology 6
Findings ______________________________________________________________ 7
Conclusions and Recommendations _______________________________________ 34
Appendix 1 50
Appendix 2 52
Appendix 3 ___________________________________________________________ 55
References 58

Acronyms

AHIC American Health Information Community
AHRQ Agency for Healthcare Research and Quality
CDS clinical decision support
CHF Consumers Health Foundation of Australia
CMS Centers for Medicare and Medicaid Services
DHB district health board
ECDL-F European Computer Driving Licence Foundation
EDI electronic data interchange
EHR electronic health record
eiPHR integrated personal health record
ePHR electronic personal health record
ERDIP Electronic Record Development and Implementation Programme
EU European Union
GDP gross domestic product
GMS General Medical Services
GP general practitioner
HIPC Healthcare Information Privacy Code
HIS-NZ Health Information Strategy for New Zealand
HIPAA Health Insurance Portability and Accountability Act
HIT health information technology
IBD inflammatory bowel disease
ICD International Classification of Diseases
ICT information and connectivity technologies
IOM Institute of Medicine
IPA independent practitioner association
IT information technology
NCVHS National Committee on Vital and Health Statistics
NEHTA National E-Health Transition Authority
NHII national health information infrastructure
NHS National Health Service
NLM National Library of Medicine
NPfIT National Programme for Information Technology
NRC National Research Council
NZHIS New Zealand Health Information System
OECD Organisation for Economic Co-operation and Development
ONC Office of the National Coordinator
PACS picture archiving and communications systems
PAERS patient access to their electronic record system
PALS Patient Advice and Liaison Services
PHI Personal Healthcare Identifier
PHR personal health record
PING Personal Internetworked Notary and Guardian
PIP Practice Incentive Program
i
PIPEDA Personal Information and Electronic Documents Act
POSP Physician Office System Program
QMAS Quality Management and Analysis System
RIXG Renal Information Exchange Group
® ® SNOMED-CT SNOMED Clinical Terms
SWPE standardized whole patient equivalent
SUSTAIN Support Users to Access Information and Services
USB universal serial bus
VCUR vendor conference and usability requirements
WHO World Health Organization
ii
Foreword

Although the potential of health information technology (HIT) to improve health care
quality is widely acknowledged, the United States (U.S.) lags considerably behind many
of the developed countries in HIT adoption. On the assumption that there are valuable
lessons to be learned from other countries that have outpaced the U. S. in HIT adoption,
and with a particular interest in personal health records (PHRs) as a means of helping
consumers become better informed, AARP commissioned Dr. Detmer and Ms. Steen,
both experts in international HIT, to determine the extent to which PHRs are in use in
several English-speaking countries (Australia, Canada, England, and New Zealand).

The key objective of the research was to identify experiences in the international arena
that might inform policies in the U.S. The authors found that the underlying cultural
differences among the U.S. and the countries studied (that are attributable to their
different delivery systems, financing approaches, and national health information
infrastructures) account for a disparity in interest in PHRs and divergent approaches to
HIT. Nevertheless, they also identify areas of common focus, including recognition of the
need to improve the quality and safety of the health care system, the need for robust
information infrastructures, and the importance of designing systems that are patient-
centric and that focus explicitly on the patient. While AARP does not necessarily endorse
all of the authors’ recommendations, we are eager to stimulate discussion about personal
health technology and hope that this study will contribute to that discussion.

Joyce Dubow
Associate Director
AARP Public Policy Institute
March 2006
iii
Tables

Table 1: A Framework for Comparing PHR Models (Connecting for Health, 2004) ___ 5
Table 2: An Overview of the Health Sectors _________________________________ 41
Table 3: Overview of Findings with Respect to National Action__________________ 45

iv
Executive Summary

Background

Electronic personal health records (ePHRs) are a relatively young technology with
1limited but growing use. At their most basic level, personal health records (PHRs) are
tools that allow individual patients or citizens to manage their health information. There
are several models of ePHRs, all of which have a common goal (i.e., to provide patient
access to personal health data to support personal health management and enable sound
decision making). But they do vary in terms of the technologies or applications used, the
kinds of functions offered (e.g., basic information management [ePHR], how they are
integrated for full interaction with health care professionals [eiPHR]), and the source and
types of data in the record. Considerable progress has been made in advancing the
concept of ePHRs but there is still ambiguity surrounding their form and function.

Purpose

AARP commissioned this study to examine the use of and approaches to personal health
records in selected English-speaking countries (Australia, Canada, England, and New
Zealand) with the goal of identifying best practices and lessons that may be applicable to
development of PHRs in the United States.

Methodology

The study methodology included interviews with health information technology experts
in each country; a review of the published literature; and a review of websites related to
health technology and PHRs to gather information on the structure of the health system,
the health information technology environment, concept and status of a national health
information infrastructure, and experience with PHRs in each country. In addition, the
study gathered highlights of PHR activity in Scotland and Sweden as well as the
European Union. After compiling information on each country, we compared and
contrasted the experiences in these countries to identify common themes and lessons that
might prove instructive for PHR development in the United States. Our analysis focused
on what private and public organizations could do in the United States to create an
environment that would foster ePHR development and implementation, with particular
attention to federal national health information infrastructure (NHII) policy.

1 We distinguish several types of personal health records due to their differing scope and value. The
commonly used term, personal health record (PHR), encompasses both paper- and computer-based PHRs.
Electronic personal health records (ePHRs) are computer-based records that are not integrated with the
information technology systems of caregivers. Electronic integrated personal health records (eiPHRs) do
have such integration.
v
Findings