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FOIA Number: 2006-0223-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the William J. Clinton
Presidential Library Staff.
Collection/Record Group:
Clinton Presidential Records
Subgroup/Office of Origin:
First Lady's Office
Series/Staff Member:
Maggie Williams; Evan Ryan; Melanne Verveer
Subseries:
Misc. Subject Files
OA/ID Number:
12822
FolderiD:
Folder Title:
American Physicians Lawsuit-HCTF (Health Care Task Force); 2-23-93 Info Flow
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INFORMATION FLOW DIAGRAMS
FOR QUAL-ITY MEASUREMENT AND IMPROVEMENT
Version 1.0, February 23, 1993
Workgroup on Quality Measurement and Improvement (Group 9)
INTRODUCTION
By its very nature, the measurement and improvement of quality
.. .. .
involves information. Examples include the reports an Accountable
Health Practice (AHP) must provide to help Health Insurance
Purchasing Corporations (HIPCs) and consumers select AHPs,
resear~h information on the effectiveness of treatments, and
guidelines on the appropriate use of diagnostic tests. One of the
major .tasks.of the Q~ality workgroup is to defin~ th~ ~nformation
··.:on cost, · ·quali·ty cind· ace·e'ss
t.ha·t~
Will· bEr· re!quired ·to peiform·· the·
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essential functions of the health care system. Because of the
extreme complexity of the health care system, both as it is
currently configured and as it is envisioned for the future, and
because issues of quality relate to virtually every aspect of the
system, the Quality workgroup faced the problem that unless it
developed a systematic approach to its work it would run a great
risk of missing important functions and transactions that affect
quality. To help develop a comprehensive picture of all the
information that will be required to measure and improve quality,
the workgroup has developed a set of information flow diagrams
that systematically identify the main processes that must be
performed in-the. new system, and the information flows between
processes that will be required for their performance~- To keep
the diagrams relatively simple, only the most important
information flows relating to each process are described in the
diagrams. These diagrams should also be useful to the Informat-ion
workgroup that is responsible for designing the infrastructure · ·
that will collect, store and transmit the information, and to
other workgroups that need to visualize the relationship between
the functions they are analyzing and other functions to which they
relate.
INFORMATION FLOW DIAGRAMS
Information flow diagrams are convenient and powerful ways to
describe the processes a system uses to achieve its objectives and
the information required and produced by those processes. An
information flow diagram uses four main symbols. Processes are
represented by circles, information flowing between processes are
represented by arrows, data stores are represented by double lines
that break arrows (to symbolize that the information is not
transmitted instantaneously between two functions, but is stored
temporarily to be drawn on when needed), and processes outside the
system of primary interest are represented by squares. In
reality, data flows between processes occur in both directions.
For example, in a financial transaction a seller will submit a
bill and a buyer will write a check. To simplify the
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representation of such transactions, however, only the most
important d~rection of flow will usually be shown, using an
arr,owhead. In some cases the choice of a direct~on was arbitrary.
....
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It is important to understand that an information flow diagram
focuses on functions, not on the entities that are performing
those functions. This distinction is important because there is
rarely a one-to-one correspondence between functions and entities.
For example, one entity can perform several functions, the way an
HMO both arranges for financing, and provides care. Similarly,
most functions are performed by a wide variety of entities. For
example, financing is also provided by insurance companies, the
federal government, state governments, business (as an employee
benefit1, and individual patients (as out-of-pocket expenses).
After an information flow diagram has been developed to identify
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functJ.ons can be added.
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Another point about information flow diagrams is that multiple
diagrams can be used to describe various levels of detail about
functions and information flows. For example, an insurance
company whose primary function is financing has many subfunctions
that include the design of benefit packages, marketing,
accounting, reporting, legal support, and so forth. Deeper levels
of detail are illustrated by creating •layers• of diagrams, where
each successive layer "blows up" the details of higher levels of
functions. Macintosh users can think of "double clicking• on a
fun~tj,.on .to ~xpose the subfu.nct~ons .. This use of layers. of
diagrams is not intended to imply any hierarchy of·control
(although such a hierarchy might exist). In an information flow
diagram, it is only intended to show different levels of detail.
·,.
Because each of the functions are performed by a wide variety ·.of·
entities, the workgroup has chosen very general labels to describe
the functions (eg, •contract for services,• •consume services•).
The use of these general labels might suggest that the information
flow diagrams are too abstract to be useful for actual planning.
That problem disappears when functions are divided into their
components. As higher levels of detail are described, tne labels
become more precise descriptions of specific functions.
Eventually, a level of detail is reached at which it is possible
to identify the specific entities that will perform each function
and that will produce and use each piece of information.
This report describes the current draft of the information flow
diagram being developed by the workgroup on Quality Measurement
and Improvement (Group 9). Because of the charge to the
workgroup, the report concentrates on those functions and
transactions that are related to quality. It should be considered
a living document that will be revised and expanded continuously
to reflect the workgroup's progress. The diagram can easily be
expanded to incorporate the functions and information flows of
other workgroups.
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY.
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FIGURE 1. THE HEALTH CARE DELIVERY SYSTEM
Because virtually every aspect of the health care delivery system
has implications for the quality of care, an information flow
diagram for quality measurement and improvement must begin with a
description of the entire health care delivery system. The
highest level function therefore is the delivery of health care.
This process receives information from •society• in the form of
the expectations people have for health care. In this context,
•society• includes not only the individuals who make up American
society but all the nonhealth functions that are performed in
various sectors of our society, including, for example, housing,
education, transportation, business, parks, welfare, the legal
system, and agriculture. As the health care delivery system
perform~ its functions, it delivers information back to society
about the performance of the health care system, and the extent to
... wo~cn it .has ..sati~f:ieq soc;~.e.ty'.s expe.c.t~t.io:n.s.
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FIGURE 2. THE FIVE MAIN FUNCTIONS OF THE HEALTH CARE DELIVERY
SYSTEM
The health care delivery system consists of five main functions:
provision of services to maintain and improve people's health
(1.0), overall management of the system (2.0), consumption of
health care services by •consumers• (3.0), administration of
contracts to pay for the services (4.0), and supply of the wide
variety of intermediate products that are needed to provide
services (5.0).
Although there is not a one-to-one correspondence between these
functions. and the various entities.that.make up the. health car.e
system, for the purposes of understanding these functions it is
reasonable to think of examples of entities that perform each of
them. For example, in the current health care system hospitals
provide services (1.0), patients consume services (3.0), insurers
and other third-party payers administer contracts between
·
providers and consumers (4.0), and the Health Care Financing
Administration (HCFA) manages its system (2.0). Intermediate
products are supplied (5.0) by a wide variety of entities
including drug companies, device manufacturers, medical schools
(trained personnel), researchers (information on the effec~iveness
of interventions), guidelines developers, construction companies
(facilities), hospital suppliers, and so forth. Examples of new
types of entities that might be created in the new health care
system include AHPs that will perform the function of providing
services, HIPCs that will administer contracts for financing and
services, a National Health Board that will manage various aspects
of the system, such as defining a standard benefit package, and so
forth.
Each of these main functions consists of many subfunctions and is
performed by many different entities. Furthermore, a vast amount
of information of various types flows between each of the main
functions and their subfunctions. The following are some
highlights that are particularly pertinent to quality measurement
and improvement.
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Provide Health Care Services (1.0)
Providers include all the personnel who either provide health care
or who directly support the provision of health care, and the
organizations in ~hich they work. In the current system providers
include solo practitioners, group practices, hospitals, HMOs,
CHAMPUS, laboratories, pharmacies, and nursing homes. In the new
system, AHPs will provide health care services.
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Those who provide services (1.0) will not only receive information
that has been reviewed and •approved• by the managers (2.0), they
will also receive information from those who supply intermediate
products (5.0). Examples of the latter are information from
researchers about the effectiveness of treatments, information
from pharmaceutical companies about their products, and so forth.
The quality of this information will vary widely, from peerreviewed research publications to highly distorted marketing
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"nonapproved" to distingi.lish it from information that has been
formally reviewed and approved by the managers. This is not
intended to be a pejorative term, and some of the nonapproved
information will be of very high quality. The important point is
that those who receive nonapproved information will have to judge
its quality for themselves.
Providers will enter into contracts with those who contract for
services, such as insurers and HIPCs (4.0). The contract will
specify the services the provider will provide, the information on
the budget for providing the services, and the information that
providers must report to enable contractors to administer the
provision of services·. ·Providers might. alsO" report ii).formation to
managers (2.0) on the. quality, cost and utilization of their
services so that the managers can monitor the overall performance
of the system, and to consumers of services (3.0) so that .. they can
make choices between providers.
Manage the Health Care System (2.0)
This function is concerned with the top-level management of the
health care system as a whole. Examples of specific functions
that might be performed by top-level management are the definition
of the standard benefit package, the assessment of specific
services that might be excluded from the standard benefit package,
the monitoring of the overall performance of the system (cost,
quality, access, utilization, variations), and the •accreditation"
of HIPCs and AHPs. Some of these functions are currently being
performed by HCFA, state health commissioners, and state insurance
commissioners. It is important to distinguish between these
global management functions and the management that occurs at the
level of individual health care providers and other organizations
(eg, hospital administration, management of insurance companies).
To help keep the distinction clear, terms such as •macro"
management and "oversight" will be used to describe the former,
and "micro" management and "administration" will be used to
describe the latter.
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The information flows pertinent to the management function
correspond to its major subfunctions. In the proposed health care
system, it is envisioned that one or more national boards (eg,
National Health Board, Outcomes Management Board; Health Standards
Board) will manage the overall operation of the health care system
by performing such functions as designing the standard benefit
package that will be used by those who write contracts with
providers and consumers (4.0); reviewing information about medical
practices and passing on to providers (1.0) •approved• information
in the form of •approved" research results, technology assessments
and guidelines; and providing to consumers (3.0) standardized
reports about the quality of providers so that the consumers can
choose between different providers. National boards and other
entities that perform the management functions might also provide
feedback both formally and informally to the suppliers of
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. ·companies. a"i-id. ..device· ·inam..ifacturer·s·· about:· cOverage ({ecisions .·····. ... .
concerning their products, feedback to medical educators about the
demand for various types of practitioners, requests to the
research establishment for information about the effectiveness of
particular services, and so forth.
Consume Health Care Services (3.0)
The term •consumer" is used to describe any entity that makes
choices between providers, that contracts with contractors (eg,
that joins a prepaid plan, buys insurance, or accepts Medicare),
or that actually consumes health care services. Consumers can be
organiz.ed at several levels of aggregation, ranging from..
individual people to large groups· of people ·created for the
purpose of collective. bargaining (eg, AARP, unions). ·The term
also includes the consumer function of HIPCs, which must evaluate
AHPs.
To help them make choices about providers, consumers receive
information on the quality, cost and access of various providers.
This information will come from two main sources: "standardized"
or "approved" information will be provided by system managers such
as a National Health Board, or the monitoring function of a HIPC
(2.0). In addition, consumers will undoubtedly receive ·
information directly from providers (1.0). This information will
not have been evaluated by managers, and therefore will be called
"nonapproved." Consumers will also receive "nonapproved"
information directly from suppliers such as drug companies (5.0).
As consumers make their choices, they will enter into contracts
with contractors (4.0), and will make decisions about specific
providers and health care services (eg, participate in decisions
about treatments).
Contract for Services (4.0)
ucontracting" is used in a general sense to describe the financial
arrangements made between providers and consumers of services. In
the current system this function is performed by insurers, other
third-party payers, and prepaid health plans .
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Those who contract for services will enter into contracts with
both consumers (3.0) and providers (1.0) to arrange the coverage
for the standard benefit package. The contractors will also
provide consumers (3.0) with jnformation about the quality of
various providers. There will also be information flows between
consumers, providers and contractors associated with the reporting
and resolution of grievances.
--·.·· ·
Supply Intermediate Products (5.0)
As stated above, a wide variety of products is needed to provide
services. They include personnel, facilities, equipment,
supplies, drugs, devices, research information, guidelines,
information systems, management tools, and so forth. Providers
organize and convert these products into the forms necessary to
provide· actual health care services to consumers. For example, a
.hospital will assemble surgeons, nurses, an operating room,
.inst·rumEmts·,,· . sPe>riges,.· know-ledge.) .,technical· skfl.ls·•...and :·other< . . .. :, ··, .. ·:· ·:.,.
products to perform the health care service of operating on a
patient with a hernia.
Suppliers of intermediate products will receive ideas for new
products required to deliver health care services, and feedback
about existing products from health care providers (1.0), managers
(2.0), and contractors (4.0). This information can range from
informal suggestions from providers, to formal research results,
to coverage decisions. Suppliers of intermediate products will
provide information to providers (1.0), managers (2.0),
contractors (4.0) and consumers (3.0) about their products.
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Finally, those who supply intermediate products (5.0) .will
undoubtedly receive information from contractors in the form of
feedback about coverage decisions and the outcomes of their
products.
FIGURE 3. PROVIDE HEALTH CARE SERVICES (1.0)
Providers of services will perform three main functions. They
include actually providing care to consumers (1.3), administering
the organizations that provide care (1.1), and improving quality
(1.2). This function also includes a data store (DS 1.1). that
contains information about the provider system.
Administrators of provider systems (1.1) such as administrators of
HIPCs (1.1) will require information from several sources:
feedback on provider performance from the managers of the health
care system (2.0), contracts from the contractors (4.0), and
feedback from the quality improvement process on the performance
and efficiency of the system they are administering (1.2). In
turn, this function will pass administrative information to the
practitioners who actually provide care (1.3); information on
quality, cost and utilization, to the managers of the health care
system (2.0) in the form of standardized reports, contract
information to contractors (4.0), and reports on quality, cost and
access to consumers (3.0) to help them choose between various
providers.
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The process of providing services (1.3) will receive information
from several sources. They include •approved" guidelines as well
as feedback on performance from managers (2.0), nonapproved
information from suppliers of intermediate products such as
researchers and drug companies (5.0), and feedback on the
effectiveness and efficiency of the service delivery system from
the quality improvement process (1.2). It will also draw on the
data store (DS 1.1) for the patient-specific data needed to serve
patients. In turn, providers of services will make decisions
about services with patients (consumers, 3.0) and will pass
patient care data to the data store.
The quality improvement process (1.2) will use performance
measures developed by the managers (2.0) and others (5.0), and
will examine patient care data CDS 1.0). It will feed back
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pat1ent satisfact1on to the providers of care (1.3) and to
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administrators (1.1).
FIGURE 4. MANAGE THE HEALTH CARE SYSTEM (2.0)
The management process will perform five main functions. They
include management of the system as a whole (2.2), management of
individual services (eg, individual treatments) (2.1}, definition
of criteria for the system entities (eg, AHPs, HIPCs) and
transactions between entities (2.3), definition of the standard
benefit package (2.4), and specification of the budget limit or
cap for the standard benefit package (2.5). To perform these
f'l,lnctions, the management function will use at least two.data
st.ores. ·one~ shoWn in Figure 4 as DS 2~1, will store·.infoimation
on the effectiveness and appropriate use of specific services or
technologies (eg, mammography, coronary artery bypass surgery,
antismoking education programs). The other, shown as DS 2..2, will
store information about the quality, cost and access of providers.
The former will be called the service-specific data store.. The
latter will be called the provider-specific data store.
Management of the system is a very comprehensive and complex task.
As described above, the adjectives •macro" and •oversight" are
intended to distinguish between the management of the system as a
whole (what might be called •macro• management) and the management
of the particular organizations within the system that actually
provide care (•micro• management, or •administration•). In the
new system being envisioned, one of the most important entities
responsible for the management function is the National Health
Board.
Management of service improvement (2.2) involves evaluating and
making recommendations about specific services or technologies.
An example is the evaluation and •approval" of guidelines for use
by practitioners. The managers who will perform this function
will use information (from data store 2.1) about the effectiveness
of specific services and guidelines that have been developed to
define the appropriate uses of those services. Information of
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that type will be received from suppliers of intermediate products
such as researchers and drug companies and stored in the data
store for individual services (DS 2.1). The putputs of this
function, such as the •approved• guidelines about the appropriate
use of specific services, will be passed to providers (1.0), as
well as to any others who must make decisions about appropriate
services. For example, some decisions of this type might be made
at the local level by HIPCs. These results will undoubtedly also
be of great interest to those who supply intermediate products
(5.0) (eg, drug companies).
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Those who are managing the performance of the system as a whole
(2.1) (as opposed to managing individual services) will receive
reports· about the quality, cost and access of the care being
provided by providers (1.0). They will use that information to
,.frack:fhe· over.ai.l-.qual'ity.· of.:. t:b.e:- h¢al.tll :car.$. sys.tem ·as .. w.~lJ. .. q.~ ~<;>;:....... .
identify specific providers that might need techn.i'cal assistance.
The information gathered through this process will be stored in
the second data store that contains information about the
performance of specific providers (DS 2.2).
The management process will also perform a variety of functions
relating to defining the criteria that will establish the various
entities that will comprise the new health care system, and the
transactions that will occur between those entities. Examples
from the current system are the criteria the federal government
uses to define an HMO, the criteria the JCAHO uses to accreditate
hospitals, anO. the .. crite.ria. the N9,tional Cancer Institute :uses to
define a comprehensive cancer center.· In· the new· system,· this···
function would define·the criteria for what constitutes an HIPC or
AHP. Examples of information required for transactions are the
information on quality, cost and access that providers must r~port
to enable consumers to evaluate and make choices between AHPs.
For this function, information will be needed about both the
performance and structures of specific providers (data store 2.2)
as well as about the effectiveness and utilization of specific
services (data store 2.1). Once developed, the criteria will be
passed to providers (1.0), suppliers (5.0) and contractors (4.0).
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One of the most important and visible functions of the managers
will be to specify the standard benefit package to which all
patients will have access. Determining the standard benefit
package will require information about the effectiveness and
recommended uses of specific services (DS 2.1), as well as
information about the quality, cost and utilization of services
being offered by providers (from DS 2.2). Additional information
will be needed about the maximum budget or cap under which the
standard benefit package must fit. This budget or cap will be
determined by the budget-setting function (2.5) of the management
function (eg, the National Health Board). Once the standard
benefit package has been defined, it will be passed to those who
contract for services (4.0) so that they can enter into contracts
with both providers and consumers.
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FIGURE 5. CONSUME HEALTH CARE SERVICES (3.0)
Consumers of services will perform three main functions. They are
to make a variety of decisions or choices (3.3); to receive health
care services when they develop health problems or are exposed to
health programs (eg, prevention programs) (3.2); and to provide
evaluative information (3.1) about such things as what diseases
they get (epidemiology), what is done to them (utilization), and
what happened afterward (outcomes).
.,,
· ··
··=:
Consumers make choices of many different types. They range from
deciding whether to join a HIPC at all (eg, a business can decide
between developing its own contract or joining a HIPC), to
selecting an AHP, to selecting a specific provider (eg, a
particular back specialist), to deciding on a treatment (eg,
lumpectomy vs radical mastectomy for breast cancer). To make
these choices, consumers will draw on information about
cont.ra·ctors .( 4; 0"·) ·, .. :such ·;·as· the ·pros·.· ·and<cons .. c)._t j·o~inirig· a·· HtPC·i.' :. ·, • ·.·. · ·
and about providers of services (1.0), such as their quality, cost
and access. Once a choice about a HIPC or provider has been made,
contracts can be developed (4.0). Decisions about individual
services will draw on information from providers (1.0) and will
determine the particular services that patients receive (3.2).
Managers (2.0) might also want to track information on the choices
consumers make.
Because the process of rece1v1ng services (3.2) affects service
utilization, information of this type will be important to
providers (1.0) and contractors (4.0).
The third main function of consumers is to provide information
( 3 . 1) to providers ( 1·. 0) , contractors ( 4 . 0) , and managers ( 2 . 0)
about their care, to help them assess needs, utilization and
outcomes. The types of information required for managing ··and, .
improving the delivery system include information on who they are
(demographics), what health problems they have (epidemiology),
what is done to them (utilization), what happens (outcomes), how
they feel about it (patient satisfaction), and what it costs
{resources). The information consumers report will be determined
by providers (1.0) and contractors {4.0) through such instruments
as questionnaires, interviews, and measurements.
FIGURE 6. CONTRACT FOR SERVICES (4.0)
The contract function includes three main processes. The most
obvious is to write and administer contracts for benefit packages
(4.1), both the standard benefit package developed by the
management function (2.0), as well as additional packages
developed locally by individual HIPCs or insurers. The second is
to provide fiscal intermediary services (4.2) such as setting
rates {including any adjustment for risks), receiving money from
consumers, investing the money, paying out money to providers and
maintaining an acceptable reserve. The third function is to
manage the activities of providers {4.3) that fall within the
scope of the contracts.
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY.
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The first function, contracting for benefit packages (4.1)
requires information about the standard benefit package from the
managers (2.0). To the extent that the contractors want tc·
develop other benefit packages they will also need information
about the cost, effectiveness and utilization of specific services
that might be contained in the new benefit package. This
information can be obtained from providers as well as from
suppliers of intermediate products (in the form of research on
services). This function will pass information on covered
services to the fiscal intermediary function (4.2), and the
provider management function (4.3). This function will also pass
information to managers (reports on quality, cost and access of
provid~rs), providers (contracts), and suppliers (feedback on
coverage and utilization of their products).
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third 'function,· ·mana.g·ing· providers ''<'4··. j:~ ~·· wiii···dra\.i···on-··; ··
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evaluation criteria provided b¥ managers (2.0) as well as
information on covered services provided b¥ the administration
function (4.1). In turn, the management function will involve
passing reports on quality, cost and access to consumers (3.0) and
managers (2.0) and making payments to providers (1.0).
FIGURE 7. SUPPLY INTERMEDIATE PRODUCTS (5.0)
The term uintermediate product• is intended to be extremely
general, to encompass a very wide variety of •products• that are
used b¥ providers to provide health care services to consumers.
There are three main types of intermediate products. One is
trained personnel ·(5.1). Examples of suppliers of.such products
are medical schools, dental schools, postdoctoral fellowship
programs, CME programs, and annual meetings of professional
societies. The second type of intermediate product consists of
tangible products such as drugs, devices, sponges, and cafeteria
trays (5.2). They are developed and manufactured b¥ drug
· ·
companies, device manufacturers, hospital supply companies, and so
forth. The third type of intermediate product consists of
information {5.3). This information can vary from raw data, to
published research results, to guidelines.
For all of these functions, data will be stored in and retrieved
from a variety of data stores, summarized in this diagram as data
store 5.1. Specific examples of data stores pertinent to this
function include medical libraries, journal articles sitting on
physicians' shelves, the archives of the Food and Drug
Administration, and the Medicare databases used by health services
researchers. Those who produce information (eg, researchers) will
also receive information directly from consumers (3.0), providers
{1.0), from the management function (2.0) (eg, about utilization
patterns, the quality of specific types of providers), and from
contractors such as insurance companies or HIPCs {4.0). A wide
variety of information will be obtained from these sources. They
include information on the effectiveness of specific treatments,
information on utilization of services, suggestions for research
priorities and agendas, information on service delivery systems,
and so forth.
PRELIMINARY STAFF WORKING PAPER FOR ILLUSTRATIVE PURPOSES ONLY.
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Suppliers of intermediate products will also provide a great deal
of information to providers, consumers and the management
function. For examples: The training function (5.1) will provide
medical knowledge to providers (1.0); the tangib~e products
production function (5.2) will provide information of varying
degrees of validity about the effectiveness of their products; and
the research function (5.3) will provide information about the
effectiveness, harms and costs of specific services to clinical
providers, consumers and researchers. Researchers and experts
will also provide information to administrators and managers in
the form of guidelines, planning tools, statistical methods,
advice, and so forth.
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INFORMATION FLOW DIAGRAM
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SUPPLY
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Figure 2
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Figure 6
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hillary Rodham Clinton's Appointment to Chair the Health Care Task Force
Creator
An entity primarily responsible for making the resource
White House Office of Records Management
Office of the Counsel to the President
First Lady's Office
National Security Council
Date
A point or period of time associated with an event in the lifecycle of the resource
1993
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Description
An account of the resource
This collection largely consists of memos, background files, and meeting notes from the First Lady's Office concerning the formation and actions of the Health Care Task Force and working groups. These files include records pertaining to the Health Care Task Force and working group development; the Association of American Physicians and Surgeons lawsuit brought against Hillary Clinton; and the final Report on Health Care Reform. Files also contain correspondence concerning President Clinton’s decision to appoint the First Lady to chair the Health Care Task Force.
Extent
The size or duration of the resource.
72 files in 6 boxes
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Office of Records Management
Clinton Presidential Records: White House Staff and Office Files
Clinton Presidential Records: NSC Cable, Email, and Records Management Systems
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Is Part Of
A related resource in which the described resource is physically or logically included.
<a href="http://clinton.presidentiallibraries.us/items/show/36141" target="_blank">Collection Finding Aid</a>
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Original Format
The type of object, such as painting, sculpture, paper, photo, and additional data
Paper
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
American Physicians Lawsuit HCTF (Health Care Task Force); 2-23-93 Info Flow
Creator
An entity primarily responsible for making the resource
First Lady's Office
Maggie Williams
Evan Ryan
Melanne Verveer
Identifier
An unambiguous reference to the resource within a given context
2006-0223-F
Is Part Of
A related resource in which the described resource is physically or logically included.
Box 6
<a href="http://www.clintonlibrary.gov/assets/Documents/Finding-Aids/2006/2006-0223-F.pdf" target="_blank">Collection Finding Aid</a>
<a href="https://catalog.archives.gov/id/2194630" target="_blank">National Archives Catalog Description</a>
Provenance
A statement of any changes in ownership and custody of the resource since its creation that are significant for its authenticity, integrity, and interpretation. The statement may include a description of any changes successive custodians made to the resource.
Clinton Presidential Records: White House Staff and Office Files
Publisher
An entity responsible for making the resource available
William J. Clinton Presidential Library & Museum
Format
The file format, physical medium, or dimensions of the resource
Adobe Acrobat Document
Medium
The material or physical carrier of the resource.
Reproduction-Reference
Date Created
Date of creation of the resource.
1/8/2015
Source
A related resource from which the described resource is derived
42-t-2194630-20060223F-006-004-2015
2194630