Although information technology (IT) is increasingly recognized as a critical tool to improve clinical quality of care, adoption of IT in healthcare lags far behind other industries - in part because of a lack of a national infrastructure. While the creation of a national health information infrastructure (NHII) is currently being discussed, little consensus exists about what the structure of an NHII should be, and even less is known about the potential costs of creating and maintaining an NHII. With the support of PHSI and the Commonwealth Fund of New York City, Dr. Rainu Kaushal is leading a study to assess the structure and costs of an NHII.

An abstract based on the results of the first stage of this project - titled "Assessing the Level of Healthcare Information Technology Adoption in the United States: A 2003 Snapshot of the Boston and Denver Markets" - was accepted by Medinfo 2004. Dr. Kaushal and her colleagues are now in the process of modeling the costs of an NHII. Findings will be disseminated to policy makers and will be featured at national conferences, including the Annual Health Information Management Systems Society (HIMSS) Capitol Day on the Hill and a Commonwealth Fund meeting in Washington, DC. For more information on this project, please visit the PHSI website or email us at phsi@harvard.edu.

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Measuring Return on Investment for Healthcare Expenditures
It is no secret that healthcare in the United States is expensive and growing more so everyday. But these expenditures also bring with them benefits in terms of longer and healthier lives. It is increasingly important that we get a better understanding of how much value we receive from our spending on healthcare, and learn ways to maximize the return we get from our investments. With support from the National Bureau of Economic Research (NBER) and PHSI, Harvard economist Dr. David Cutler and his associates, Drs. Rebecca Woodward and Susan Stewart, are developing a summary measure of the U.S. adult population health to assess the cumulative return we get for our healthcare investments. By building a measure of population health and taking into account how diseases with the greatest impact on the U.S. population (social, cognitive, physical, etc.) affect quality of life as well as mortality, the researchers will examine the value of medial treatment, evaluate how these diseases affect the quality of our lives, and forecast how these diseases are likely to affect population health in the future.

Comparing Value in Healthcare vs. Non-healthcare Interventions
With the support of PHSI, Dr. Peter Neumann at Harvard's School of Public Health has begun working with researchers in diverse fields to create a comprehensive Cost-Effectiveness Registry that includes non-healthcare interventions. Dr. Neumann and his colleagues will attempt to assess the cost-effectiveness of an array of interventions that do not involve the direct provision of medical services - including but not limited to environmental, safety, and occupational programs. The outcomes and results generated by programs such as these can then be compared to those resulting from medical interventions. Drs. Neumann and Cutler will be presenting at a conference sponsored by PHSI this spring. The conference, title "Reassessing the Value Equation: The Consequences of Biomedical Innovation and Healthcare Spending" will be held on April 28, 2004 at the Harvard Medical School Conference Center. For more information, please email us at phsi@harvard.edu.

Improving Healthcare is a Matter of Trust
When the Harvard School of Public Health launched its Trust Initiative in 2002, it set an ambitious goal of regaining lost groun and setting a higher standard for the future. The enthusiastic response from professionals throughout the healthcare industry demonstrated widespread agreement on the importance of the issue and an encouraging level of commitment to reversing the trend toward distrust. The Trust Initiative's first four offering for 2004 respond to the expressed need for events focused on particular areas of interest and are designed for nurses, healthcare executives, managed care professionals, and the wide range of clinicians and administrators concerned with the urgent issue of disparities. For more information and dates for upcoming programs, visit the the Trust Initiative's website at www.hsph.harvard.edu/trustinhealthcare.

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