Understanding whether electronic health records, as currently adopted, improve quality and efficiency has important implications for how best to employ the estimated $20 billion in health information technology incentives authorized by the American Recovery and Reinvestment Act of 2009. We examined electronic health record adoption in U.S. hospitals and the relationship to quality and efficiency. Across a large number of metrics examined, the relationships were modest at best and generally lacked statistical or clinical significance. However, the presence of clinical decision support was associated with small quality gains. Our findings suggest that to drive substantial gains in quality and efficiency, simply adopting electronic health records is likely to be insufficient. Instead, policies are needed that encourage the use of electronic health records in ways that will lead to improvements in care.T he health care industry lags behind others in its use of technologies that promote high quality of service and efficient organizational processes. For years, policy makers have been optimistic that electronic health records could bring important improvements in the coordination and quality of care; generate cost savings by reducing redundant, error-prone care; and improve the overall efficiency of the health care system. 1,2Beginning in 2004, a series of major policy initiatives were launched, whose purpose was to drive the adoption of health information technology (IT). These initiatives, started during the George W. Bush administration, culminated in the enactment of the Health Information Technology Economic and Clinical Health (HITECH) Act as part of the American Recovery and Reinvestment Act (ARRA) of 2009.3 ARRA authorizes an estimated $20 billion in direct grants and financial incentives to promote the adoption and meaningful use of electronic health records among health care providers. 3,4 There is strong evidence that specific electronic health record functions, such as clinical decision support and computerized physician order entry, can improve quality, 5 reduce unnecessary tests, 6-8 and eliminate medication errors. 8,9 However, much of this evidence comes from a small number of high-performing institutions with electronic health record systems tailored to the organization's unique needs. 6,8,10 Evidence of the effect of electronic health records on quality and costs, beyond these pioneering institutions, has been limited.ARRA set a requirement that institutions must demonstrate "meaningful use" of health IT before they can receive federal dollars to help pay for it. The federal government has now proposed regulatory language comprising twenty-five different measures of meaningful use in such areas as care coordination, privacy and security, quality, and safety. As the debate over what constitutes the meaningful use of health information technology continues, understanding whether

BackgroundDue to long waits for primary care appointments and extended emergency department wait times, newer sites for episodic primary care services, such as urgent care centers, have developed. However, little is known about these centers. The purpose of this study is to provide information about the organization and functioning of urgent care centers based on a nationally representative U.S. sample.MethodsWe conducted a mail survey with telephone follow-up of urgent care centers identified via health insurers' websites, internet searches, and a trade association mailing list. Descriptive statistics are presented.ResultsUrgent care centers are open beyond typical office hours, and their scope of services is broader than that of many primary care offices. While these characteristics are similar to hospital emergency departments, such centers employ significant numbers of family physicians. The payer distribution is similar to that of primary care, and physicians' average salaries are comparable to those for family physicians overall. Urgent care centers report early adoption of electronic health records, though our findings are qualified by a lack of strictly comparable data.ConclusionWhile their hours and scope of services reflect some characteristics of emergency departments, urgent care centers are in many ways similar to family medicine practices. As the health care system evolves to cope with expanding demands in the face of limited resources, it is unclear how patients with episodic care needs will be treated, and what role urgent care centers will play in their care.

With increasing attention paid to reducing racial/ethnic disparities in care and the growth of pay-for-performance programs, policy makers and payers are considering the use of such incentive mechanisms to target disparities reduction. This article describes the results of qualitative interviews with hospital executives to assess the potential impact that such programs would have on hospitals and their minority patients. The authors find that executives have significant concerns regarding funding mechanisms and implementation costs, financial risks for safety net hospitals, and resource constraints, as well as how such programs can be used to create incentives to care for minority patients. The findings suggest that payers should be hesitant to use pay-for-performance as a mechanism for reducing disparities until a wide variety of concerns about the design of such programs can be addressed.

Purpose To determine both the intended and unintended effects of the National Institutes of Health (NIH) 2005 ethics rules by examining changes in publishing rates and the frequency of external relationships among NIH scientists. Method After identifying eligible intramural scientists and administrators from institute’s web pages and central directories, a mailed survey was administered to 900 NIH research faculty between October 2008 and January 2009 (response rate 70.1%).A Results Eighty percent of respondents believed the NIH ethics rules were too restrictive. While nearly half (45%) of respondents believed the rules positively impacted the public’s trust in the NIH, over three-quarters (77%) believed the rules hindered the NIH’s ability to complete its mission. Implementation of the ethics rules significantly decreased self-reported GIRs among NIH faculty (from 51.8% to 33.2%, P<.01), including significant drops in consulting (33.1% to 7.8%, P<.01) and scientific advisory board membership (31.5% to 16.0%, P<.01). The policy had limited impact on NIH faculty participation in non-industrial professional service roles and had no detectable change in publishing behavior (5.29 articles per researcher per year from 2002–2005 vs. 5.26 from 2005–2008, P = .88). Conclusions The NIH ethics rules accomplished much of what they were intended to do, limiting relationships with industry while maintaining NIH researchers’ association with external scientific and professional organizations. However, the rules negatively affected personnel morale and the perceived progress of research.