The journey to meaningful use of electronic health records

The American Recovery and Reinvestment Act and its important Health Information Technology Act provision became law on February 17, 2009. Commonly referred to as "The Stimulus Bill" or "The Recovery Act," the landmark legislation allocated $787 billion to stimulate the economy, including $147 billion to rescue and reform the nation's seriously ailing health care industry. Of these funds, $19 billion in financial incentives were earmarked for the relatively short period of 5 years to drive reform through the use of advanced health information technology (HIT) and the adoption of electronic health records (EHRs). he incentives were intended to help health care providers purchase and implement HIT and EHR systems, and the HITECH Act also stipulated clear penalties would be imposed beyond 2015 for both hospitals and physician providers who failed to adopt use of EHRs in a meaningful way. Nurses will be integral to achieving a vision that will require a nationwide effort to adopt and implement EHR systems in a meaningful way.     

Townhouse residents’ use of interior products in the social zones of their homes as a demonstration of their need for uniqueness

Town houses or cluster homes refer to housing developments where the exterior façade of adjacent units are architecturally identical or very similar. A pertinent disadvantage of this type of tenure is that residents are not allowed to alter the exterior of their homes to reflect personal differences. This study focussed on the probability that residents in these type of townhouses would make intentional effort to demonstrate their uniqueness through counter‐conforming choice of interior objects for the social areas of their homes where guests are received and entertained. The study involved 182 respondents who lived in townhouses in a major urban area in South Africa who were recruited through convenient snowball sampling. Findings indicate that townhouse residents' interior product decisions are predominantly of a creative counter conformity nature which is the safer alternative than avoidance of similarity or unpopular choice counter‐conformity practices that might evoke criticism from peers or reference groups. Interior product choices are therefore predominantly cautious and aimed to evoke the admiration of others rather than critique. A positive outcome of this study in terms of future research is confirmation of the usefulness of the measuring instrument, which was originally developed for clothing research. Findings are insightful for property developers, interior designers, interior decorators and retailers in terms of consumer facilitation and the appropriate marketing of interior products.     

On Welfare under Cournot and Bertrand Competition in Differentiated Oligopolies

Häckner (2000, Journal of Economic Theory 93, 233–239) shows that in a differentiated oligopoly with more than two firms, prices may be higher under Bertrand competition than under Cournot competition, implying that the classical result of Singh and Vives (1984, Rand Journal of Economics, 15, 546–554) that Bertrand prices are always lower than Cournot prices is sensitive to the duopoly assumption. Häckner (2000, Journal of Economic Theory, 93, 233–239), however, leaves unanswered the important question of whether welfare may be lower under price competition. This note shows that in Häckner’s model both consumer surplus and total surplus are higher under price competition than under quantity competition, regardless of whether goods are substitutes or complements.     

‘Sameness’ and ‘Difference’ Revisited: Which Way Forward For Equal Opportunity Initiatives?

Recent interest in ‘managing diversity’ has reopened debates about forms of equality in the workplace. Approaches to equality developed in the 1970s and 1980s have been characterized as an attempt to ensure that if individuals bring the same abilities to work, or perform in the same way, they should receive the same access to jobs and employment benefits, regardless of social group membership. Managing diversity appears to be about a more positive valuing of difference. Benefits are seen to derive from different perspectives and approaches and these should be nurtured and rewarded rather than suppressed. Feminists have long argued about the extent to which women are the same as, or different from, men, and about the political consequences of adopting these positions. Recent theoretical developments have led to some novel solutions to this dilemma. These include asserting claims to both ‘sameness’ and ‘difference’, the deconstruction of ‘difference’, and the reconstruction of ‘sameness’ on women's terms. This paper explores approaches to equal opportunities through both established and novel theoretical perspectives. It argues that existing practice cannot be fitted neatly into the conventional distinctions between ‘sameness’ and ‘difference’, and explores the potential characteristics and strengths and weaknesses of equality initiatives based on the new theoretical perspectives.     

Essential health care: affordable for all?

Access to affordable health care has become a national crisis. The uninsured have many faces and many reasons for being uninsured. The nation cannot afford to sustain this broken system; not in terms of resources, nor in terms of the deteriorating health of the public. Universal coverage could offer a promising opportunity to begin to ameliorate the unsustainable use of expensive illness care now substituting for effective low-cost prevention and early detection. A proposal for essential health care coverage, a balance between cost and choice to maximize use of beneficial care, is presented.     

Board Gender Diversity,Auditor Fees,and Auditor Choice

We examine whether the presence of female directors and female audit committee members affect audit quality in terms of audit effort and auditor choice by using observations from a sample of U.S. firms, spanning the years 2001–2011. We find, after controlling for endogeneity and other board, firm, and industry characteristics, that firms with gender‐diverse boards (audit committees) pay 6 percent (8 percent) higher audit fees and are 6 percent (7 percent) more likely to choose specialist auditors compared to all‐male boards (audit committees). Our findings suggest that boards (audit committees) with female directors (members) are likely to demand higher audit quality, ceteris paribus.     

Rethinking “Strength of Incentives” for Executives of Financial Institutions

The recent crisis has caused some finance theorists and practitioners to rethink the effects of managerial incentives on the total enterprise value of large financial institutions. This re-examination has identified and analyzed a number of potential problems with the use of equity-based compensation, including insufficiently long managerial time horizons as well as the temptation for excessive risk-taking provided by “asymmetric” payoff structures in which shareholders have virtually all the upside while debtholders bear most of the downside risk. In an attempt to address such problems, finance and governance scholars have increasingly explored the possible value of aligning managerial interests with those of not only shareholders, but other important corporate claimants such as debtholders and taxpayers. After reviewing the latest thinking about risk and managerial incentives at financial institutions, the authors come to the following conclusions:

• • The design of incentives for value maximization needs to reflect a healthy appreciation of downside risk as well as upside reward, and both senior and subordinated debt may be ideal instruments for establishing that balance. At the same time, most senior executives should continue to receive equity-linked compensation in addition to significant proportions of “inside debt.”
• • Since decision-makers below the highest level executives of large financial institutions collectively wield enormous power to assume and manage risks, this “upper-middle” tier of managers deserves special attention. Rather than rewarding these managers with stock or options, the authors suggest use of a combination of uncapped but “held-at-risk” bonuses denominated in subordinated inside debt as the best way of rewarding effort and competence while controlling opportunities for risk-shifting.

     

Top management team diversity,group process,and strategic consensus

This study integrated concepts from upper echelons, group process and social cognition theories to investigate how demographic diversity and group processes influence strategic consensus within the top management team (TMT), where strategic consensus is defined as the degree to which individual mental models of strategy overlap. Data from 76 high‐technology firms in the United States and Ireland were used to examine three alternative models. The results showed that while demographic diversity alone did have effects on strategic consensus the overall fit of the model was not strong. Adding two intervening group process variables, interpersonal conflict and agreement‐seeking, to the model greatly improved the overall relationship with strategic consensus. For the most part, TMT diversity had negative effects on strategic consensus. The model with superior fit showed both direct and indirect effects of diversity on strategic consensus. Copyright © 1999 John Wiley & Sons, Ltd.     

Life Sciences Roundtable: Strategy and Financing

In light of the challenges facing the pharmaceutical industry, a distinguished group of pharma executives and strategic and financial advisers discusses the following corporate decisions:

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