Health affairs
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We review the extent and functionality of computerized physician order entry (CPOE) systems in seven Western countries. We compare nations' implementation levels; linkages with other health care information technologies; amount and types of use by clinicians; drivers of implementation; inclusion of decision-support systems and electronic medical records; and goals (for example, patient safety and efficiency). Implementation of CPOE is slower and more problematic than anticipated (adoption rates are 20 percent or less) and often poorly integrated, inducing new errors and generating frustration with user interfaces and repetitive tasks. Nevertheless, the advantages of CPOE remain compelling.
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This study responds to recent calls for information about how personal health expenditures from the National Health Expenditure Accounts are distributed across medical conditions. It provides annual estimates from 1996 through 2005 for thirty-two conditions mapped into thirteen all-inclusive diagnostic categories. ⋯ The most costly conditions were mental disorders and heart conditions. Spending growth rates were lowest for lung cancer, chronic obstructive pulmonary disease, pneumonia, coronary heart disease, and stroke, perhaps reflecting benefits of preventive care.
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This optimistic assessment of the prospects for health reform from senior Democratic and Republican congressmen spells out several reasons why reform can be achieved early in the first year of the Obama administration. Political and policy factors suggest that President-elect Barack Obama is in a much better position than his predecessors to achieve comprehensive health reform, including universal coverage. The Obama administration will have to overcome numerous obstacles and resistance to enact reform. Still, after decades of frustration and disappointment, policymakers should set aside their differences and enable the United States to join the ranks of developed nations by making sure every American has health insurance.
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We examined the impact of implementing a comprehensive electronic health record (EHR) system on ambulatory care use in an integrated health care delivery system with more than 225,000 members. Between 2004 and 2007, the annual age/sex-adjusted total office visit rate decreased 26.2 percent, the adjusted primary care office visit rate decreased 25.3 percent, and the adjusted specialty care office visit rate decreased 21.5 percent. Scheduled telephone visits increased more than eightfold, and secure e-mail messaging, which began in late 2005, increased nearly sixfold by 2007. Introducing an EHR creates operational efficiencies by offering nontraditional, patient-centered ways of providing care.