<p>  </p> <p>Although community pharmacists have further reduced medication errors and improved care with access to patient data through unidirectional health information exchange (HIE), access to routine patient data has not been sustained. Several barriers to sustaining use and access of HIE in community pharmacies have been noted, such as lack of implementation supports and technological restrictions. Further, pharmacists and pharmacy technicians have not been involved in the development of HIE systems for their use previously. My research aims to optimize HIE access for community pharmacists through our co-developed HIE interface prototype specifically for use by community pharmacy teams in collaboration with PioneerRx, a pharmacy dispensing software system and our state HIE, the Indiana Health Information Exchange (IHIE), and provide supports for the sustainability of community pharmacist access to HIE.</p> <p>Therefore, the objectives of my research are to 1) conduct a formative usability evaluation of the HIE interface prototype with community pharmacists and pharmacy technicians to inform strategies to improve the HIE interface design for future implementation in community pharmacies (“<em>Study One”</em>) and 2) identify the potential barriers, facilitators, and recommendations for HIE implementation in community pharmacies through semi-structured interviews to create a curated list of resources to address identified implementation needs to assist with the future implementation of HIE (“<em>Study Two”</em>).</p> <p>The findings from Study One demonstrate the HIE interface prototype was viewed favorably by pharmacists and pharmacy technicians, with the average System Usability Scale (SUS) score 69 (scale 0 – 100, where 100 is the best). Pharmacists reported higher satisfaction than technicians on average (74 vs. 65, respectively). Key problems identified included accessibility of HIE links and placement in the existing workflow and application label name clarifications. The same eight pharmacists and eight pharmacy technicians, with the addition of seven patients, completed interviews in Study Two. Five barriers, four facilitators, and two recommendations were identified. These were further characterized into four key implementation needs: instruction on how to use HIE, guidance on workflow and team roles, and provider and patient facing resources for discussing HIE. Curated draft implementation resource items that are responsive to all four key implementation needs are in development. The combination of findings from Study One and Study Two create the blueprint for pharmacy-team informed implementation of HIE in community pharmacies.</p>

Aim: This study explores what type of information patients and nurses share with, or provide to, each other, and whether or not the information received was relevant and sufficient for their needs. Background: Information exchange, as part of shared decision-making, is advocated in policy and practice throughout the healthcare sector. Much of the literature on information exchange relates to one-to-one consultations with consultants or GPs. To date, no studies have explored information exchange between patients and nurses in ward settings. Nursing literature on patients’ information needs focuses on one-way information provision from nurses to patients, rather than on two-way information exchange between patients and nurses. Methods: Interactions between patients and nurses were observed and audio-recorded using a remotely controlled audio-recording system. Semi-structured individual face-to-face interviews were then conducted to clarify and add to the observation data. A multiple case study design was used for this study: each case comprised one patient, the nurses caring for that patient, and the interactions between them. A pilot study was undertaken to inform the methods for recruitment and data collection for the main study. Results: The pilot study comprised five cases (patients n=5, nurses n=3). Changes to the recruitment strategy for the main study included surgical patients being invited to participate in the same way as medical patients. There were no difficulties with the data collection methods. The main study comprised nineteen cases (patients n=19, nurses n=22). Information exchange seemed unfamiliar to ward-based nurses. The findings show that information exchange may not be a one-off event but a complex series of interactions. Patients did not distinguish between clinical and non-clinical information in the same way as nurses. Primary reasons for patients’ hospital admission were not discussed and nurses did not share information about nursing interventions. The relevance for patients and nurses differed; patients generally wanted information for reducing anxiety and socialization; nurses wanted information for assessment and care planning. In terms of sufficiency, observation sessions highlighted that insufficient information was provided, often due to lost opportunities and paternalistic practice. However, the majority of patients and nurses perceived that they had exchanged sufficient information. Conclusion: This multiple case study provides insights into the type, relevance and sufficiency of information for patients and nurses in ward settings. In ward settings, information exchange as conceptualised by Charles et al. (1997 and 1999) may be difficult to achieve due to the complexity of patient/nurse interactions. Therefore, there are implications for policy makers as policies are not context specific. However, information exchange may be helpful for reducing patients’ anxieties. The concepts of shared decision-making and information exchange are not part of ward-based cultures and philosophies, which suggests implications for patient and nurse education. Research on information exchange between patients and nurses in other ward contexts may contribute to further understanding of information exchange in ward settings.

Several factors are driving the transition from paper-based health records to electronic health record systems. In the United States, the adoption rate of electronic health record systems significantly increased after "Meaningful Use" incentive program was started in 2009. While increased use of electronic health record systems could improve the efficiency and quality of healthcare services, it can also lead to a number of security and privacy issues, such as identity theft and healthcare fraud. Such incidents could have negative impact on trustworthiness of electronic health record technology itself and thereby could limit its benefits. In this dissertation, we tackle three challenges that we believe are important to improve the security and privacy in electronic health record systems. Our approach is based on an analysis of real-world incidents, namely theft and misuse of patient identity, unauthorized usage and update of electronic health records, and threats from insiders in healthcare organizations. Our contributions include design and development of a user-centric monitoring agent system that works on behalf of a patient (i.e., an end user) and securely monitors usage of the patient's identity credentials as well as access to her electronic health records. Such a monitoring agent can enhance patient's awareness and control and improve accountability for health records even in a distributed, multi-domain environment, which is typical in an e-healthcare setting. This will reduce the risk and loss caused by misuse of stolen data. In addition to the solution from a patient's perspective, we also propose a secure system architecture that can be used in healthcare organizations to enable robust auditing and management over client devices. This helps us further enhance patients' confidence in secure use of their health data.

因應傳播科技發展與市場化競爭，台灣電視新聞記者愈來愈常見利用MSN「會稿」與新聞畫面的「合帶」，進行緊密的集體合作行為。電視新聞記者透過集體「會稿」，不漏新聞又能掌握各台動向，因此受到新聞室組織的默許，甚而影響各台的新聞取向與編輯策略。而原只存在於駐地記者的「合帶」行為，也逐漸向上擴展到地方新聞中心，甚至台北總部，使得記者對集體合作的依存度更高。 電視台記者的跨台集體合作行為，導致台灣電視新聞出現特殊的「合工效應」，新聞內容更趨「同質化」與「濫獨家」現象充斥。電視記者蒐集新聞資訊方式從過去佈線經營人脈，轉變為倚賴同業關係而獲得，但二手資訊卻常使得新聞的錯誤率增加。 本研究透過訪談20位資深電視新聞記者，勾勒出「會稿」與「合帶」集體合作行為的三層次形貌，剖析不同層次集體合作的運作方式與目的，並探討集體合作對於新聞產製流程、電視記者職能與專業態度的影響，同時對電視新聞媒體現況提出省思。 / The development of communication technology and growing competition have led TV reporters in Taiwan to rely on underground inter-station and interpersonal cooperation, which consists mainly of information exchange on MSN and news video sharing. Despite the potential violation of work ethics, such cooperation eliminates the possibility of missing out on any news story, and hence is given silent permission from the news room. Such news gathering, however, has to a certain extent changed the selection and editing strategies in TV stations. News video sharing, a method originally used only among local correspondents, has spread to regional news centers, and sometime even the headquarters in Taipei. These in turn reinforce reporters’ reliance on interpersonal cooperation. Such interpersonal cooperation of TV reporters in Taiwan has also resulted in a homogeneous news industry full of meaningless “exclusive” news stories. While reporters used to gather news from independent sources, they have now turned to share information with other TV stations. Despite the convenience, such second-hand facts are of more potential errors. The researcher of this paper has interviewed twenty senior TV reporters and depicted a tri-tier cooperative system—from local correspondents, regional news centers, to headquarters. This study looks into the means and purposes of this cooperation model on all the three levels and probes into its possible effects on the news reporting process, TV reporters’ competencies, and professional attitudes.

No description available.

The thesis is focused mainly on changes in the field of tax planning, global exchange of information and documents, on the basis of which the information exchange is realized. The thesis is also devoted to protection of identity of owners of assets and income, and various instruments which allows preserving it. The practical part of the thesis is formed by a case study. The aim of the thesis is to coherently examine and summarize the changes that took place in international tax planning over the past few years, mainly because of increased international cooperation in tax matters.

yes / Efforts to combat and prevent illicit trafficking in, and proliferation and misuse of, small arms and light weapons (SALW) are hampered by lack of relevant information-exchange and transparency. International information exchange and transparency arrangements are key elements of each of the main elements of the international action programme on SALW to be launched at the UN 2001 Conference. There is great scope to develop information management and distribution arrangements to disseminate and exchange of relevant information on SALW without seriously compromising national security, necessary commercial secrecy, or law enforcement. Indeed, national security, commerce, crime prevention and law enforcement are generally enhanced by appropriate transparency and information exchange

yes / The 1990s witnessed a change in the way wars were fought as the amount of available weaponry increased and the types of actors engaged in warfare multiplied. The opening up of the international arms trade, in particular with new buyers and more channels of supply, has raised concerns about who purchases weapons and for what use. Afeature of this changing nature of conflict has been the continuing, if not growing, presence of mercenaries and the emergence of private companies contracted to provide military and security services. These range from logistical support and training to advice and procurement of arms and on-the-ground intervention. This briefing highlights how the activities of mercenaries and private military and security companies can contribute to small arms proliferation and misuse and examines steps the international community can take at the UN Small Arms Conference and elsewhere to effectively combat mercenarism and regulate the activities of private military and security companies. The role played by these companies relates not only to provisions contained in the contracts they sign with their clients to provide large amounts of weaponry, but also how the military and security services and training that they provide contributes to the demand for weapons in the regions where they operate. There are a number of ways in which mercenaries and private military and security companies are involved in small arms proliferation. These include: l Arms brokering and transportation activities l Violations of UN arms embargoes l Impact on human rights and humanitarian law l Driving demand for small arms Various measures already exist to ban the activities of mercenaries and regulate some of the activities of private military and security companies either through national legislation or international agreements. However, there is concern these efforts are neither comprehensive nor accepted widely enough to effectively control the activities of mercenaries and private military and security companies.

租稅協定不僅協調各國間稅收關係並妥善劃分課稅管轄權，進而降低企業全球化經營下所面臨的租稅課徵不確定性。然而國外文獻關於租稅協定對直接投資或海外關係企業活動之成效仍有諸多爭議，且國內仍未有利用長期性個體資料來檢視租稅協定效果的研究，因此本文以 2000 年至 2013年台灣上市公司之海外關係企業的財務資料進行分析。另外，因近年各國日益重視反避稅措施與跨國間稅收的徵管合作，故本文也進一步探討利益限制條款和資訊交換的嚴謹程度對於海外關係企業營運活動之影響。 本文建構三個固定效果模型來分析不平衡追蹤資料，其中模型一分析租稅協定對於海外關係企業營運活動的影響，而模型二檢視利益限制條款是否為其中的重要因素，模型三則分析資訊交換條款的嚴格程度是否影響海外關係企業的營運規模。實證結果顯示不論是租稅協定本身、利益限制或是資訊交換皆為影響台灣上市公司海外關係企業營運活動之重要關鍵。租稅協定的生效不僅造成海外關係企業的銷售額下降，並隨著資訊交換規範越嚴格，其下降的幅度越大。最後，在細分不同產業的條件下，得歸納出租稅協定帶來的效果並不一致之結論。

Preliminary investigation at the beginning of this research showed that informatics on point-of-care (POC) devices was limited to basic data generation and processing. This thesis is based on publications of several studies during the course of the research. The aim of the research is to model and analyse information generation and exchange in telehealth systems and to identify and analyse the capabilities of these systems in managing chronic diseases which utilise point-of-care devices. The objectives to meet the aim are as follows: (i) to review the state-of-the-art in informatics and decision support on point-of-care devices. (ii) to assess the current level of servitization of POC devices used within the home environment. (iii) to identify current models of information generation and exchange for POC devices using a telehealth perspective. (iv) to identify the capabilities of telehealth systems. (v) to evaluate key components of telehealth systems (i.e. POC devices and intermediate devices). (vi) to analyse the capabilities of telehealth systems as enablers to a healthcare policy. The literature review showed that data transfer from devices is an important part of generating information. The implication of this is that future designs of devices should have efficient ways of transferring data to minimise the errors that may be introduced through manual data entry/transfer. The full impact of a servitized model for point-of-care devices is possible within a telehealth system, since capabilities of interpreting data for the patient will be offered as a service (c.f. NHS Direct). This research helped to deduce components of telehealth systems which are important in supporting informatics and decision making for actors of the system. These included actors and devices. Telehealth systems also help facilitate the exchange of data to help decision making to be faster for all actors concerned. This research has shown that a large number of capability categories existed for the patients and health professionals. There were no capabilities related to the caregiver that had a direct impact on the patient and health professional. This was not surprising since the numbers of caregivers in current telehealth systems was low. Two types of intermediate devices were identified in telehealth systems: generic and proprietary. Patients and caregivers used both types, while health professionals only used generic devices. However, there was a higher incidence of proprietary devices used by patients. Proprietary devices possess features to support patients better thus promoting their independence in managing their chronic condition. This research developed a six-step methodology for working from government objectives to appropriate telehealth capability categories. This helped to determine objectives for which a telehealth system is suitable.