Recent policy efforts to encourage the use of health information technology are emphasizing development of communitywide health information exchanges to share clinical data across patient care settings. Interviews in twelve U.S. communities show that most large hospitals have or are developing physician portals to provide admitting physicians with remote access to patient records, but there is little data sharing among unaffiliated organizations. Competition among hospitals for physicians is a key factor driving adoption of these proprietary systems. In contrast, provider and health plan competition and adversarial relationships between providers and plans are viewed as major barriers to communitywide clinical data sharing. [Health Affairs 25, no. 6 (2006): 1629-1636 10.1377/hlthaff.25.6.1629 A c o m p e lli n g a r g u m e n t for speeding the adoption of health information technology (IT) is to provide physicians with timely and complete access to their patients' medical records. The fragmentation of the health care delivery system means that pieces of patients' records are housed at multiple locations, most often on paper. Even when provider organizations have clinical IT systems at a given site of care, the systems have limited ability to "talk with each other." Moreover, data usually cannot be shared electronically across sites within an organization or among affiliated providers, let alone with unaffiliated providers.While earlier efforts to promote IT focused on adoption within "silos" (isolated settings) of care, broader "interconnecting" of clinicians has also become a priority for IT advocates more recently. Some providers have begun connecting electronically with others they work with regularly. In contrast, a small number of communities have made progress in developing the infrastructure to support electronic exchange of clinical data among all providers in the market.The Bush administration is actively leading the development of a national health information network (NHIN) that has at its core an interoperable network of regional health information organizations (RHIOs) that can exchange information across the country. In response, many new multistakeholder organizations have sprung up.1 However, major challenges remain in developing a nationwide web of operational RHIOs. 2 M a r k e t W a t c h H E A LT H A F F A I R S~Vo l u m e 2 5 , N u m b e r 6 1 6 2 9

This paper describes gaps in services for low-income people with serious

More than four years after September 11, 2001, bioterrorism preparedness remains a high priority for federal, state, and local governments. With reasonably flexible federal funding, communities have strengthened their ability to respond to public health emergencies, according to assessments by stakeholders and market observers. Collaborative relationships developed for bioterrorism preparedness have proved useful in addressing other threats, such as natural disasters and infectious disease outbreaks. Major ongoing challenges include funding constraints, inadequate surge capacity, public health workforce shortages, competing priorities, and jurisdictional issues.

ABSTRACT:We examine how an integrated delivery system responded to threatened exclusion from an insurer's high-performance network by attempting to reduce costs through fundamental redesign of care processes. Some factors facilitating this transformation, such as its structure as a large salaried medical group exclusively affiliated with a hospital, might be specific to the organization and its market. Other essential elements could be replicated. But in a fee-for-service payment system, cost reduction from reducing the number of services or changing their mix can reduce profitability. Making the business case for sustaining desirable provider behavior may require that purchasers and plans make equally fundamental changes in payment policy. [Health Affairs 26, no. 4 (2007): w532-w544 (published online 10 July 2007; 10.1377/hlthaff.26.4.w532)] H e a lt h c a r e pu r c h a s e r s a r e e x p e r i m e n t i n g with market-based strategies to induce providers to improve value. With tightly managed care out of favor, incentive programs such as pay-for-performance (P4P) and tiered networks garner growing attention. These programs profile providers' performance, give feedback, and offer incentives-direct financial rewards or the promise of higher patient volume-for providers who already have higher quality and lower costs or who reengineer care delivery to improve both.To date, sponsors of incentive programs have been preoccupied with fully engaging providers and with technical design and implementation issues.1 These programs are regarded as not yet achieving full potential.2 It is therefore instructive to consider a case where a provider, willingly engaged, raises questions about w 5 3 2 1 0 J u l y 2 0 0 7 R e d e s i g n i n g C a r e