Differing Strategies to Meet Information‐Sharing Needs: Publicly Supported Community Health Information Exchanges Versus Health Systems’ Enterprise Health Information Exchanges

POLICY POINTS: Community health information exchanges have the characteristics of a public good, and they support population health initiatives at the state and national levels. However, current policy equally incentivizes health systems to create their own information exchanges covering more narrowly defined populations. Noninteroperable electronic health records and vendors' expensive custom interfaces are hindering health information exchanges. Moreover, vendors are imposing the costs of interoperability on health systems and community health information exchanges. Health systems are creating networks of targeted physicians and facilities by funding connections to their own enterprise health information exchanges. These private networks may change referral patterns and foster more integration with outpatient providers. CONTEXT: The United States has invested billions of dollars to encourage the adoption of and implement the information technologies necessary for health information exchange (HIE), enabling providers to efficiently and effectively share patient information with other providers. Health care providers now have multiple options for obtaining and sharing patient information. Community HIEs facilitate information sharing for a broad group of providers within a region. Enterprise HIEs are operated by health systems and share information among affiliated hospitals and providers. We sought to identify why hospitals and health systems choose either to participate in community HIEs or to establish enterprise HIEs. METHODS: We conducted semistructured interviews with 40 policymakers, community and enterprise HIE leaders, and health care executives from 19 different organizations. Our qualitative analysis used a general inductive and comparative approach to identify factors influencing participation in, and the success of, each approach to HIE. FINDINGS: Enterprise HIEs support health systems' strategic goals through the control of an information technology network consisting of desired trading partners. Community HIEs support obtaining patient information from the broadest set of providers, but with more dispersed benefits to all participants, the community, and patients. Although not an either/or decision, community and enterprise HIEs compete for finite organizational resources like time, skilled staff, and money. Both approaches face challenges due to vendor costs and less-than-interoperable technology. CONCLUSIONS: Both community and enterprise HIEs support aggregating clinical data and following patients across settings. Although they can be complementary, community and enterprise HIEs nonetheless compete for providers' attention and organizational resources. Health policymakers might try to encourage the type of widespread information exchange pursued by community HIEs, but the business case for enterprise HIEs clearly is stronger. The sustainability of a community HIE, potentially a public good, may necessitate ongoing public funding and supportive regulation

Using Bibliometric Big Data to Analyze Faculty Research Productivity in Health Policy and Management

Bibliometric big data and social media tools provide new opportunities to aggregate and analyze researchers' scholarly impact. The purpose of the current paper is to describe the process and results we obtained after aggregating a list of public Google Scholar profiles representing researchers in Health Policy and Management or closely-related disciplines. We extracted publication and citation data on 191 researchers affiliated with health administration programs in the U.S. With these data, we created a publicly available listing of faculty that includes each person's name, affiliation, year of first citation, total citations, h-index, and i-10 index. The median of total citations per individual faculty member was 700, while the maximum was 46,363. The median h-index was 13, while the maximum was 91. We plan to update these statistics and add new faculty to our public listing as new Google Scholar profiles are created by faculty members in the field. This listing provides a resource for students and faculty in our discipline to easily compare productivity and publication records of faculty members in their own and other departments. Similarly, this listing provides a resource for faculty, including department chairs and deans, who desire discipline-specific context for promotion and tenure processes

Not only teachers: What do health administration faculty members do?

Researchers have long been interested in how university faculty allocate their time between professional tasks. This study uses multiple years of Health Administration (HA) faculty survey data to examine how work activity has changed over time, and how work activity relates to faculty rank and the type of school in which a faculty member is employed. We report on faculty time allocation to research, teaching, and administration by survey year, faculty rank, and type of school. We also examine factors related to faculty's status as a principal investigator, teaching load, and research funding. On average, HA faculty spent 43% of their time teaching, 31% doing research, 20% in administrative activities, and 5% in other activities. Full professors spent significantly less time teaching, had lighter teaching loads, and spent more time on administration than other faculty. Faculty in schools of health professions, business, and other schools spent more time in teaching and had lower research funding expectations than faculty in schools of public health and medicine. These findings may help faculty identify jobs that best align with their interests and benchmark their work against industry norms. These findings may also help administrators in HA programs set appropriate expectations for their faculty

Quantum Coherence Preservation in Extremely Dispersive Plasmonic Media

Quantum plasmonics experiments have on multiple occasions resulted in the observation of quantum coherence of discrete plasmons, which exhibit remarkable preservation of quantum interference visibility, a seemingly surprising feature for systems mixing light and matter with high Ohmic losses during propagation. However, most experiments to date used essentially weakly confined plasmons, which experience limited light-matter hybridization, thus limiting the potential for decoherence. In this paper, we investigate experimentally the robustness of coherence preservation in a plasmonic system: our setup is based on a hole-array chip supporting plasmons near the surface plasma frequency, where plasmonic dispersion and confinement are much stronger than in previous experiments, making the plasmons much more susceptible for decoherence processes. We, however, report preservation of quantum coherence even in these extreme conditions. We generate polarization-entangled pairs of photons using type-I spontaneous parametric down-conversion and transmit one of the photons through a plasmonic hole array that is numerically designed to convert incident single photons into highly dispersive single surface-plasmon polaritons. Our results show that the quality of photon entanglement after the plasmonic channel is unperturbed by the introduction of a highly dispersive plasmonic element. Our findings provide a lower bound of 100 fs for the pure dephasing time for dispersive plasmons in gold, and show that even in a highly dispersive regime surface plasmons preserve quantum mechanical correlations, making possible harnessing of the power of extreme light confinement for integrated quantum photonics

Disability in activities of daily living, depression, and quality of life among older medical ICU survivors: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>Accurate measurement of quality of life in older ICU survivors is difficult but critical for understanding the long-term impact of our treatments. Activities of daily living (ADLs) are important components of functional status and more easily measured than quality of life (QOL). We sought to determine the cross-sectional associations between disability in ADLs and QOL as measured by version one of the Short Form 12-item Health Survey (SF-12) at both one month and one year post-ICU discharge.</p> <p>Methods</p> <p>Data was prospectively collected on 309 patients over age 60 admitted to the Yale-New Haven Hospital Medical ICU between 2002 and 2004. Among survivors an assessment of ADL's and QOL was performed at one month and one-year post-ICU discharge. The SF-12 was scored using the version one norm based scoring with 1990 population norms. Multivariable regression was used to adjust the association between ADLs and QOL for important covariates.</p> <p>Results</p> <p>Our analysis of SF-12 data from 110 patients at one month post-ICU discharge showed that depression and ADL disability were associated with decreased QOL. Our model accounted for 17% of variability in SF12 physical scores (PCS) and 20% of variability in SF12 mental scores (MCS). The mean PCS of 37 was significantly lower than the population mean whereas the mean MCS score of 51 was similar to the population mean. At one year mean PCS scores improved and ADL disability was no longer significantly associated with QOL. Mortality was 17% (53 patients) at ICU discharge, 26% (79 patients) at hospital discharge, 33% (105 patients) at one month post ICU admission, and was 45% (138 patients) at one year post ICU discharge.</p> <p>Conclusions</p> <p>In our population of older ICU survivors, disability in ADLs was associated with reduced QOL as measured by the SF-12 at one month but not at one year. Although better markers of QOL in ICU survivors are needed, ADLs are a readily observable outcome. In the meantime, clinicians must try to offer realistic estimates of prognosis based on available data and resources are needed to assist ICU survivors with impaired ADLs who wish to maintain their independence. More aggressive diagnosis and treatment of depression in this population should also be explored as an intervention to improve quality of life.</p