In this paper we assess the value of electronic health care information exchange and interoperability (HIEI) between providers (hospitals and medical group practices) and independent laboratories, radiology centers, pharmacies, payers, public health departments, and other providers. We have created an HIEI taxonomy and combined published evidence with expert opinion in a cost-benefit model. Fully standardized HIEI could yield a net value of dollar 77.8 billion per year once fully implemented. Nonstandardized HIEI offers smaller positive financial returns. The clinical impact of HIEI for which quantitative estimates cannot yet be made would likely add further value. A compelling business case exists for national implementation of fully standardized HIEI.

OBJECTIVE—To determine the financial and clinical benefits of implementing information technology (IT)-enabled disease management systems. RESEARCH DESIGN AND METHODS—A computer model was created to project the impact of IT-enabled disease management on care processes, clinical outcomes, and medical costs for patients with type 2 diabetes aged >25 years in the U.S. Several ITs were modeled (e.g., diabetes registries, computerized decision support, remote monitoring, patient self-management systems, and payer-based systems). Estimates of care process improvements were derived from published literature. Simulations projected outcomes for both payer and provider organizations, scaled to the national level. The primary outcome was medical cost savings, in 2004 U.S. dollars discounted at 5%. Secondary measures include reduction of cardiovascular, cerebrovascular, neuropathy, nephropathy, and retinopathy clinical outcomes. RESULTS—All forms of IT-enabled disease management improved the health of patients with diabetes and reduced health care expenditures. Over 10 years, diabetes registries saved $14.5 billion, computerized decision support saved $10.7 billion, payer-centered technologies saved $7.10 billion, remote monitoring saved $326 million, self-management saved $285 million, and integrated provider-patient systems saved $16.9 billion. CONCLUSIONS—IT-enabled diabetes management has the potential to improve care processes, delay diabetes complications, and save health care dollars. Of existing systems, provider-centered technologies such as diabetes registries currently show the most potential for benefit. Fully integrated provider-patient systems would have even greater potential for benefit. These benefits must be weighed against the implementation costs.

We compare health information technology (IT) in the Department of Veterans Affairs (VA) to norms in the private sector, and we estimate the costs and benefits of selected VA health IT systems. The VA spent proportionately more on IT than the private health care sector spent, but it achieved higher levels of IT adoption and quality of care. The potential value of the VA's health IT investments is estimated at $3.09 billion in cumulative benefits net of investment costs. This study serves as a framework to inform efforts to measure and calculate the benefits of federal health IT stimulus programs.

This study was conducted to determine the effects of dietary probiotic supplementation on the ileal digestibilities of nutrients and growth performance in broilers. Two thousand, eight hundred and eighty male broiler chickens at 1 day of age were randomly allotted to eight treatment groups and fed for 6 weeks the maize-soybean meal-based diets containing 0, 0.2, 0.4 or 0.6% AgiPro A100 (a probiotic) and 0 or 6 ppm flavomycin (an antibiotic). This well-established antibiotic was used as a positive control for the efficacy of AgiPro A100. Dietary supplementation with either the probiotic or the antibiotic alone did not affect (P > 0.05) feed intake or average daily gain (ADG) of broilers between days 1 and 42 of life. However, there was a significant antibiotic × probiotic interaction effect (P < 0.05) in increasing ADG during the entire experimental period. Notably, dietary supplementation with the probiotic or the antibiotic consistently improved (P < 0.05) the ileal digestibilities of crude protein and most amino acids in 21-and 42-day-old chickens. Supplementing the probiotic to broiler diets also improved (P < 0.05) the ileal digestibilities of dry matter, energy, calcium and phosphate in the birds. Collectively, these results indicated that AgiPro A100 is an effective alternative to flavomycin in chicken production.

The COVID-19 pandemic response in the United States has exposed significant gaps in information systems and processes to enable timely clinical and public health decision-making. Specifically, the use of informatics to mitigate the spread of SARS-CoV-2, support COVID-19 care delivery, and accelerate knowledge discovery bring to the forefront issues of privacy, surveillance, limits of state powers, and interoperability between public health and clinical information systems. Using a consensus building process, we critically analyze informatics-related ethical issues in light of the pandemic across three themes: (1) public health reporting and data sharing, (2) contact tracing and tracking, and (3) clinical scoring tools for critical care. We provide context and rationale for ethical considerations and recommendations that are actionable during the pandemic, and conclude with recommendations calling for long-term, broader change (beyond the pandemic) for public health organization and policy reform.

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Objective This article reports results from a systematic literature review related to the evaluation of data visualizations and visual analytics technologies within the health informatics domain. The review aims to (1) characterize the variety of evaluation methods used within the health informatics community and (2) identify best practices. Methods A systematic literature review was conducted following PRISMA guidelines. PubMed searches were conducted in February 2017 using search terms representing key concepts of interest: health care settings, visualization, and evaluation. References were also screened for eligibility. Data were extracted from included studies and analyzed using a PICOS framework: Participants, Interventions, Comparators, Outcomes, and Study Design. Results After screening, 76 publications met the review criteria. Publications varied across all PICOS dimensions. The most common audience was healthcare providers (n = 43), and the most common data gathering methods were direct observation (n = 30) and surveys (n = 27). About half of the publications focused on static, concentrated views of data with visuals (n = 36). Evaluations were heterogeneous regarding setting and measurements used. Discussion When evaluating data visualizations and visual analytics technologies, a variety of approaches have been used. Usability measures were used most often in early (prototype) implementations, whereas clinical outcomes were most common in evaluations of operationally-deployed systems. These findings suggest opportunities for both (1) expanding evaluation practices, and (2) innovation with respect to evaluation methods for data visualizations and visual analytics technologies across health settings. Conclusion Evaluation approaches are varied. New studies should adopt commonly reported metrics, context-appropriate study designs, and phased evaluation strategies.

Telehealth has great potential to improve access to care but its adoption in routine health care has been slow. The lack of clarity about the value of telehealth implementations has been one reason cited for this slow adoption. The Center for Information Technology Leadership has examined the value of telehealth encounters in which there is a provider both with the patient and at a distance from the patient. We considered three models of telehealth: store-and-forward, real-time video and hybrid systems. Evidence from the literature was extrapolated using a simulation, which found that the hybrid model was the most cost-effective of the three. The simulation predicted savings of $4.3 billion per year if hybrid telehealth systems were to be implemented in emergency rooms, prisons, nursing home facilities and physician offices across the US. We also conducted a sensitivity analysis to determine which factors most affected costs and savings. For all three telehealth models, the highest sensitivities were to the cost of a face-to-face visit, the cost of a telehealth visit and the success rate of a telehealth visit, i.e. the proportion of telehealth visits that avoided the need for a face-to-face visit. Payers, providers and policy-makers should work together to remove the barriers to the adoption of telehealth in order to make it widely available to all.