The National Institute of Standards and Technology (NIST) Measurements and Standards Laboratories (MSL) provide technical leadership for the nation's measurement and standards infrastructure and assure the availability of essential reference data and measurement capabilities. At NIST's request the National Research Council (NRC) carries out a biennial assessment of the seven MSL. The assessment focuses on each laboratory's technical quality and merit; and effectiveness. It also examines the relevance of the NIST programs and how well laboratory facilities, equipment, and personnel are able to fulfill the MSL mission. This report presents an overall assessment of the MSL followed by detailed assessments of each of the seven laboratories.
In the United States, health care devices, technologies, and practices are rapidly moving into the home. The factors driving this migration include the costs of health care, the growing numbers of older adults, the increasing prevalence of chronic conditions and diseases and improved survival rates for people with those conditions and diseases, and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as in its quality and cost. Health Care Comes Home reviews the state of current knowledge and practice about many aspects of health care in residential settings and explores the short- and long-term effects of emerging trends and technologies. By evaluating existing systems, the book identifies design problems and imbalances between technological system demands and the capabilities of users. Health Care Comes Home recommends critical steps to improve health care in the home. The book's recommendations cover the regulation of health care technologies, proper training and preparation for people who provide in-home care, and how existing housing can be modified and new accessible housing can be better designed for residential health care. The book also identifies knowledge gaps in the field and how these can be addressed through research and development initiatives. Health Care Comes Home lays the foundation for the integration of human health factors with the design and implementation of home health care devices, technologies, and practices. The book describes ways in which the Agency for Healthcare Research and Quality (AHRQ), the U.S. Food and Drug Administration (FDA), and federal housing agencies can collaborate to improve the quality of health care at home. It is also a valuable resource for residential health care providers and caregivers.
For the first time, a single reference identifies medical technology assessment programs. A valuable guide to the field, this directory contains more than 60 profiles of programs that conduct and report on medical technology assessments. Each profile includes a listing of report citations for that program, and all the reports are indexed under major subject headings. Also included is a cross-listing of technology assessment report citations arranged by type of technology headings, brief descriptions of approximately 70 information sources of potential interest to technology assessors, and addresses and descriptions of 70 organizations with memberships, activities, publications, and other functions relevant to the medical technology assessment community.
The goal of the Institute of Medicine's Council on Health Care Technology is to promote the development and application of technology assessment in health and medicine. Among the activities cited in the congressional charge that provided for its formation, the council is to "identify needs in the assessment of health care technology." Early in its deliberations, the council decided to expand its charge to identify priority clinical conditions as well as medical technologies and practices. The process for setting assessment priorities demonstrated in this pilot study and the initial set of 20 priority assessment areas selected are in response to this expanded charge. The priority-setting group decided to undertake a pilot effort that would set a framework for national priority-setting, outline national priority-setting criteria, and use a consensus process to identify a preliminary list of priority clinical conditions and medical technologies. The priority-setting approach demonstrated here relies upon explicit criteria that are applicable at the national level and reflect the diverse needs of patients, clinicians, researchers payers, health facility managers, and policymakers.
Increasingly, the core mission of the Centers for Medicare and Medicaid Services (CMS), an agency of the Department of Health and Human Services, is expanding from one of focusing on prompt claims payment to one of becoming more broadly involved in improving health care quality and efficiency. The requirements for the information technology (IT) systems of CMS are changing as its mission changes, and the efforts to evolve its systems from those designed to support the agency's historical mission come in the midst of a push to modernize the nation's health care IT more broadly. These new challenges arise even as CMS must meet challenging day-to-day operational requirements and make frequent adjustments to its business processes, code, databases, and systems in response to changing statutory, regulatory, and policy requirements. In light of these and other emerging challenges, CMS asked the National Research Council to conduct a study that would lay out a forward-looking vision for the Centers for Medicare and Medicaid Services, taking account of CMS's mission, business processes, and information technology requirements. The study is being conducted in two phases. The first, resulting in the present volume, draws on a series of teleconferences, briefings, and an information-gathering workshop held in Washington, D.C., on September 27-28, 2010. The second phase, drawing on that workshop and on additional briefings, site visits, and committee deliberations, will result in a final report with recommendations, to be issued at the end of the project in 2011.
The Centers for Medicare and Medicaid Services (CMS) is the agency in the Department of Health and Human Services responsible for providing health coverage for seniors and people with disabilities, for limited-income individuals and families, and for children-totaling almost 100 million beneficiaries. The agency's core mission was established more than four decades ago with a mandate to focus on the prompt payment of claims, which now total more than 1.2 billion annually. With CMS's mission expanding from its original focus on prompt claims payment come new requirements for the agency's information technology (IT) systems. Strategies and Priorities for Information Technology at the Centers for Medicare and Medicaid Services reviews CMS plans for its IT capabilities in light of these challenges and to make recommendations to CMS on how its business processes, practices, and information systems can best be developed to meet today's and tomorrow's demands. The report's recommendations and conclusions offered cluster around the following themes: (1) the need for a comprehensive strategic technology plan; (2) the application of an appropriate metamethodology to guide an iterative, incremental, and phased transition of business and information systems; (3) the criticality of IT to high-level strategic planning and its implications for CMS's internal organization and culture; and (4) the increasing importance of data and analytical efforts to stakeholders inside and outside CMS. Given the complexity of CMS's IT systems, there will be no simple solution. Although external contractors and advisory organizations will play important roles, CMS needs to assert well-informed technical and strategic leadership. The report argues that the only way for CMS to succeed in these efforts is for the agency, with its stakeholders and Congress, to recognize resolutely that action must be taken, to begin the needed cultural and organizational transformations, and to develop the appropriate internal expertise to lead the initiative with a comprehensive, incremental, iterative, and integrated approach that effectively and strategically integrates business requirements and IT capabilities.
In October 2003 the U.S. Agency for International Development (USAID) and the National Research Council (NRC) entered into a cooperative agreement. The agreement called for the NRC to examine selected aspects of U.S. foreign assistance activities-primarily the programs of the USAID-that have benefited or could benefit from access to strong science, technology, and medical capabilities in the United States or elsewhere. After considering the many aspects of the role of science and technology (S&T) in foreign assistance, the study led to the publication of The Fundamental Role of Science and Technology in International Development. In the book special attention is devoted to partnerships that involve the USAID together with international, regional, U.S. governmental, and private sector organizations in fields such as heath care, agriculture and nutrition, education and job creation, and energy and the environment. This book explores specific programmatic, organizational, and personnel reforms that would increase the effective use of S&T to meet the USAID's goals while supporting larger U.S. foreign policy objectives.
This volume consists of four "white papers," prepared for the Clinton administration as it took office, on important national policy issues in which science and technology play a central role. Topics covered are science and technology leadership, climate change policy, technology policy and industrial innovation, and health care reform. Also included are brief summaries of ten potentially high impact reports issued by various committees of the National Research Council.
In June 2006, seventeen scientists and educators selected by the National Academies, the Academy of Sciences of Iran, and the Académie des Sciences of France held a workshop at the estate of the Fondation des Treilles in Toutour, France, to discuss issues concerning the role of science in the development of modern societies. Science and Technology and the Future Development of Societies includes the presentations made at the workshop and summarizes the discussions that followed the presentations. Topics of the workshop included science and society issues, the role of science and engineering in development; obstacles and opportunities in the application of science and technology to development; scientific thinking of decision makers; management and utilization of scientific knowledge; and science, society, and education. This book also provides useful background for the further development of interactions of Western scientists and educators with Iranian specialists.
An NRC ad hoc committee analyzed the current status and future development potential of Armenia's science and technology base, including human and infrastructural resources and research and educational capabilities. The committee identified those fields and institutions offering promising opportunities for contributing to economic and social development, and particularly institutions having unique and important capabilities, worthy of support from international financial institutions, private investment sources, and the Armenian and U.S. governments. The scope of the study included both pure and applied research as well as education in science-related fields. The committee's report addresses the existing capacity of state and private research institutions, higher education capabilities and trends, scientific funding sources, innovative investment models, relevant success stories, factors hindering development of the science sector, potential domestic Armenian customers for scientific results and products, and opportunities for regional scientific collaboration. An Armenian language version of the report is also available.
The report on the ITL presents a general assessment of the laboratory including a look at its research strategies, opportunities, planning for growth, research culture, and computing infrastructure; and provides assessments of the laboratory's six divisions. The report notes that the work of the ITL generally ranks at or near the top of the work being done by peer institutions.
Kazakhstan has an ambitious program to increase its technological competitiveness in the global market place during the next few years, but achieving success will depend in large measure on the effectiveness of upgraded science and technology (S&T) capabilities. This report identifies important opportunities and limitations in the education system, research and development (R&D) institutions, production companies, and service organizations to help governmental organizations in Kazakhstan with strong interests in S&T chart the future course of the country.
Privacy is a growing concern in the United States and around the world. The spread of the Internet and the seemingly boundaryless options for collecting, saving, sharing, and comparing information trigger consumer worries. Online practices of business and government agencies may present new ways to compromise privacy, and e-commerce and technologies that make a wide range of personal information available to anyone with a Web browser only begin to hint at the possibilities for inappropriate or unwarranted intrusion into our personal lives. Engaging Privacy and Information Technology in a Digital Age presents a comprehensive and multidisciplinary examination of privacy in the information age. It explores such important concepts as how the threats to privacy evolving, how can privacy be protected and how society can balance the interests of individuals, businesses and government in ways that promote privacy reasonably and effectively? This book seeks to raise awareness of the web of connectedness among the actions one takes and the privacy policies that are enacted, and provides a variety of tools and concepts with which debates over privacy can be more fruitfully engaged. Engaging Privacy and Information Technology in a Digital Age focuses on three major components affecting notions, perceptions, and expectations of privacy: technological change, societal shifts, and circumstantial discontinuities. This book will be of special interest to anyone interested in understanding why privacy issues are often so intractable.
The rapid growth of home health care has raised many unsolved issues and will have consequences that are far too broad for any one group to analyze in their entirety. Yet a major influence on the safety, quality, and effectiveness of home health care will be the set of issues encompassed by the field of human factors research-the discipline of applying what is known about human capabilities and limitations to the design of products, processes, systems, and work environments. To address these challenges, the National Research Council began a multidisciplinary study to examine a diverse range of behavioral and human factors issues resulting from the increasing migration of medical devices, technologies, and care practices into the home. Its goal is to lay the groundwork for a thorough integration of human factors research with the design and implementation of home health care devices, technologies, and practices. On October 1 and 2, 2009, a group of human factors and other experts met to consider a diverse range of behavioral and human factors issues associated with the increasing migration of medical devices, technologies, and care practices into the home. This book is a summary of that workshop, representing the culmination of the first phase of the study.
The Federal Bureau of Investigation (FBI) is in the process of developing a modern information technology (IT) systemâ€"the Trilogy programâ€" that is designed to provide a high-speed network, modern workstations and software, and an applicationâ€"the Virtual Case File (VCF)â€"to enhance the ability of agents to organize, access, and analyze information. Implementation of this system has encountered substantial difficulties, however, and has been the subject of much investigation and congressional concern. To help address these problems, the FBI asked the National Research Council (NRC) to undertake a quick review of the program and the progress that has been made to date. This report presents that review. The current status of four major aspects of the programâ€"the enterprise architecture, system design, program management, and human resourcesâ€"are discussed, and recommendations are presented to address the problems.
The growth in government programs to support high-technology industry within national economies and their impact on international science and technology cooperation and on the multilateral trading system are of considerable interest worldwide. Accordingly, these topics were taken up by STEP in a study carried out in conjunction with the Hamburg Institute for Economic Research and the Institute for World Economics in Kiel. One of the principal recommendations for further work emerging from that study was a call for an analysis of the principles of effective cooperation in technology development, to include lessons from national and international consortia, including eligibility standards and assessments of what new cooperative mechanisms might be developed to meet the challenges of international cooperation in high-technology products.
The U.S. information technology (IT) research and development (R&D) ecosystem was the envy of the world in 1995. However, this position of leadership is not a birthright, and it is now under pressure. In recent years, the rapid globalization of markets, labor pools, and capital flows have encouraged many strong national competitors. During the same period, national policies have not sufficiently buttressed the ecosystem, or have generated side effects that have reduced its effectiveness. As a result, the U.S. position in IT leadership today has materially eroded compared with that of prior decades, and the nation risks ceding IT leadership to other nations within a generation. Assessing the Impacts of Changes in the Information Technology R&D Ecosystem calls for a recommitment to providing the resources needed to fuel U.S. IT innovation, to removing important roadblocks that reduce the ecosystem's effectiveness in generating innovation and the fruits of innovation, and to becoming a lead innovator and user of IT. The book examines these issues and makes recommendations to strengthen the U.S. IT R&D ecosystem.
When you visit the doctor, information about you may be recorded in an office computer. Your tests may be sent to a laboratory or consulting physician. Relevant information may be transmitted to your health insurer or pharmacy. Your data may be collected by the state government or by an organization that accredits health care or studies medical costs. By making information more readily available to those who need it, greater use of computerized health information can help improve the quality of health care and reduce its costs. Yet health care organizations must find ways to ensure that electronic health information is not improperly divulged. Patient privacy has been an issue since the oath of Hippocrates first called on physicians to "keep silence" on patient matters, and with highly sensitive data--genetic information, HIV test results, psychiatric records--entering patient records, concerns over privacy and security are growing. For the Record responds to the health care industry's need for greater guidance in protecting health information that increasingly flows through the national information infrastructure--from patient to provider, payer, analyst, employer, government agency, medical product manufacturer, and beyond. This book makes practical detailed recommendations for technical and organizational solutions and national-level initiatives. For the Record describes two major types of privacy and security concerns that stem from the availability of health information in electronic form: the increased potential for inappropriate release of information held by individual organizations (whether by those with access to computerized records or those who break into them) and systemic concerns derived from open and widespread sharing of data among various parties. The committee reports on the technological and organizational aspects of security management, including basic principles of security; the effectiveness of technologies for user authentication, access control, and encryption; obstacles and incentives in the adoption of new technologies; and mechanisms for training, monitoring, and enforcement. For the Record reviews the growing interest in electronic medical records; the increasing value of health information to providers, payers, researchers, and administrators; and the current legal and regulatory environment for protecting health data. This information is of immediate interest to policymakers, health policy researchers, patient advocates, professionals in health data management, and other stakeholders.
America's Children is a comprehensive, easy-to-read analysis of the relationship between health insurance and access to care. The book addresses three broad questions: How is children's health care currently financed? Does insurance equal access to care? How should the nation address the health needs of this vulnerable population? America's Children explores the changing role of Medicaid under managed care; state-initiated and private sector children's insurance programs; specific effects of insurance status on the care children receive; and the impact of chronic medical conditions and special health care needs. It also examines the status of "safety net" health providers, including community health centers, children's hospitals, school-based health centers, and others and reviews the changing patterns of coverage and tax policy options to increase coverage of private-sector, employer-based health insurance. In response to growing public concerns about uninsured children, last year Congress voted to provide $24 billion over five years for new state insurance initiatives. This volume will serve as a primer for concerned federal policymakers and regulators, state agency officials, health plan decisionmakers, health care providers, children's health advocates, and researchers.
The tremendous growth in use of information technology (IT) has led to an increased interest in understanding its social and economic impacts. This book presents examples of crosscutting research that has been conducted to understand the impact of information technology on personal, community, and business activities. It explores ways in which the use of methodology from economics and social sciences contributes to important advances in understanding these impacts. The book discusses significant research issues and concerns and suggests approaches for fostering increased interdisciplinary research on the impacts of information technology and making the results of this research more accessible to the public and policymakers. This volume is expected to influence funding priorities and levels of support for interdisciplinary research of this kind.
Where should the United States focus its long-term efforts to improve the nation's environment? What are the nation's most important environmental issues? What role should science and technology play in addressing these issues? Linking Science and Technology to Society's Environmental Goals provides the current thinking and answers to these questions. Based on input from a range of experts and interested individuals, including representatives of industry, government, academia, environmental organizations, and Native American communities, this book urges policymakers to: Use social science and risk assessment to guide decision-making. Monitor environmental changes in a more thorough, consistent, and coordinated manner. Reduce the adverse impact of chemicals on the environment. Move away from the use of fossil fuels. Adopt an environmental approach to engineering that reduces the use of natural resources. Substantially increase our understanding of the relationship between population and consumption. This book will be of special interest to policymakers in government and industry; environmental scientists, engineers, and advocates; and faculty, students, and researchers.
Information technology has been touted as a boon for productivity, but measuring the benefits has been difficult. This volume examines what macroeconomic data do and do not show about the impact of information technology on service-sector productivity. This book assesses the ways in which different service firms have selected and implemented information technology, examining the impact of different management actions and styles on the perceived benefits of information technology in services.
Matching DNA samples from crime scenes and suspects is rapidly becoming a key source of evidence for use in our justice system. DNA Technology in Forensic Science offers recommendations for resolving crucial questions that are emerging as DNA typing becomes more widespread. The volume addreses key issues: Quality and reliability in DNA typing, including the introduction of new technologies, problems of standardization, and approaches to certification. DNA typing in the courtroom, including issues of population genetics, levels of understanding among judges and juries, and admissibility. Societal issues, such as privacy of DNA data, storage of samples and data, and the rights of defendants to quality testing technology. Combining this original volume with the new update--The Evaluation of Forensic DNA Evidence--provides the complete, up-to-date picture of this highly important and visible topic. This volume offers important guidance to anyone working with this emerging law enforcement tool: policymakers, specialists in criminal law, forensic scientists, geneticists, researchers, faculty, and students.
The field of health care technology assessment focuses on the use of medical technologies--their impacts on safety, efficacy, and effectiveness; cost-effectiveness and cost benefit; quality; and their social, legal, and ethical implications. This wide-ranging monograph addresses some of the gaps in understanding health status and quality of life, such as the use of quality-of-life measures in technology assessment, organ transplantation, and pharmaceutical trials. One chapter provides basic references for the technical attributes of many established measures and some lesser known ones. The final chapter offers recommendations concerning the appropriate applications of these measures and highlights areas for cooperative research.
Despite a strong commitment to delivering quality health care, persistent problems involving medical errors and ineffective treatment continue to plague the industry. Many of these problems are the consequence of poor information and technology (IT) capabilities, and most importantly, the lack cognitive IT support. Clinicians spend a great deal of time sifting through large amounts of raw data, when, ideally, IT systems would place raw data into context with current medical knowledge to provide clinicians with computer models that depict the health status of the patient. Computational Technology for Effective Health Care advocates re-balancing the portfolio of investments in health care IT to place a greater emphasis on providing cognitive support for health care providers, patients, and family caregivers; observing proven principles for success in designing and implementing IT; and accelerating research related to health care in the computer and social sciences and in health/biomedical informatics. Health care professionals, patient safety advocates, as well as IT specialists and engineers, will find this book a useful tool in preparation for crossing the health care IT chasm.
Technology assessment can lead to the rapid application of essential diagnostic technologies and prevent the wide diffusion of marginally useful methods. In both of these ways, it can increase quality of care and decrease the cost of health care. This comprehensive monograph carefully explores methods of and barriers to diagnostic technology assessment and describes both the rationale and the guidelines for meaningful evaluation. While proposing a multi-institutional approach, it emphasizes some of the problems involved and defines a mechanism for improving the evaluation and use of medical technology and essential resources needed to enhance patient care.
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