Congress has expressed concern about electronic health record (EHR) vendors and health care providers knowingly interfering with the electronic exchange of patient health information. These “information blocking” practices would privately benefit vendors and providers but limit the societal quality and efficiency benefits from EHR adoption. We found that information blocking is reported to frequently occur among EHR vendors as well as hospitals and health systems, and that it is perceived to be motivated by opportunities for revenue gain. Because information blocking is largely legal today, the most effective policy response likely involves a combination of direct enforcement and the altering of market conditions that promote information blocking. Context Congress has raised concerns about providers and electronic health record (EHR) vendors knowingly engaging in business practices that interfere with electronic health information exchange (HIE). Such “information blocking” is presumed to occur because providers and vendors reap financial benefits, but these practices harm public good and substantially limit the value to be gained from EHR adoption. Crafting a policy response has been difficult because, beyond anecdotes, there is no data that captures the extent of information blocking. Methods We conducted a national survey of leaders of HIE efforts who work to enable HIE across provider organizations. We asked them about the frequency of information blocking, its specific forms, and the effectiveness of various policy strategies to address it. We received responses from 60 individuals (57% response rate). We calculated descriptive statistics across responses. Findings Half of respondents reported that EHR vendors routinely engage in information blocking, and 25% of respondents reported that hospitals and health systems routinely do so. Among EHR vendors, the most common form of information blocking was deploying products with limited interoperability. Among hospitals and health systems, the most common form was coercing providers to adopt particular EHR or HIE technology. Increasing transparency of EHR vendor business practices and product performance, stronger financial incentives for providers to share information, and making information blocking illegal were perceived as the most effective policy remedies. Conclusions Information blocking appears to be real and fairly widespread. Policymakers have some existing levers that can be used to curb information blocking and help information flow to where it is needed to improve patient care. However, because information blocking is largely legal today, a strong response will involve new legislation and associated enforcement actions.

Silence is often described as to be some kind of important and powerful phenomenon or acoustic appearance in music therapy and of course in other disciplines too. Therefore, it is pertinent to gain more knowledge about how people perceive silence, what effects it has on the individual’s levels of relaxation and human perception of self, time and space. Silence lasting 6:30 minutes preceded by two different conditions consisting of either a university seminar or a session of Depth Relaxation Music Therapy (DRMT) were the two arms of this study carried out at a university with students as subjects. The silence after the DRMT was judged more relaxing than the silence after the seminar. Participants also had a lower sense of space and time, as well as a reduced future perspective. They estimated the silence as having lasted longer in the condition following the DRMT session. These effects support further investigations concerning the idea that silence (combined with DRMT) may be of preventive (e.g. regarding stress-related diseases, depression, burnout and anxiety disorders), relaxing and health-promoting interest for clinical and non-clinical applications.  Keywords: relaxation, music therapy, silence, time, hypnotherapySpanishCambios en el estado de conciencia durante un Período de Silencio , luego de una sesión de Depth Relaxation Music Therapy (DRMT – Relajación Profunda Musicoterapia)El silencio es descripto a menudo como un tipo de fenómeno importante y poderoso o como una aparición acústica en musicoterapia y por supuesto en otras disciplinas también. Por lo tanto, es pertinente contar con más conocimiento sobre cómo las personas perciben el silencio, qué efectos tiene en los niveles de relajación y en la percepción del self, del tiempo y del espacio del individuo. En este estudio, realizado con estudiantes universitarios como sujetos, se realiza un periodo de silencio de 6:30 minutos despues de dos condiciones diferentes: un seminario universitario o una sesión de Depth Relaxation Music Therapy (DRMT). El silencio despues de DRMT se percibió como más relajante que el silencio despues del seminario. Los participantes también tuvieron una menor sensación de espacio y tiempo , así como una perspectiva de futuro reducida. Los autores estimaron que el silencio había durado menos tiempo después de la sesión de DRMT. Estos efectos promueven investigaciones concernientes a que la idea de que el silencio (combinado con DRMT) puede ser preventivo (por ejemplo; enfermedades relacionadas al stress, depresión , burnout, y trastornos de ansiedad), ser relajante y promover el interés por la salud para aplicaciones clínicas y no clínicasPalabras claves: Relajación , musicoterapia, silencio , tiempo , hipnosis GermanVeränderungen im Bewusstseinszustand während einer Periode der Stille nach einer Sitzung tiefenentspannter Musiktherapie (DRMT)Eric PfeiferStille wird oft als eine Art wichtiges und kraftvolles Phänomen oder akustische Erscheinung in der Musiktherapie beschrieben,  und natürlich auch in anderen Disziplinen. Deshalb ist es angemessen, mehr Wissen über Menschen zu erlangen, die Stille erfahren haben – was für Effekte dies auf den individuellen Level an Entspannung und menschliche Erfahrungen von Selbst, Zeit und Raum hat. Die 6,30 minütige Stille , die zwei verschiedenen Bedingungen, bestehend aus einem universitären Seminar oder einer Sitzung von tiefenentspannter Musiktherapie (DRMT) vorausging, bildeten die zwei Teile dieser Studie, die mit Studenten der Universität durchgeführt wurde. Die Stille nach der DRMT wurde als entspannender bewertet als die Stille nach dem Seminar. Die Teilnehmer hatten auch weniger Gefühl für Zeit und Raum, ebenso wie eine reduziertere Zukunftsperspektive. Sie erlebten die Stille in der Zeit die der DRMT folgte, als länger andauernd. Diese Effekte unterstützen zukünftige Untersuchungen die Idee betreffend, dass Stille (zusammen mit DRMT) präventive (z.B. für stress-bedingte Krankheiten, Depression, Burnout und Angststörungen), entspannende und gesundheitsfördernde  Bedeutung für klinische und nicht-klinische Anwendungen haben könnte.Keywords: Entspannung, Musiktherapie, Stille, Zeit, Hypnotherapie  ItalianVariazione dei Stati di Coscienza nel corso di un Periodo di Silenzio dopo una sessione di Depth Relaxation Music Terapy (DRMT) , (Musicoterapia e Rilassamento Profondo)Eric PfeiferIl silenzio è spesso descritto come un fenomeno molto importante e potente, o un aspetto acustico in musicoterapia e naturalmente anche in altre discipline. Perciò è il caso di acquisire maggiori informazioni su come le persone percepiscono il silenzio, quali effetti ha sui livelli individuali di relax e di percezione umana del tempo e dello spazio. Il silenzio di una durata di 6:30 minuti preceduto da due differenti condizioni consistenti in un seminario universitario o in una sessione di Depth Relaxation Music Therapy (DRMT) erano i due diversi modi di effettuare lo studio presso un universitá con gli  studenti. Il silenzio dopo la DRMT è stato giudicato più rilassante rispetto al silenzio dopo il seminario. I partecipanti hanno anche avuto una bassa percezione dello spazio e del tempo, e anche una bassa percezione del futuro. Essi hanno quantificato che il silenzio fosse durato più a lungo dopo aver fatto la sessione di DRMT. Questi effetti supportano ulteriori indagini in materia circa l’idea che il silenzio (in combinazione con la DRMT) può essere di prevenzione (ad esempio per quanto riguarda disagi legati allo stress, depressione, esaurimenti e disturbi d’ansia), rilassante e salutare per applicazioni cliniche e non. Parole Chiave: relax, musicoterapia, silenzio, tempoChinese深度放鬆音樂治療(DRMT)後靜默時間內的意識狀態變化 靜默在音樂治療中常被描述為重要而有力的現象且具有聽覺上的存在感，在其他領域中也常被提及。因此，我們對於人們如何感知靜默需要更多的認識，究竟一個人的放鬆程度以及對自我、時間和空間的觀感如何影響了他對靜默的感知。本研究以大學生為對象，參與者在大學的研討會或深度放鬆音樂治療這兩種不同的情境之後保留為時六分三十秒的靜默時間。跟參加研討會之後的靜默感知相比，在深度放鬆音樂治療之後的靜默被認為感覺較為放鬆。參與者較少感受到空間與時間，也降低了未來感。參與者預期深度放鬆音樂治療之後的靜默時間是比較長的。這些影響可用來支持未來關於靜默的討論研究(與DRMT結合)，激發人們對於靜默的臨床與非臨床應用的興趣，並用於預防性治療(例如，壓力相關疾患、憂鬱、倦怠或焦慮疾患)，放鬆與促進健康 。JapaneseDepth Relaxation Music Therapy (DRMT)後のサイレンス期間における意識状態の変化Eric Pfeifer   サイレンスは度々音楽療法においてある種の重要性、効果現象もしくは音響的輪郭があると描写され、それは他の専門分野においても同様である。それゆえ、人々がどのようにサイレンスを認識するのか、また、何がリラクゼーションの 個人レベル、そして、人間の自己、時間、空間への知覚に影響するのか、さらなる知識を増やすことは適切である。サイレンスは6分30秒の長さで、大学でのセミナー、もしくはDRMTのセッション後という2つの異なった状態で構成され、本研究は大学で学生を被験者として実地された。DRMT後のサイレンスはセミナーの後のサイレンスよりリラックスできると判断された。被験者は空間と時間の知覚が低く、将来への見通しも縮小した。これらの効果は、サイレンス （DRMTとの組み合わせ）は予防的（例：ストレス関連疾患、鬱、バーンアウト症候群、不安障害など）である可能性があること、臨床と非臨床のためのリラクゼーションと健康促進の適用のための重要性があることの考察について、将来の調査を支援する。 Keywords: relaxation, music therapy, silence, time, hypnotherapyキーワード：リラクゼーション、音楽療法、サイレンス、時間、催眠療法 KoreanDepth Relaxation 심층 이완 음악 치료(DRMT) 세션 이후 침묵하는 동안 의식 상태에 생긴 변화Eric Pfeifer침묵은 다른 분야는 물론 음악 치료에서 중요하고 강력한 현상 또는 음향적 식별로 종종 설명이 되곤 한다. 따라서 어떻게 사람들이 침묵을 인식하는 지, 침묵이 개인의 이완 수준과, 자아, 시간, 공간에 대한 인간의 인식에 어떠한 영향을 끼치는 지에 대해 좀 더 많은 지식을 얻는 것이 적합하다. 대학 세미나나 Depth Relaxation Music Therapy(DRMT) 세션으로 구성된 두 가지의 다른 조건을 실시한 후 6시간 30분 동안 지속된 침묵이, 한 대학교에서 학생들을 대상으로 실시한 본 연구의 두 가지 부분이다. DRMT 후 침묵은 세미나 후 침묵보다 더 이완을 시켜주는 것으로 나타났다. 또한 참가자들은 미래에 대한 관점이 줄어들었을 뿐만 아니라 더 낮은 시간과 공간 인식을 가지고 있었다. 그들은 DRMT 세션 종료 상황에서 침묵이 더 오래 지속되었다고 평가했다. 이런 효과는 침묵(DRMT와 접목시킨)이 임상학적으로나 비임상학적으로 예방해주고(예, 스트레스 관련 질병, 우울증, 불안 장애, 극도의 피로) 이완시켜주고, 건강을 증진시키는 효과가 있을 수 있다는 생각과 관련된 추후 조사들을 뒷받침해준다.키워드: 이완, 음악 치료, 침묵, 시간, 최면요법

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SummaryBackground: As EHR adoption in US hospitals becomes ubiquitous, a wide range of IT options are theoretically available to facilitate physician-nurse communication, but we know little about the adoption rate of specific technologies or the impact of their use. Objectives: To measure adoption of hardware, software, and telephony relevant to nurse-physician communication in US hospitals. To assess the relationship between non-IT communication practices and hardware, software, and telephony adoption. To identify hospital characteristics associated with greater adoption of hardware, software, telephony, and non-IT communication practices. Methods: We conducted a survey of 105 hospitals in the National Nursing Practice Network. The survey captured adoption of hardware, software, and telephony to support nurse-physician communication, along with non-IT communication practices. We calculated descriptive statistics and then created four indices, one for each category, by scoring degree of adoption of technologies or practices within each category. Next, we examined correlations between the three technology indices and the non-IT communication practices index. We used multivariate OLS regression to assess whether certain types of hospitals had higher index scores. Results: The majority of hospitals surveyed have a range of hardware, software, and telephony tools available to support nurse-physician communication; we found substantial heterogeneity across hospitals in non-IT communication practices. More intensive non-IT communication was associated with greater adoption of software (r=0.31, p=0.01), but was not correlated with hardware or telephony. Medium-sized hospitals had lower adoption of software (r =-1.14,p=0.04) in comparison to small hospitals, while federally-owned hospitals had lower software (r=-2.57, p=0.02) and hardware adoption (r=-1.63, p=0.01). Conclusions:The positive relationship between non-IT communication and level of software adoption suggests that there is a complementary, rather than substitutive, relationship. Our results suggest that some technologies with the potential to further enhance communication, such as CPOE and secure messaging, are not being utilized to their full potential in many hospitals.

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