Traditional systems are managed to minimize the cost. Health care must be managed to maximize the value.”

By WB Rouse (2008)

 The main purpose of healthcare system provision is to introduce proper health services and find new solutions to current health problems. The detailed meaning of healthcare value still up to till now unclear because according to each part of healthcare party, they describe the different value according their working benefits and there still a question is what exactly the real meaning of healthcare value and what after if the current value definitions exceed the patient/ customers rights to receive proper and good health services. Lately; perspectives working with healthcare value and keep study how to improve real meaning of value try to design parameters or code through we can measure value development with many health working sectors. 

Privately viewpoint; healthcare provision and associated system is like a product differ from country to another or society to society and also the forms of value assessments definitely are differ according to certain community concepts and education background and determined depending in the main object serve the involved categories. It does not mean, we going to use different definition for each society because general value parameter and unites of evaluations actually the same in most of present countries but at least when apply value determinations measurements, just keep in mind that there are little difference enclosing there appeared from the main object of healthcare value determinations.

The healthcare system serves many society sectors and deal with many public categories, that nearly put the real burden to whom going to design and create healthcare delivery system covering all the objects and needs, for so what make patient satisfaction main target or in another word called final outcome considered the main goal and has reflected till what level the working healthcare systems work properly. 

Meaning of value should express the whole healthcare process and reflect the main purpose of people needs, in order to prove the success of new modern applications and how innovative technology help humankind and achieve the life welfare as most of people expected. From many prospects they agreed to put the direct link between the final patient outcome and cost paid whether these costs came from the governments in the form form of public medical insurance or came from private paid enterprises (insurance). Still we have dilemma describing the level of confusion touch healthcare value.  

In 23 December 2010, Michael E. Porter, Ph.D. published article describe the meaning of healthcare value regarding the procedures involved and the related advantaged from the value improvement processes, the main point of value meaning how to deliver proper healthcare services with final outcome comparison with fund paid, this is considered the backbone of any healthcare value core; the link between patient outcome differ parallel with certain society concerns and considerations. The cost is the main point of arguments among all healthcare providers moreover; when it works with the business targets and the enterprises profits annual targets, but from the opposite side; meaning here is our patient still does not care with profit of healthcare providers but unfortunately the patient feedback or final outcome determine almost everything in the healthcare domain or even exceeded that limit to flourish or vanish the whole healthcare economic process and business.

Talk about the cost as denominator of healthcare value measurement, such ideas does not work effectively with patient objects due to their will to see any health improvement, from their viewpoint, therefore; they should see improvement because all these services was paid cost from taxes, most of patients in ill developed countries used to pay taxes monthly, some of these taxes very small fund not matching to create any standard healthcare level services but still they need good and effective healthcare services with proper standards. From this glance the evaluation of healthcare systems depending on cost effectiveness may be considered unfair equation but ongoing minimization of  services costs are unfair either.

In most of tradition health delivery procedures the playing parties try always to minimize the cost and that because the availability of finance and healthcare funding is not enough to cover all. The traditional healthcare systems have a lot of setbacks, most of them are only restricted to the funding resources and involved distributions. huge mistakes have been done by governmental authorities toward their citizens and many still till now. 

Capitalism theory prove that providing services and save the government supervision with control, to enable all healthcare parties to correct all working mistakes and do always continuous evaluations matching with customer needs and demands. Exaggerating the role of introduced value that opens new and innovative development opportunities with good business yield in future. The healthcare system improvement still needs more effort and correction from healthcare workers and to create better life. 

Hierarchical decomposition does not work

for complex adaptive systems

One of the main difference has declared between an old or traditional healthcare system and complex adaptive one is how communication network look like? Previously; that leaded to subsequently to what has built certain sort of gaps between them, whether from work behavior or way of thinking. Although the sort of network involved in most traditional healthcare systems used Hierarchy pattern of delivery services neglecting one of the real purposes of healthcare delivery channel values by which simplify actions of delivered steps complemented with the whole picture of healthcare value measured and to maximize the patient final outcomes related to paid cost. By the contrast; there are many other differences between both being delivery system and the hierarchy working pattern, is  one of the which open wide door to many other disadvantages with management frames and length of service capacity therefore, a lot of working errors with inferior outcomes and modest distribution government, insurance paid finances and resources,

While in the complex adaptive healthcare systems owns the hierarchy network delivery channels with more working independence and autonomy with feasible agility threshold, not only the efficiency that to clarify the patient commitment in unique working methodology but at least not as in traditional systems depending on contractual mode act.

Reforming the traditional working healthcare system has not long term uphold process along many decades whereas, the persistence willingness to do constructive changes is considered the first line of defense because there are a lot of beneficial organizations get ongoing benefits financially. Actually. we can add also the bureaucratic sort of governments and their way of thinking which reflect strongly on operational process and execution. That actually give us the meaningful point, why some countries have attained big steps forwardly while many other ones still thinking how to design or even how to implement.

It worth be mentioned; that was the main target in the early 1990s to develop new modern and find new innovative healthcare system provide good services and put scaffold to maximize the real value matching with paid costs by citizens, at the end of 2008 Estonian healthcare system became the real example express the strong will and challenge to break the routine and different government bureaucracy resistance mechanisms. Moreover; that proved the persistence of government in order to change the traditional medical systems and put Estonian healthcare system among those who achieved top healthcare welfare in very short time as Sweden and Norway.

Undoubtedly; I agree that traditional healthcare frame work does not work with adaptive complex model. Particularly ahead with appearance of Tele-medicine and M-medicine applications  which do uncovering to real working gaps hinder the final patient awaited outcome.

Initial impact of EHR on physicians and nurses

Electronic health records and associated impacts on physicians and nurses are describing the real challenge of difficulties might face the health workers in their career. A study from the Center for Disease Control and Prevention's National Center for Health Statistics survey of 2011 trends showed that 85% of all physicians with EHRs are satisfied with their system, and 74% reported that EHRs enhanced their overall patient care (DesRoches et al., 2012).  The HC working performance indicators own remarkable identification and proving wide gaps among working stakeholders; clearly showing to how far they could be matched and accommodated with new technologies and different way of working. On the level of hospitals; there are many burdens embedded  in the process of digitalize the working business model such as the level of IT skills of the physicians and nurses acceptance and the interest to learn new working systems. It has become predominantly that human feelings play and change resistant pattern figures and reflected the paid effort and training should in future be implemented to reach professionalism.

In the new HC systems, there are three main categories of working items regardless segment names or specialities; patient, provider and society. Moreover; the process of service provision and time of intervention have strong determination closely to the real and realistic uphold with forward predictions whether to whom the services have been introduced or currently done. Therefore; in the future should be. Till there is no complete network of EHR succeeded reach hundred percent coverage particularly between private and public HC providers while mean non-profit providers still little of unaccountability while far away from the public EHR working networks. That do detailed check to the available infrastructure integrated to make EHRs real. The benefits would be got considered, with other definition the 2^nd use of the medical data carries hug demand to the process of numerous healthcare registries on different authorities.

Recently, A University of Pennsylvania study found that nurses working with EHRs consistently reported more improvements to nursing care and better health outcomes for patients than nurses working in hospitals without these working applications. Whatever; where EHR implemented, still some essential characteristica should be over there:

ü  Setting up strong training programs to the HC workers regularly, measuring the level of patient outcomes, identify measuring performance indicators as well as degree of employee acceptance with new apps.

ü  Determine the multiple procedures of securities with patient medical data starting from administration/accessibility, storage, retrieval, processing and monitoring till 2^nd use of data what is called sometimes built out using.

ü  Apply random probing working sample to improve the quality of feedback and correct behind mistakes may affect work pathway later.

ü  The whole EHR should be entirely implemented on the level of state and getting necessary IT infrastructure and associated funds.

ü  Distinguishing a society culture barriers and level of IT skills.

All agree, it takes more time and effort to clearly differentiate the barriers stand in front of EHR. Is that lack of experiences, poor IT development with skills, not enough funds, modest citizens interest to receive medical services through modern technologies or/and lack of enough will from governments to spend more if they can spend less avoiding other considerations. If you have different viewpoint let us know?