In industries outside healthcare, highly skilled employees enable substantial gains in productivity after adoption of information technologies. The authors explore whether the presence of highly skilled, autonomous clinical support staff is associated with higher performance among physicians with electronic health records (EHRs). Using data from a survey of general internists, the authors assessed whether physicians with EHRs were more likely to be top performers on cost and quality if they worked with nurse practitioners or physician assistants. It was found that, among physicians with EHRs, those with highly skilled, autonomous staff were far more likely to be top performing than those without such staff (OR 7.0, 95% CI 1.7 to 34.8, p=0.02). This relationship did not hold among physicians without EHRs (OR 1.0). As we begin a national push towards greater EHR adoption, it is critical to understand why some physicians gain from EHR use and others do not.

In this paper we assess the value of electronic health care information exchange and interoperability (HIEI) between providers (hospitals and medical group practices) and independent laboratories, radiology centers, pharmacies, payers, public health departments, and other providers. We have created an HIEI taxonomy and combined published evidence with expert opinion in a cost-benefit model. Fully standardized HIEI could yield a net value of dollar 77.8 billion per year once fully implemented. Nonstandardized HIEI offers smaller positive financial returns. The clinical impact of HIEI for which quantitative estimates cannot yet be made would likely add further value. A compelling business case exists for national implementation of fully standardized HIEI.

Electronic clinical data exchange promises substantial financial and societal benefits, but it is unclear whether and when it will become widespread. In early 2007 we surveyed 145 regional health information organizations (RHIOs), the U.S. entities working to establish data exchange. Nearly one in four was likely defunct. Only twenty efforts were of at least modest size and exchanging clinical data. Most early successes involved the exchange of test results. To support themselves, thirteen RHIOs received regular fees from participating organizations, and eight were heavily dependent on grants. Our findings raise concerns about the ability of the current approach to achieve widespread electronic clinical data exchange.[Health Affairs 27, no. 1 (2008): w60-w69 (published online 11 December 2007; 10.1377/hlthaff.27.1.w60)].

We surveyed regional health information organizations (RHIOs) to assess the state of electronic health information exchange in the United States. We found fifty-five operational RHIOs, and most were focused on exchanging test results. Forty-one percent of operational RHIOs reported receiving sufficient revenue from participating entities to cover operating costs. Of the remainder, only 28 percent expected to ever do so. RHIOs in the planning stage were far more optimistic. Operational RHIOs from our 2007 survey had made little progress in expanding the breadth of their activities. Although the number of operational RHIOs is growing, their scope remains limited and their viability uncertain.

Objective: To determine the financial and clinical benefits of implementing information technology enabled disease management systems. Research Design and Methods: A computer model was created to project the impact of information technology enabled disease management on care processes, clinical outcomes and medical costs for patients with type 2 diabetes over the age of 25 in the United States. Several information technologies were modeled: diabetes registries, computerized decision support, remote monitoring, patient self-management systems and payer based systems. Estimates of care process improvements were derived from published literature. Simulations projected outcomes for both payer and provider organizations, scaled to the national level. The primary outcome was medical cost savings, in 2004 U.S. dollars discounted at 5%. Secondary measures include reduction of cardiovascular, cerebrovascular, neuropathy, nephropathy and retinopathy clinical outcomes. Results: All forms of information technology enabled disease management improved the health of patients with diabetes and reduced health care expenditures. Over ten years, diabetic registries saved $14.5 billion, computerized decision support saved $10.7 billion, payer-centered technologies saved $7.10 billion, remote monitoring saved $326 million, self-management saved $285 million, and integrated provider-patient systems saved $16.9 billion. Conclusions: Information technology enabled diabetes management has the potential to improve care processes, delay diabetic complications and save healthcare dollars. Of existing systems, provider-centered technologies such as diabetes registries currently show the most potential for benefit. Fully integrated provider-patient systems would have even greater potential for benefit. These benefits must be weighed against the implementation costs.

As a result of the high cost of diabetes, an array of interventions for managing this disease has been developed. Estimating the cost of various approaches to diabetes disease management is critical to inform purchasing decisions. This review focuses on 5 provider- and payer-sponsored diabetes management approaches that use information technology (IT) and provides cost estimates for each approach based on a literature review and interviews with 38 provider practices, hospitals, payers, and vendors. Cost estimates are reported for "typical" small, medium, and large provider practices and payers. Provider-sponsored diabetes registries are estimated to be the least expensive approach for small and medium sized practices. For large practices with electronic health record systems, modifying such systems with diabetes-specific clinical decision support capabilities is projected to be the most economical approach. While limited data prevented the inclusion of all implementation costs, these projections serve as a starting point to inform the purchasing decisions of organizations planning to introduce IT-enabled diabetes management.(Disease Management 2007;10:115-128).

Interim results of the Medicare health support (MHS) demonstration projects suggest that commercial disease management (DM) is unable to deliver short-term medical cost savings. This is not surprising given the current DM program focus on compliance with process measures that may only lead to cost savings in the long-term. A program focused on reducing near-term hospitalizations is more likely to deliver savings during the initial 3-year phase of MHS. If the early trends in MHS are indicative of the final results, CMS will face the decision of whether to abandon commercial DM in favor of other chronic care management strategies. This article supports the upcoming assessment by describing the characteristics of the current commercial DM model that limit its ability to deliver short-term medical cost savings and the changes required to overcome these limitations.

OBJECTIVE: To estimate costs and benefits for Australia of implementing health information exchange interoperability among health care providers and other health care stakeholders. DESIGN: A cost-benefit model considering four levels of interoperability (Level 1, paper based; Level 2, machine transportable; Level 3, machine readable; and Level 4, machine interpretable) was developed for Government-funded health services, then validated by expert review. RESULTS: Roll-out costs for Level 3 and Level 4 interoperability were projected to be $21.5 billion and $14.2 billion, respectively, and steady-state costs,$1470 million and $933 million per annum, respectively. Level 3 interoperability would achieve steady-state savings of $1820 million, and Level 4 interoperability,$2990 million, comprising transactions of: laboratory $1180 million (39%); other providers,$893 million (30%); imaging centre,$680 million (23%); pharmacy,$213 million (7%) and public health,$27 million (1%). Net steady-state Level 4 benefits are projected to be $2050 million:$1710 million more than Level 3 benefits of $348 million, reflecting reduced interface costs for Level 4 interoperability due to standardisation of the semantic content of Level 4 messages. CONCLUSIONS: Benefits to both providers and society will accrue from the implementation of interoperability. Standards are needed for the semantic content of clinical messages, in addition to message exchange standards, for the full benefits of interoperability to be realised. An Australian Government policy position supporting such standards is recommended.

Abstract: With heightened interest in Regional Healthcare Information Organizations, policy makers may require guidance on the potential benefits and costs of systems that enable healthcare information exchange and interoperability (HIEI) in their communities. The United Hospital Fund of New York (UHF) engaged CITL to determine the net value of electronic transactions between state healthcare stakeholders with the goal to inform New York healthcare IT policy discussion.