Objectives With ever increasing mandates to reduce costs and increase the quality of pain management, health care institutions are faced with the challenge of adopting innovative technologies and shifting workflows to provide value-based care. Transaction cost economic analysis can provide comparative evaluation of the consequences of these changes in the delivery of care. The aim of this study was to establish proof-of-concept using transaction cost analysis to examine chronic pain management in-clinic and through telehealth. Methods Participating health care providers were asked to identify and describe two comparable completed transactions for patients with chronic pain: one consultation between patient and specialist in-clinic and the other a telehealth presentation of a patient’s case by the primary care provider to a team of pain medicine specialists. Each provider completed two on-site interviews. Focus was on the time, value of time, and labor costs per transaction. Number of steps, time, and costs for providers and patients were identified. Results Forty-six discrete steps were taken for the in-clinic transaction, and 27 steps were taken for the telehealth transaction. Although similar in costs per patient ($332.89 in-clinic vs. $376.48 telehealth), the costs accrued over 153 business days in-clinic and 4 business days for telehealth. Time elapsed between referral and completion of initial consultation was 72 days in-clinic, 4 days for telehealth. Conclusions U.S. health care is moving toward the use of more technologies and practices, and the information provided by transaction cost analyses of care delivery for pain management will be important to determine actual cost savings and benefits.

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Part I: Introduction Are cities ready for self-driving, artificially intelligent, vehicles and robotics? The urban marketplace is increasingly filled with products emblematic of "smart" cities, from widely discussed autonomous vehicles to smaller variations on the theme, such as robotics for delivery, security, and entertainment. 1 Altogether, such urban robotics represent a new wave of technology in which digital sensors, networked devices, and their associated data stores are given the algorithmic, physical, and legal means to move in public space. 2 As time goes on, the public is increasingly likely to encounter self-driving vehicles, robots, and drones on city streets, sidewalks, and in urban airspace. How should cities respond to these new and impending technologies? Firms have technological, market, and financial interest in testing and deploying their products in public space, but the implications for cities span a broad array of intended and unintended consequences. Cities are natural sites of experimentation for firms interested in bringing these products to market, and the perception of economic opportunity associated with tech firms is leading city representatives to reclaim public spaces, transforming them into testbeds for product development. 3 It is worth noting, however, that experimentation involves trial and error, and there are limitations to the ability of artificial intelligence to navigate the wide range of conditions and events that comprise the urban environment. 4 Ultimately, the design of the 1

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