Real World Performance of the 21st Century Cures Act Population Level Application Programming Interface

OBJECTIVE: To evaluate the real-world performance in delivering patient data on populations, of the SMART/HL7 Bulk FHIR Access API, required in Electronic Health Records (EHRs) under the 21st Century Cures Act Rule. MATERIALS AND METHODS: We used an open-source Bulk FHIR Testing Suite at five healthcare sites from April to September 2023, including four hospitals using EHRs certified for interoperability, and one Health Information Exchange (HIE) using a custom, standards-compliant API build. We measured export speeds, data sizes, and completeness across six types of FHIR resources. RESULTS: Among the certified platforms, Oracle Cerner led in speed, managing 5-16 million resources at over 8,000 resources/min. Three Epic sites exported a FHIR data subset, achieving 1-12 million resources at 1,555-2,500 resources/min. Notably, the HIE's custom API outperformed, generating over 141 million resources at 12,000 resources/min. DISCUSSION: The HIE's custom API showcased superior performance, endorsing the effectiveness of SMART/HL7 Bulk FHIR in enabling large-scale data exchange while underlining the need for optimization in existing EHR platforms. Agility and scalability are essential for diverse health, research, and public health use cases. CONCLUSION: To fully realize the interoperability goals of the 21st Century Cures Act, addressing the performance limitations of Bulk FHIR API is critical. It would be beneficial to include performance metrics in both certification and reporting processes

Protecting border groundwater in Ambos Nogales: Application of the Segerson model and the Bellagio Draft Treaty to the Arizona-Sonora border

The purpose of this dissertation is to examine potential solutions to the problem of groundwater contamination between Arizona and Sonora, Mexico. The focus of the study is the binational Santa Cruz River, and other groundwater resources, shared by the two countries. The Santa Cruz River runs through the shared farming and cattle-raising areas to the south and east of Nogales, Sonora and Nogales, Arizona (Ambos Nogales). In addressing the potential problem of contamination in this border area, two approaches are applied to address this potential problem. First, an economic model, the Kathleen Segerson model, which was developed to assess the liability of farmers and agricultural chemical manufacturers in the United States, was expanded to include Mexico and to examine cross-border agricultural contamination. Secondly, a binational groundwater management model, the Bellagio Draft Treaty, was applied to the region of Ambos Nogales to see how it might work in addressing both cross-border agricultural contamination on the Santa Cruz River, as well as industrial and bacterial contamination in the Nogales Wash. Segerson showed that an economically efficient solution could be achieved by holding agricultural chemical manufacturers liable for groundwater contamination. However, the legal difficulties associated with establishing manufacturer liability are numerous and substantial. In addition, holding farmers to best management practices in Mexico is doubtful based on Mexico's ineffective environmental regulatory system. Because of these difficulties, the conditions established by Segerson for the model to work cannot be met. A more effective solution lies in the Bellagio Draft Treaty. The Bellagio Draft Treaty was determined to be a potentially effective way to solve a spectrum of border water issues for the Ambos Nogales area. Some of the problems that could be addressed under the Draft Treaty include: water contamination, equitable division of shared water, health emergencies, and drought planning and response. While this dissertation determines that the Bellagio Draft Treaty could be applicable to the water related problems of Ambos Nogales, the author states that much work will be needed to actually expand the powers of a potential management agency, such as the International Boundary and Water Commission (IBWC)

Household labor decisions and migration in San Luis Potosi, Mexico

In central Mexico's semi-arid highlands, it is common practice for ejidatarios (members of a communal farm, or ejido) to migrate to the United States and other parts of Mexico in order to generate enough household income. Economic and demographic traits within the household affect the decision of an ejidatario to migrate. This thesis examines the effects of those traits on migration decisions. Migration data and household characteristics were collected from 169 ejidatario families (1415 individual family members) from four ejidos in the state of San Luis Potosi, Mexico. In addition, representatives of various governmental and non-governmental organizations who work with the ejidos were interviewed

Aquifer Contamination and Safe Drinking Water: The Recent Santa Cruz County Experience

From the Proceedings of the 1996 Meetings of the Hydrology Section - Arizona-Nevada Academy of Science - April 20, 1996, University of Arizona, Tucson, ArizonaThis article is part of the Hydrology and Water Resources in Arizona and the Southwest collections. Digital access to this material is made possible by the Arizona-Nevada Academy of Science and the University of Arizona Libraries. For more information about items in this collection, contact [email protected]

Effluent Dependent Streams of Arizona

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NEMO Watershed-Based Plan Middle Gila Watershed

Section 1: Introduction, Section 2: Physical Features, Section 3: Biological Resources, Section 4: Social/Economic Characteristics, Section 5: Important Resources, Section 6: Watershed Classification, Section 7: Watershed Management, Section 8: Local Watershed Planning, Section 9: Key Elements, Appendix A: Table 1, Appendix B: Suggested Readings, Appendix C: RUSLE, Appendix D: AGWAU.S. Environmental Protection Agency under the Clean Water Act, Arizona Department of Environmental Quality’s Water Quality Protection Division, University of Arizona Technology and Research Initiative Fund (TRIF), Water Sustainability Program through the Water Resources Research Cente

NEMO Watershed-Based Plan Salt Watershed

Section 1: Introduction, Section 2: Physical Features, Section 3: Biological Resources, Section 4: Social/Economic Characteristics, Section 5: Important Resources, Section 6: Watershed Classification, Section 7: Watershed Management, Section 8: Local Watershed Planning, Section 9: Key Elements, Appendix A: Table 1, Appendix B: Suggested Readings, Appendix C: RUSLE, Appendix D: AGWAU.S. Environmental Protection Agency under the Clean Water Act, Arizona Department of Environmental Quality’s Water Quality Protection Division, University of Arizona Technology and Research Initiative Fund (TRIF), Water Sustainability Program through the Water Resources Research Cente