ahier’s posterous

First, they teleported photons, then atoms and ions. Now one physicist has worked out how to do it with energy, a technique that has profound implications for the future of physics.

In 1993, Charlie Bennett at IBM's Watson Research Center in New York State and a few pals showed how to transmit quantum information from one point in space to another without traversing the intervening space.

The technique relies on the strange quantum phenomenon called entanglement, in which two particles share the same existence. This deep connection means that a measurement on one particle immediately influences the other, even though they are light-years apart. Bennett and company worked out how to exploit this to send information. (The influence between the particles may be immediate, but the process does not violate relativity because some informatiom has to be sent classically at the speed of light.) They called the technique teleportation.

That's not really an overstatement of its potential. Since quantum particles are indistinguishable but for the information they carry, there is no need to transmit them themselves. A much simpler idea is to send the information they contain instead and ensure that there is a ready supply of particles at the other end to take on their identity. Since then, physicists have used these ideas to actually teleport photons, atoms, and ions. And it's not too hard to imagine that molecules and perhaps even viruses could be teleported in the not-too-distant future.

But Masahiro Hotta at Tohoku University in Japan has come up with a much more exotic idea. Why not use the same quantum principles to teleport energy?

Today, building on a number of papers published in the last year, Hotta outlines his idea and its implications. The process of teleportation involves making a measurement on each one an entangled pair of particles. He points out that the measurement on the first particle injects quantum energy into the system. He then shows that by carefully choosing the measurement to do on the second particle, it is possible to extract the original energy.

All this is possible because there are always quantum fluctuations in the energy of any particle. The teleportation process allows you to inject quantum energy at one point in the universe and then exploit quantum energy fluctuations to extract it from another point. Of course, the energy of the system as whole is unchanged.

He gives the example of a string of entangled ions oscillating back and forth in an electric field trap, a bit like Newton's balls. Measuring the state of the first ion injects energy into the system in the form of a phonon, a quantum of oscillation. Hotta says that performing the right kind of measurement on the last ion extracts this energy. Since this can be done at the speed of light (in principle), the phonon doesn't travel across the intermediate ions so there is no heating of these ions. The energy has been transmitted without traveling across the intervening space. That's teleportation.

Just how we might exploit the ability to teleport energy isn't clear yet. Post your suggestions in the comments section if you have any.

But the really exciting stuff is the implications this has for the foundations of physics. Hotta says that his approach gives physicists a way of exploring the relationship between quantum information and quantum energy for the first time.

There is a growing sense that the properties of the universe are best described not by the laws that govern matter but by the laws that govern information. This appears to be true for the quantum world, is certainly true for special relativity, and is currently being explored for general relativity. Having a way to handle energy on the same footing may help to draw these diverse strands together.

Interesting stuff. There's no telling where this kind of thinking might lead.

Ref: arxiv.org/abs/1002.0200: Energy-Entanglement Relation for Quantum Energy Teleportation

The push by healthcare providers to create electronic medical record systems is creating demand for new talent.

Government Technology reports that hospitals are interested in converting to electronic health records now because last year's American Reinvestment and Recovery Act set aside $19 billion in incentives for systems that meet specific criteria. Dr. Mark Leavitt, chairman of the Certification Commission for Healthcare Information Technology, referred to the stimulus package as "the biggest thing that's ever happened in health IT."

Indeed, the Texas Tribune reports that according to the Office of the National Coordinator in Washington, D.C., the country will need an additional 50,000 skilled workers in the next five years to help convert to electronic health records. To help train students in these new jobs, Texas State University in San Marcos and the University of Texas at Austin are partnering with the University of Texas School of Health Information in Houston to apply for a new federal grant in health information which is expected to bring as much as $6 million to the three schools.

Susan Fenton, an assistant professor at Texas State who is heading the grant application, noted that the demand for technologically skilled workers will be especially high in rural areas in the state. "Not only would they have the demand because they haven't had the resources to implement already," she explained to the Tribune, "but they would also have the most need in terms of the training because it's hard for them to improve staff."

Similarly, Austin Community College began training health IT students this fall after launching a new associate's degree program in health information technology. According to Norma Mercado, the program director, those who enroll in the program are current hospital employees interested in gaining additional skills.

Information Week adds that healthcare IT professionals are probably in the best position to find jobs in 2010. MEDecision, for example, a Pennsylvania-based company specializing in healthcare management solutions, added 50 employees in 2009 and plans to hire another 100 IT and health IT professionals this year, according to CEO Scott Storrer.

New research on Type 2 diabetes by Trinity College Dublin  researchers could benefit young adults (aged 18-25 years) with the condition. The research led by Professor John Nolan of Trinity College Dublin and St James’s Hospital, Dublin, has just been published online in the leading international journal, Diabetes Care¹.

The study findings demonstrate new mechanisms in muscle cells that may explain severe insulin resistance which is the body’s decreased ability to respond to the effects of insulin, and a reduced response to aerobic exercise in young obese patients with Type 2 diabetes.   These important findings will contribute in the longterm to the development of more specific treatments for young people with Type 2 diabetes.

Type 2 diabetes is the most common form of diabetes. It occurs because the body produces too little insulin and is unable to properly use the insulin that is secreted. It usually occurs in older people although it is becoming more common among younger people, partly due to lifestyle factors such as diet, lack of physical activity and obesity. The highest rates occur in countries with modern lifestyles.  Type 2 diabetes accounts for approximately 85%-90% of all cases of diabetes in European countries².  It is estimated that 129,052 people in the Republic of Ireland have adult Type 2 diabetes or 4.3% of the adult population³.

Commenting on the significance of the  research, Professor John Nolan of the Department of Clinical Medicine, TCD, who led the Metabolic Research Group, said: “Type 2 diabetes is presenting in much younger people, usually because of early onset obesity and a strong family background of diabetes.  These studies provide us with important new insights into the way diabetes develops and progresses in these young patients.  In this study, we have shown that obese young patients with Type 2 diabetes, in contrast to equally obese young people without diabetes, have abnormal function of key mitochondrial genes and proteins.  Mitochondria are the energy centres in cells and these abnormalities contribute to insulin resistance and a severely blunted response to physical exercise.  Aerobic exercise is very effective in preventing and treating Type 2 diabetes in middle aged and older people.”

 “Type 2 diabetes is the major chronic disease of modern societies”, continued Professor Nolan, “and threatens the health of populations, most dramatically in Asia and developing countries.  Designing specific treatments for Type 2 diabetes in young people depends on a more exact understanding of the cellular mechanisms of this disease.  Our studies of muscle mitochondrial function have allowed us to focus intervention studies on these important new mechanisms.”

The research was carried out by the Metabolic Research Unit at Trinity College Dublin based at St James’s Hospital. These studies are part of an ongoing research programme by Professor Nolan’s team into the causes and treatment of Type 2 diabetes and severe insulin resistance in young people.  The investigations were done in collaboration with Professor Antonio Zorzano at the Institute for Research in Biomedicine, Barcelona. The studies were funded by grants from the European Foundation for the Study of Diabetes and from the EU Commission as well as grants from the Ministerio de Educación y Cultura in Spain.

Notes to the Editor:

1. Diabetes Care is a journal published by the American Diabetes Association.
The full title of the article is Subjects with early-onset type 2 diabetes show defective activation of the skeletal muscle PGC-1α/mitofusin-2 regulatory pathway in response to physical activity.  The article was published online on December 23rd last, and will appear in print version in March, 2010.

2.  Making Diabetes Count: What does the future hold?  Institute of Public Health in Ireland  (2006), p. 14

3.  Making Diabetes Count: What does the future hold?  Institute of Public Health in Ireland (2006), p. 40

 

Ally Zwahlen and her husband Steve are eager to start a family. They are both in good health. But they want to assess the risks: are they in danger of having children with a rare, inherited disease or some sort of devastating illness?

Hundreds of patients try a new cancer treatment after a "World News" report.

A new form of screening, called the Counsyl Universal Genetic Test, could give them the answers they need.

"I'm confident that it's going to alleviate a lot of uncertainties, and provide peace of mind," Ally, who is 32 and lives in Danville, Calif., told ABC News.

"Before you get pregnant, do this test"

Some doctors are gushing about the new test.

"I tell all my friends about it," said Dr. Aimee Eyvazzadeh of John Muir Health Systems near San Francisco. "You know, my girlfriends who are getting married right now and who are planning a pregnancy? I tell them, 'Before you get pregnant, do this test.'"

Unlike traditional genetic tests, which require a blood sample to help find one specific disease, the new test uses a little saliva to look for genetic markers linked to 109 inherited diseased ranging from cystic fibrosis and Pompe disease to sickle cell disease and Tay-Sachs.

"We are looking for mutations that parents unknowingly carry. They would have no symptoms," said Ramji Srinivasan, CEO of Counsyl, the company making the new test. "Before today, it had never been easy, convenient and reliable to get a pre-pregnancy test at home," he said. "This will dramatically reduce the incidence of diseases that are passed from parent to child."

For $350, Counsyl says it will screen the samples at its lab in Redwood City, Calif., looking for more than 400 genetic mutations. The company says the results are available in less than a week.

Other Options

If both husband and wife test positive for the same disease, there are steps they can take to protect their future children. Couples could go through in vitro fertilization, for example; doctors could check each resulting embryo and implant only those that appear free of disease.

Many geneticists we contacted, though excited about the new test, do urge caution.

"This new genetic test is an important first step," says Dr. Priya Kishnani, a geneticist at Duke University Medical Center told ABC News. "But the jury is still out on whether it can deliver everything it promises; whether it's as thorough and definitive as the marketing suggests."

Article below originally appeared at hhnmag.com

By Gene J. O'Dell & Lee Ann Runy

The 2010 American Hospital Association Environmental Scan provides insight and information about market forces that have a high probability of affecting the health care field. It is designed to help hospital and health system executives better understand the health care landscape and the critical trends and issues their organizations will likely face in the foreseeable future. The 2010 AHA Environmental Scan foldout is compiled from 35 nationally recognized sources with recommendations from select AHA governance committees. The scan is produced by Gene J. O'Dell, the AHA's vice president for strategic and business planning, with research assistance from Donna J. Aspy, project manager, strategic and business planning. Lee Ann Runy, H&HN's senior editor of custom publications, compiled the information.

Information Technology & E-Health

• The projected IT priorities of hospitals for the next two years are: inpatient clinical information systems (40 percent), the reduction of medical errors and the promotion of patient safety (39 percent), EMR implementation (38 percent), and connecting the hospital with remote environments (30 percent). 14

   

• Hospitals will make significant investments in their systems for measuring and reporting clinical outcomes over the next two years, according to a survey of managers from more than 50 U.S. health systems conducted by Health Care Management Insight. Only 12 percent report that substantial detail is available and easy to analyze for clinical process data and 21 percent for clinical outcomes data. By contrast, 39 percent of hospitals represented in the survey say they can easily analyze detailed data about departmental financial performance. About 80 percent of respondents said departmental financial performance data is available to most managers. The distribution of clinical process and outcomes reports is limited to a few managers at about 42 percent of hospitals. 15

   

• The most significant barriers to implementing IT were: lack of financial support (26 percent), lack of staffing resources (13 percent) and vendors' inability to effectively deliver product (12 percent). 14

   

• Implementing new technology is costly to hospitals, however, the benefits—both financial and nonfinancial—accrue primarily to payers and patients. 16

   

• The American Recovery and Reinvestment Act of 2009 has a number of goals, one of which is to reduce long-term costs by modernizing health care through the use of information technology. To drive adoption of electronic health records by 2015, the federal government will invest $36 billion in Medicare and Medicaid providers and through government agencies between 2010 and 2017. The funding will go to providers that show meaningful use government-certified systems. Analysis shows that an average 500-bed hospital would receive an average of $6.1 million in incentives. 17

   

• Many Americans think that greater access to information would improve health care quality. Seventy-four percent say the quality of the medical care they receive would improve if they had access to more information about the success of different treatment options. Thirty-five percent indicate that quality would improve if they knew the full price of the health care services they receive, not just what they pay. 18

Insurance & Coverage

• Medicare now spends more than 25 percent of its budget on patients in their last year of life. 19

   

• Uncompensated care in 2008 totaled $57.4 billion. Of that, $35 billion was provided by hospitals, $14.6 billion by community based providers, and $7.8 billion by private office-based physicians. Uncompensated care has been relatively stable at 6 percent of hospital costs for many years, despite a steady increase in the percentage of people uninsured. 34

   

• While health care costs continue to rise and health insurance becomes less affordable, the public sector has fewer resources to respond to growing needs for coverage or subsidized care. The combination of ongoing state budget constraints, unwillingness to raise taxes and federal budget pressures has left state and local governments hard-pressed to keep up with growing needs for coverage and care. 20

   

• Payers will look to implement a variety of programs that reduce costs and emphasize health outcomes. 21

   

• UnitedHealth Group is testing a new model of health care that will give doctors more authority and money than usual in return for closely monitoring their patients' progress, even when patients go to specialists or require hospitalization. The insurer will also move away from paying doctors solely on the basis of how many services they provide, and will start rewarding them for the overall quality of care patients receive. The theory is that by providing a home base for patients and coordinating their treatment, doctors can improve care, prevent unnecessary emergency room visits, reduce hospitalizations, and lower overall medical spending. 22

   

• If everyone in the United States had health insurance coverage, the possible cumulative health system savings could amount to more than $1.5 trillion over 10 years. Rather than national health expenditures rising from 16 percent of GDP in 2006 to 20 percent by 2017—as is currently projected—spending could be held to 18.5 percent of GDP. 23

Political Issues

• On the patient-safety front, Congress and the administration will expand existing reporting requirements and adopt new ones, and will expand existing Medicare policy that penalizes providers financially for medical errors. 24

   

• Medicare, Medicaid and commercial insurance companies are placing additional focus on hospital performance. The Centers for Medicare & Medicaid Services has proposed adding a new index starting in October 2009: the total performance score. It's part of Medicare's move to value-based purchasing. If Congress approves, CMS would replace the current quality reporting system with one in which Medicare withholds between 2 percent and 5 percent of its reimbursements to hospitals, which the hospital would have to earn back through performance and progress on quality metrics. 5

   

• The federal government will use direct and indirect interventions to control Medicare spending. Direct interventions will include the application of traditional techniques for controlling Medicare costs, primarily through reductions in the annual provider rate updates. 24

   

• The sensitivity of state budgets to economic cycles contributes to fluctuations in health coverage, eligibility, benefits and provider payment levels in public programs, as well as support for safety net hospitals and community health centers. Along with bolstering support of safety net providers and raising Medicaid payments for private physicians, some states advanced even more ambitious health reform proposals. Yet across communities, safety net systems face mounting challenges of caring for more uninsured patients, and these pressures will likely increase given the current economic downturn. 25

   

• The current trajectory of increasing utilization and costs of health care cannot and will not be sustained over the long term. Government, business and primary payers have begun initiating reforms that will seek to pay for services based on value and to create a more granular level of detail on the services provided by expanding the diagnosis-related group system. 9

Provider Organizations & Physicians

• Hospitals are responding to the economic challenges that are impairing financial performance. Hospitals are: making greater use of board members' financial and investment expertise when formulating budgets, debt plans and investment allocations; garnering board support for expense reductions; delaying nonessential capital spending to increase liquidity until financial performance improves or access to the capital market is more favorable; and re-evaluating return on new investment for large-scale capital projects given current economic realities. 26

   

• There is a growing gap between the have and have-not hospitals. While some hospitals today enjoy healthy profit margins, many hospitals continue to be unprofitable. For hospitals to be economically viable in the future, the following principles must be pursued: align performance and payment systems to meet quality and efficiency-related goals; use process-improvement tools to increase efficiency and reduce costs; pursue coverage options to ensure patient access to, and affordability of, health care services; and address how both general acute care hospitals and specialty hospitals can fulfill the social mission for health care delivery. 27

   

• Hospitals are experiencing an increase in bad debt. Payer mix is shifting away from relatively lucrative commercial insurers toward Medicare, Medicaid and self-pay. Charitable donations and investment income are down, and improvement projects involving capital outlays for IT, facilities and equipment have been put on hold. 5

   

• Physician employment by hospitals will increase. This trend will continue as physicians question the economic viability of the private practice model. Younger physicians have different lifestyle expectations, meaning more physician activity will be split into an inpatient medicine component and an office-based practice component. 35

Quality & Patient Safety

• A majority of health care leaders responding to a Commonwealth Fund study believe that the U.S. health care system is not providing sufficiently high quality care and that changes must be made at the highest level. About 95 percent of respondents believe that fundamental payment reform is needed and 56 percent support the creation of a new public-private entity to formulate a national quality agenda and coordinate quality efforts. 28

   

• According to the Agency for Healthcare Research and Quality's National Healthcare Quality Report, aggregate quality of care improved each year from 1994 to 2008. However, the rate of improvement seems to have slowed. The median annual rate of change for the 39 core measures was 1.8 percent over the past six years. NHQR data shows that sustaining a steady rate of improvement over time is a challenge and that there is significant geographic variation in quality of care. 29

   

• It is likely that all hospital boards will have a committee or subcommittee on hospital quality and patient safety by 2014. Boards will devote more of their meeting time to discussing quality than to discussing financial performance. 18

   

• Coordinating care over time and sites, especially for those with complex conditions, can help ensure that patients receive appropriate follow-up treatment and minimize the risk of errors and complications. Having a doctor who is available and serves as a central source of primary care and referral facilitates care continuity and coordination. Yet nearly one-third of adults and more than half of all children do not have such a primary care medical home. 30

Science & Technology

• New technology—its introduction and its use—accounted for 20 percent to 40 percent of the annual rise in U.S. health care spending since 1960. 31

   

• Telemedicine is transforming the traditional view of medicine. It can help determine whether or not a patient needs to go to the emergency department or the doctor's office. Physician reimbursement has been a barrier to the use of remote monitoring technology. It's difficult for doctors to support the technology that adds more work to their day without payment. Medical liability and other legal concerns, as well as security and privacy issues, have also come into play as potential obstacles to the growth of telemedicine. 32

   

• The direct-to-consumer market for genetic testing will expand as the cost continues to drop. Direct-to-consumer marketing of these tests bypasses traditional clinicians, raising questions about how the information affects diagnosis and treatment. The National Human Genome Research Institute has set $1,000 as the target price for genome sequencing. Providers, payers and regulators must adhere to the Genetic Information Nondiscrimination Act passed in 2008. Insurers won't be able to deny coverage or raise premiums to individuals based on their genetic predispositions to developing certain diseases. 5

   

• The number of activist disease foundations—foundations that operate with speed and urgency and a business model completely unlike the traditional foundation model—is growing. These groups use all their money to finance targeted research, hold conferences where scientists must share information, and underwrite clinical trials conducted by drug companies. The Michael J. Fox Foundation has used its money to take control of Parkinson's research like few other foundations have ever done. The foundation has upended the way scientific research is done, and the way academics interact with pharmaceutical and biotech companies. It demands accountability and information sharing that is almost unheard of in the broad scientific community. 37

Human Resources

• A large part of the employment growth in America over the next two decades will be in the health care sector. The biggest growth will occur in the front-line workforce—nursing, assistants, home health aides, long-term care assistants and others—who will provide essential care and services to an aging population. However, unlike many other health professionals, these individuals are often at risk by making lower wages, having less generous benefits and fewer opportunities for education and advancement. It's likely that much of this workforce is, or soon will be, unionized. 12

   

• Saying they need a more "powerful national movement" to protect nurses, three unions merged in late February. United American Nurses, the California Nurses Association National/Nurses Organizing Committee and the Massachusetts Nurses Association formed the United American Nurses—National Nurses Organizing Committee. The 150,000-member union is part of the AFL-CIO. The group's highest priority is RN unionization. Legislatively, the group will push for nurse staffing ratios, workplace safety rules and a national pension for RNs. 8

   

• Few young physicians are going into primary care and many physicians already in primary care are under such stress that they are looking for an exit strategy, according to the American College of Physicians. Challenges include: declining incomes, high patient volume, rising expenses and policies from insurers that encourage rushed office visits. As a result, more primary care doctors are retiring than are graduating from medical school. 13

Consumers & Demographics

• Nearly 44 percent of the U.S. civilian, noninstitutionalized population had one or more chronic conditions in 2005. Of these, one in five reported living with one chronic condition, 10.7 percent reported two conditions, and 13.3 percent had three or more chronic conditions. The most dramatic rise in the presence of chronic disease occurred among adults between early adulthood (ages 20 to 44) and midlife (ages 45 to 64). These age groups had an increase of 32.4 percent and 63.1 percent, respectively, of people with at least one chronic condition. 4

   

• Employers are increasingly interested in incentives to encourage responsible health behaviors and participation in wellness and disease management programs. According to a survey by PricewaterhouseCoopers, large employers are leading this trend, with more than 60 percent at least somewhat likely to offer incentives as a health strategy over the next 12 to 24 months. In addition, half of the small employers surveyed are at least somewhat likely to employ the strategy. However, wellness programs don't work if employees don't participate, and most don't. Less than 15 percent of eligible individuals enroll in wellness programs. 5

   

• Mental illness causes more disability than any other class of illness in the United States. One-in-four Americans experience mental illness at some point in their lifetimes. Twice as many Americans live with schizophrenia as live with HIV/AIDS. A study by the National Alliance on Mental Illness gives the nation's public mental health care system a D grade. As the country faces the deepest economic crisis since the Great Depression, state budget shortfalls mean budget cuts to mental health services. 6

   

• About 66 percent of Americans are overweight or obese, according to the Centers for Disease Control and Prevention. Death due to poor diet and physical inactivity rose by 33 percent in the past decade and may soon overtake tobacco as the leading preventable cause of death. 7

Economy & Finance

• Hospitals' median days-cash-on-hand reached a historic low in the third quarter of 2008 of 110 days. The median bad debt percentage is within historic range, while charity care percentage is consistently trending upward. The hospital industry is not recession-proof. Observed impacts that appear related to the recession, include: hospital nonoperating and total margins have decreased dramatically, especially in the third quarter of 2008 and total margins are at historically unprecedented lows. Approximately 50 percent of hospitals are operating in the red. 8

   

• Access to capital will become more strained and expensive. Even solid-performing organizations will experience a change in access to capital due to the overall condition of the capital markets. Providers will have to make serious choices about what services and programs they are able to fund over others. 9

   

• In a survey of 639 hospitals, the vast majority reported that their ability to rely on philanthropic contributions and borrow funds through tax-exempt bonds and bank loans—the three most common sources of capital—has become significantly more difficult or even impossible. 10

   

• More than half of all health care spending, calculated at up to $1.2 trillion of the $2.2 trillion spent nationally, is attributable to defensive medicine ($210 billion annually), inefficient claims processing (up to $210 billion annually) and care spent on preventable conditions related to obesity and overweight ($200 billion annually). 11

Associations

• Associations must produce products and services that deliver the highest possible value to members. To be effective, associations should discover their members' unarticulated needs and innovate and develop valuable benefits that meet these needs. Associations should also be aware of programs that provide low value or that distract staff from working on higher value programs. It may be necessary to drop these programs. Associations that identify and articulate a purpose that inspires its members to feel that they are contributing to the advancement of society may hold an advantage over those that do not. 1

   

• To remain credible, associations may have to demonstrate their own dedication to responsible and sustainable business practices while taking care of their own triple bottom line—member value (profit), staff and community (people) and the environment (the planet). 2

   

• Remarkable associations maintain a clear understanding of their core purpose and willingly adapt how they do business in order to remain consistent with that purpose, regardless of whether change is anticipated. Successful associations remain more steadfast in their commitment to their members and their mission. 3

   

• Associations face the constant challenge of remaining trusted and relevant in a world of changing values and attitudes. 2

   

• A potential opportunity to take a leadership role for associations is to facilitate strategic conversations about the future of their sectors or professions. These discussions should address the opportunities and challenges associated with a changing environment and workforce dynamics. 2

Resources

1. Further Discussion of Five Super-Trends, by Benjamin Martin, ASAE & The Center for Association Leadership, 2007
2. Designing Your Future, Key Trends, Challenges, and Choices Facing Association and Nonprofit Leaders by Fast Future and ASAE & The Center for Association Leadership, 2008
3. Measures of Success, ASAE & The Center for Association Leadership, Fall 2006
4. Rising Out-of-Pocket Spending for Chronic Conditions: a Ten-Year Trend, Health Affairs Web exclusive, January/February 2009
5. Top Nine Health Industry Issues in 2009: Outside Forces will Disrupt the Industry, PricewaterhouseCoopers Health Research Institute, 2008
6. Grading the States, National Alliance on Mental Illness, 2009
7. Healthcare's Top Business Issues and Response, Cap Gemini, 2005
8. The Current Recession and U.S. Hospitals, Center for Healthcare Improvement and Thomson Reuters, 2008
9. Trends for 2008, Noblis Center for Health Innovation, 2007
10. "Tight Capital Access," Trustee, March 2009
11. The Price of Excess: Identifying Waste in Healthcare Spending, PricewaterhouseCoopers, 2008
12. Labor and Management Collaboration in Health Care, by Ed O'Neil, The Center for the Health Professions, 2005
13. U.S. Primary Care Near Collapse, Physicians Warn, Reuters by MedlinePlus, Jan. 30, 2006
14. Health Care CIO Results, 19th Annual HIMSS Leadership Survey, February 2008
15. Hospitals Will Invest to Improve Clinical and Financial Reporting, Healthcare Management Insight, August 2005
16. Adopting Technological Innovation in Hospitals: Who Pays and Who Benefits?, American Hospital Association and Avalere Health, 2006
17. Rock and a Hard Place, PricewaterhouseCoopers Health Research Institute, 2009
18. Health Confidence Survey: Dissatisfaction with Health Care System Since 1998, The Employee Benefit Research Institute Notes, vol. 27, No. 11, November 2006
19. Futurescan: Healthcare Trends and Implications 2009-2014, Society for Healthcare Strategy and Market Development and the American College of Healthcare Executives, with support from Thomson Reuters and VHA Inc., 2009
20. Initial Findings from HSC's 2005 Site Visits: Stage Set for Growing Health Care Cost and Access Problems, Center for Studying Health System Change,
    Issue Brief 97, August 2005
21. Global Research Report Business and Reality, Cap Gemini, 2005
22. "UnitedHealth and IBM Test Health Care Plan," by Reed Abelson, The New York Times, Feb. 7, 2009
23. Annual Report, The Commonwealth Fund, 2007
24. Futurescan: Healthcare Trends and Implications 2008-2013, Society for Healthcare Strategy and Market Development and the American College of Healthcare Executives, with support from Thomson Healthcare and VHA Inc., 2008
25. Relief, Restoration and Reform: Economic Upturn Yields Modest and Uneven Health Returns, Center for Studying Health System Change,
    Issue Brief 118, January 2008
26. Diagnosing Not-for-Profit Hospital Downgrades, Moody's U.S. Public Finance, December 2008
27. Hospital of the Future: Report Urges Major Changes, The Joint Commission, 2008
28. Health Care Opinion Leaders' Views on the Quality and Safety of Health Care in the United States, The Commonwealth Fund, July 2007
29. National Healthcare Quality Report, Agency for Healthcare Research and Quality, 2008
30. U.S. Health System Performance: A National Scorecard, Health Affairs Web exclusive, Sept. 20, 2006
31. Futurescan: Healthcare Trends and Implications 2007-2012, Society for Healthcare Strategy and Market Development and the American College of Healthcare Executives, with support from Solucient and VHA Inc., 2007
32. IRS Exempt Organizations (TE/GE) Hospital Compliance Project, Final Report, Internal Revenue Service, 2009
33. "Taking Science Personally," by Joe Nocera, The New York Times, Nov. 11, 2008
34. Covering the Uninsured in 2008: Current Costs, Sources of Payment, and Incremental Costs, Health Affairs Web Exclusive, August, 25, 2008
35. Trends for 2008, Noblis Center for Health Innovation, 2007