of Intermountain Healthcare discusses how evidence-based care process models (CPMs) have enabled improvements in care quality with simultaneous cost savings. Savitz illustrates the success of this strategy by discussing outcomes with implementation of the care of febrile infants evidence-based CPM, explaining that infant stays have dropped to an average of 36 hours from 69 hours previously, readmissions have decreased, and adverse events, including preventable bacterial infections, have fallen significantly. While suggesting that Intermountain’s protocols could be adopted across different models of care delivery, she additionally discusses the larger challenge of sustainability of savings beyond initial implementation.

Rainu Kaushal of Weill-Cornell Medical College posits that electronic health records (EHRs) are defined very differently across the country and that looking at the benefits and costs of interventions involving EHRs necessitates building a common language. However, she asserts that EHRs possess many benefits, including connecting physicians and other healthcare providers in the interest of furthering quality care. Citing some recent studies on EHRs, Kaushal reviews estimates of cost savings from implementation of the various components of EHRs that range up to $77 billion annually and projects even greater savings from long-term chronic disease prevention and management. However, she underscores that the estimates described are restrained by the limited availability of primary data and consequent heavy reliance on expert estimates. She also suggests that the critical cofactors needed for successful implementation and use of EHRs include financial support, technical support (i.e., regional extension center services), and refinement of standards.

Carolyn M. Clancy of the Agency for Healthcare Research and Quality (AHRQ) outlines the work of AHRQ in advancing comparative effectiveness research (CER). She describes CER as a powerful tool in providing the information needed to drive improvement in clinical care. Not only can it assist clinicians and patients in deciding on the best care option at a particular time, but, with the translation of research findings into practical tools, CER additionally promises to address many inequities in health care. She concludes by describing AHRQ’s goals of (1) ensuring that effectiveness data are more widely used, and (2) promoting an open and collaborative approach to comparative effectiveness, which have been facilitated with the support of $300 million in federal dollars dedicated to AHRQ specifically for CER.

Peter K. Smith of Duke University describes the importance of enhancing clinical data as a knowledge utility. Employing the metaphor of the Christmas tree to describe medical records today, he compares current medical records to a tree riddled with a multitude of ornamental information in apparent disarray. Smith suggests that today’s medical record is less a knowledge utility to guide practice and more a tool for controlling



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