Can Healthcare IT Save Babies?

The US has a higher infant mortality rate than most other developed nations. Electronic medical records (EMR) and other healthcare information technology (IT) improvements could reduce that rate, by standardizing treatment options and improving monitoring. We empirically quantify how healthcare IT improves neonatal outcomes. We identify this effect through variations in state medical privacy laws that distort the usefulness of healthcare IT. We find that adoption of healthcare IT by one additional hospital in a county reduces infant mortality in that county by 13 deaths per 100,000 live births. Rough cost-effectiveness calculations suggest that healthcare IT is associated with a cost of $450,140 per infant saved

Active Social Media Management: The Case of Health Care

Given the demand for authentic personal interactions over social media, it is unclear how much firms should actively manage their social media presence. We study this question empirically in a health care setting. We show that active social media management drives more user-generated content. However, we find that this is due to an incremental increase in user postings from an organization's employees rather than from its clients. This result holds when we explore exogenous variation in social media policies, employees, and clients that are explained by medical marketing laws, medical malpractice laws, and distortions in Medicare incentives. Further examination suggests that content being generated mainly by employees can be avoided if a firm's postings are entirely client focused. However, most firm postings seem not to be specifically targeted to clients' interests, instead highlighting more general observations or achievements of the firm itself. We show that untargeted postings like these provoke activity by employees rather than clients. This may not be a bad thing because employee-generated content may help with employee motivation, recruitment, or retention, but it does suggest that social media should not be funded or managed exclusively as a marketing function of the firm

Frontiers of Health Policy: Digital Data and Personalized Medicine

This paper argues that due to two unstoppable mechanisms, some of the most pressing future questions in health policy will relate to the use of digital technologies to analyze data concerning patient health. The first mechanism is the shift away from a system where patient data was essentially temporary and not intended to be reused or easily accessed again, to a new digital world where patient data is easily transferred and accessed repeatedly. The second mechanism is a fundamental deepening of the nature of patient data that enables increased personalization of health care for each individual patient, based on not only their detailed medical history, but also their likely future medical history that can be projected for their genetic makeup. We summarize our research investigating the potential consequences of policies in this new world where patient data is virtually costless to store, share, and individualize. We emphasize that issues of data management and privacy are now at the forefront of health policy considerations. Digital data and digital technologies have the potential to transform medicine through two mechanisms. First, digital patient data is far easier to share and access than traditional paper records. This has many potential upsides, but also raises the question of how the potential benefits of sharing patient data are moderated by privacy concerns. Second, the advent of digital storage has now made it possible to store, virtually costlessly, vast swathes of data about any one individual patient. Such individualized data also enables a patient-centric approach to medicine, often referred to as “personalized” or “precision” medicine, based on that individual patient’s genetic makeup. This article discusses the potential benefits and possible policy consequences of this digital shift. It emphasizes that the benefits of digital technologies are found when data is actually transferred and repeatedly accessed. This emphasizes that policies that wish to encourage the potential upside of digital technologies should emphasize easy data transfer. Empirical evidence suggests that health-care providers may not individually have the right incentives to share data, and therefore if a policy aims to encourage data transfer it needs to not only subsidize the adoption of digital technologies, but also make sure that there are the right incentives to use these technologies to share data. Often, well-meaning policies toward data security and data privacy can hamper this process. This article also suggests that there are distinct concerns related to the deepening and individualizing of data that is associated with personalized medicine, and that while there is potentially a large upside in terms of medical outcomes, the risks associated with this data are unusual. If policymakers seek to encourage personalized medicine, they might be especially successful to employ an approach to data management that gives control of the use of the data to the patient.National Science Foundation (U.S.) (Career Award 6923256

Electronic Discovery and the Adoption of Information Technology

After firms adopt electronic information and communication technologies, their decision-making leaves a trail of electronic information that may be more extensive and accessible than a paper trail. We ask how the expected costs of litigation affect decisions to adopt technologies, such as electronic medical records (EMRs), which leave more of an electronic trail. EMRs allow hospitals to document electronically both patient symptoms and health providers’ reactions to those symptoms and may improve the quality of care that makes the net impact of their adoption on expected litigation costs ambiguous. This article studies the impact of state rules that facilitate the use of electronic records in court. We find evidence that hospitals are one-third less likely to adopt EMRs after these rules are enacted

Does Workplace Competition Increase Labor Supply? Evidence from a Field Experiment

This paper develops a novel field experiment to test the implicit prediction of tournament theory thatcompetition increases work time and can therefore contribute to the long work hours required in eliteoccupations. A majority of workers in the treatment without explicit financial incentives worked pastthe minimum time, but awarding a tournament prize increased work time and effort by over 80% andlowered costs of effort or output by over a third. Effort was similar with alternative (piece rate, low-prizetournament) bonuses. Men worked longer than women in the high-prize tournament, but for the sameduration in other treatments

Effects of COVID-19 shutdowns on domestic violence in US cities

We empirically investigate the impact of COVID-19 shutdowns on domestic violence using incident-level data on both domestic-related calls for service and crime reports of domestic violence assaults from the 18 major US police departments for which both types of records are available. Although we confirm prior reports of an increase in domestic calls for service at the start of the pandemic, we find that the increase preceded mandatory shutdowns, and there was an incremental decline following the government imposition of restrictions. We also find no evidence that domestic violence crimes increased. Rather, police reports of domestic violence assaults declined significantly during the initial shutdown period. There was no significant change in intimate partner homicides during shutdown months and victimization survey reports of intimate partner violence were lower. Our results fail to support claims that shutdowns increased domestic violence and suggest caution before drawing inference or basing policy solely on data from calls to police

Privacy Protection and Technology Diffusion: The Case of Electronic Medical Records

Some policymakers argue that consumers need legal protection of their privacy before they adopt interactive technologies. Others contend that privacy regulations impose costs that deter adoption. We contribute to this growing debate by quantifying the effect of state privacy regulation on the diffusion of Electronic Medical Record technology (EMR). EMR allows medical providers to store and exchange patient information using computers rather than paper records. Hospitals may not adopt EMR if patients feel their privacy is not safeguarded by regulation. Alternatively, privacy protection may inhibit adoption if hospitals cannot benefit from exchanging patient information with one another. In the US, medical privacy laws that restrict the ability of hospitals to disclose patient information vary across time and across states. We exploit this variation to explore how privacy laws affect whether hospitals adopt EMR. Our results suggest that inhibition of EMR's network benefits reduces hospital adoption by up to 25 percent. We find similar evidence when we control for the endogeneity of state laws using variation in signups to the 'Do Not Call' list

System Size, Lock-in and Network Effects for Patient Records

We examine empirically whether the size of a firm using a network affects the scope of its network usage, and consequently network effects and lock-in within the network. We use the example of hospital information exchange. We find that hospitals in larger hospital systems are more likely to exchange electronic patient information only within their system and less likely to exchange patient information externally. We show that hospitals are also more likely to exchange information externally if others hospitals also do so. This implies that the disinclination of large hospital systems to exchange data externally harms overall levels of network use. Our results highlight that makers of technology policy designed to encourage the optimal use of networks should consider regulating the behavior of network users as well as technology vendors

Playing the Fertility Game at Work: An Equilibrium Model of Peer Effects

We study workplace peer effects in fertility decisions using a game theory model of strategic interactions among coworkers that allows for multiple equilibria. Using register-based data on fertile-aged women working in medium sized establishments in Denmark, we uncover negative average peer effects. Allowing for heterogeneous effects by worker type, we find that positive effects dominate across worker types defined by age or education. Negative effects dominate within age groups and among low-education types. Policy simulations show that these estimated effects make the distribution of where women work an important consideration, beyond simply if they work, in predicting population fertility

Playing the Fertility Game at Work: An Equilibrium Model of Peer Effects

We study workplace peer effects in fertility decisions using a game theory model of strategic interactions among coworkers that allows for multiple equilibria. Using register-based data on fertile-aged women working in medium sized establishments in Denmark, we uncover negative average peer effects. Allowing for heterogeneous effects by worker type, we find that positive effects dominate across worker types defined by age or education. Negative effects dominate within age groups and among low-education types. Policy simulations show that these estimated effects make the distribution of where women work an important consideration, beyond simply if they work, in predicting population fertility