Value of Electronic Health Records Measured Using Financial and Clinical Outcomes: Quantitative Study.

BACKGROUND: The Health Information Technology for Economic and Clinical Health Act of 2009 was legislated to reduce health care costs, improve quality, and increase patient safety. Providers and organizations were incentivized to exhibit meaningful use of certified electronic health record (EHR) systems in order to achieve this objective. EHR adoption is an expensive investment, given the resources and capital that are invested. Due to the cost of the investment, a return on the EHR adoption investment is expected. OBJECTIVE: This study performed a value analysis of EHRs. The objective of this study was to investigate the relationship between EHR adoption levels and financial and clinical outcomes by combining both financial and clinical outcomes into one conceptual model. METHODS: We examined the multivariate relationships between different levels of EHR adoption and financial and clinical outcomes, along with the time variant control variables, using moderation analysis with a longitudinal fixed effects model. Since it is unknown as to when hospitals begin experiencing improvements in financial outcomes, additional analysis was conducted using a 1- or 2-year lag for profit margin ratios. RESULTS: A total of 5768 hospital-year observations were analyzed over the course of 4 years. According to the results of the moderation analysis, as the readmission rate increases by 1 unit, the effect of a 1-unit increase in EHR adoption level on the operating margin decreases by 5.38%. Hospitals with higher readmission payment adjustment factors have lower penalties. CONCLUSIONS: This study fills the gap in the literature by evaluating individual relationships between EHR adoption levels and financial and clinical outcomes, in addition to evaluating the relationship between EHR adoption level and financial outcomes, with clinical outcomes as moderators. This study provided statistically significant evidence (P<.05), indicating that there is a relationship between EHR adoption level and operating margins when this relationship is moderated by readmission rates, meaning hospitals that have adopted EHRs could see a reduction in their readmission rates and an increase in operating margins. This finding could further be supported by evaluating more recent data to analyze whether hospitals increasing their level of EHR adoption would decrease readmission rates, resulting in an increase in operating margins. Hospitals would incur lower penalties as a result of improved readmission rates, which would contribute toward improved operating margins.

Individuals' privacy concerns and adoption of contact tracing mobile applications in a pandemic: A situational privacy calculus perspective.

OBJECTIVE: The study sought to develop and empirically validate an integrative situational privacy calculus model for explaining potential users' privacy concerns and intention to install a contact tracing mobile application (CTMA). MATERIALS AND METHODS: A survey instrument was developed based on the extant literature in 2 research streams of technology adoption and privacy calculus. Survey participants (N = 853) were recruited from all 50 U.S. states. Partial least squares structural equation modeling was used to validate and test the model. RESULTS: Individuals' intention to install a CTMA is influenced by their risk beliefs, perceived individual and societal benefits to public health, privacy concerns, privacy protection initiatives (legal and technical protection), and technology features (anonymity and use of less sensitive data). We found only indirect relationships between trust in public health authorities and intention to install CTMA. Sex, education, media exposure, and past invasion of privacy did not have a significant relationship either, but interestingly, older people were slightly more inclined than younger people to install a CTMA. DISCUSSION: Our survey results confirm the initial concerns about the potentially low adoption rates of CTMA. Our model provides public health agencies with a validated list of factors influencing individuals' privacy concerns and beliefs, enabling them to systematically take actions to address these identified issues, and increase CTMA adoption. CONCLUSIONS: Developing CTMAs and increasing their adoption is an ongoing challenge for public health systems and policymakers. This research provides an evidence-based and situation-specific model for a better understanding of this theoretically and pragmatically important phenomenon.

Running field experiments using Facebook split test.

Business researchers use experimental methods extensively due to their high internal validity. However, controlled laboratory and crowdsourcing settings often introduce issues of artificiality, data contamination, and low managerial relevance of the dependent variables. Field experiments can overcome these issues but are traditionally time- and resource-consuming. This primer presents an alternative experimental setting to conduct online field experiments in a time- and cost-effective way. It does so by introducing the Facebook A/B split test functionality, which allows for random assignment of manipulated variables embedded in ecologically-valid stimuli. We compare and contrast this method against laboratory settings and Amazon Mechanical Turk in terms of design flexibility, managerial relevance, data quality control, and sample representativeness. We then provide an empirical demonstration of how to set up, pre-test, run, and analyze FBST experiments.

Development of an oxirane/acrylate interpenetrating polymer network (IPN) resin system.

OBJECTIVE: Develop a hydrophobic, degradation-resistant dental restorative based on an Oxirane-Acrylate IPN System (OASys) with low shrinkage-stress to substantially extend clinical lifetime. METHODS: Unfilled OASys blends were prepared using dipenta-erythritol-hexaacrylate (DPHA) and p-cycloaliphatic-diepoxide (EP5000). Varying proportions of camphorquinone/iodonium photoinitiator, with a co-reactant oligomeric-diol, served as the experimental curing system. The effects of oxirane-acrylate ratio on the degree-of-cure (Durometer-D hardness), hydrophobicity (contact angle), mechanical properties (3-point bending), near-infrared FTIR degree-of-conversion (DoC), polymerization shrinkage, and shrinkage stress were determined. 70:30 BisGMA:TEGDMA resin served as control. RESULTS: Oxirane tended to decrease hardness and increase hydrophobicity. 0:100, 25:75, 50:50 EP5000:DPHA are harder after 24h than control. 75:25 and 100:0 EP5000:DPHA increased in hardness over 24h, but were softer than control. All groups increased in contact angle over 24h. After 24h, 50:50, 75:25 and 0:100 EP5000:DPHA were more hydrophobic (∼75-84°) than the control (∼65°). Acrylate DoC was ∼60% across all experimental groups. Initial oxirane conversion varied from ∼42% in 100:0 EP5000:DPHA to ∼82% 75:25 EP5000:DPHA. However, oxirane DoC increased for 100:0 EP5000:DPHA to ∼73° over 24h, demonstrating dark cure. Moduli and ultimate transverse strengths of OASys groups were higher than for 0:100 EP5000:DPHA, with 50:50 EP5000:DPHA having higher modulus than other experimental groups. However, the control had higher modulus and UTS than all experimental groups. Volumetric shrinkage averaged 7% for experimental groups, but stress decreased dramatically with increasing oxirane content. SIGNIFICANCE: Hydrophobic, low shrinkage-stress OASys resins are promising for development of composites that improve longevity and reduce the cost of dental care.

Anti-herpesviral effects of a novel broad range anti-microbial quaternary ammonium silane, K21.

We have created a novel quaternary ammonium silane, K21 through sol-gel chemistry, using an ethoxylated version of an organosilane quaternary ammonium compound and TetraEthyl Ortho Silicate (TEOS) as precursors. Previous studies using the precursor molecule quaternary ammonium compounds (QACs) and a methacryloxy version of K21, primarily designed for use in dental healthcare, have shown inhibited growth properties against several types of gram-positive and gram-negative bacteria including Escherichia coli, Streptococcus mutans, Actinomyces naeslundii and Candida albicans etc. Here we tested the effect of K21 on HSV-1, HHV-6A and HHV-7 in in vitro cell culture infection models. Our results show growth inhibitory effect of K21 on HSV-1, HHV-6A and HHV-7 infection.