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SOLUTION BRIEF
Stimulus Funding
Healthcare




Improving Health and Healthcare
with Technology
Stimulus funding will speed adoption of new digital technologies for more proactive, patient-focused
care and improvements in healthcare quality, cost, and accessibility.




                                          Achieving Better Outcomes                            efficiency and quality of patient care. About
                                          with Technology                                      25 percent of all healthcare costs are spent
                                          Containing costs while improving health and          on preparing, submitting, calculating, paying,
                                          delivery of services is critical to patients,        and collecting medical bills.3 One medical
                                          administrators, and healthcare providers             transaction can cost USD 25, while one banking
                                          at every level. Healthcare costs consume             transaction costs less than a penny.4
                                          more than one of every six dollars we earn.1
                                          Healthcare costs will continue to increase
                                          unless we find better methods for reducing
                                          administrative costs and delivering care. By             AMERICAN RECOVERY AND
                                          2015, it’s estimated that healthcare costs will          REINVESTMENT ACT (ARRA)
                                          reach USD 4 trillion per year and account for            HEALTHCARE FUNDING
                                                                                                   PROGRAMS
                                          nearly 20 percent of the U.S. economy.2
                                                                                                   USD 48.8 Billion
                                          In addition to unsustainably high costs, the             Seeks to help physicians purchase and
                                                                                                   implement Medicare and Medicaid health
                                          healthcare system faces challenges that                  IT systems.
                                          include an aging population, epidemics in
                                                                                                   USD 1.2 billion
                                          chronic conditions like diabetes, inferior patient       Supports the deployment of broadband
                                          outcomes in comparison to many countries,                infrastructure in rural areas.

                                          limited access due to lack of insurance, and             Up to USD 44,000 or USD 64,000
                                          inefficiencies throughout the system.                    Incentive payments over a five-year
                                                                                                   period to physicians who demonstrate
                                                                                                   meaningful use of electronic health
                                          Paradoxically, the U.S. healthcare industry, one         records (EHRs). Starts in 2011.
                                          of the world’s most technologically advanced
                                                                                                   For more information, see:
                                          in medical equipment, has been slow to adopt             http://healthit.hhs.gov
                                          IT solutions that could improve both overall
Effective reform requires a new healthcare         and report meaningful use of electronic health
                                             IT infrastructure that enables efficiency,         records (EHRs) will be eligible for an initial
                                             collaboration, and improved care. It requires      incentive payment of up to USD 18,000.
                                             standards-based interoperable systems
                                                                                                Incentives under the Medicaid program are
                                             designed to provide timely, accurate information
                                                                                                available for physicians, hospitals, federally
                                             delivery and electronic record keeping across
                                                                                                qualified health centers, rural health clinics,
                                             the continuum of care. It requires IT systems
                                                                                                and other providers. Physicians cannot take
                                             that improve quality of patient care by enabling
                                                                                                advantage of the incentive payment programs
                                             improved healthcare delivery, workflow, patient
                                                                                                under both Medicare and Medicaid programs;
                                             safety, clinical decision making, and cost
                                                                                                they must choose one. Eligible pediatricians
                                             performance.
                                                                                                (non-hospital based), with at least 20 percent
                                             Intel innovation will play a major role in         Medicaid patient volume, could receive up to
                                             enabling IT systems for improving the future       USD 44,000, and other physicians (non-hospital
INTEL HEALTH GUIDE
                                             of healthcare. Through our leadership and          based), with at least 30 percent Medicaid patient
A remote patient monitoring (RPM) solution
combines an in-home patient device and       unique market position, Intel offers the           volume, could receive up to USD 64,000 over a
the Intel Health Guide PHS6000 with the      foundational IT architecture, a standards-         five-year period.5
Intel® Health Care Management Suite—an       based approach, and corporate leadership to
online interface that allows clinicians to                                                      According to Radiology Business Journal, the
                                             transform healthcare to an affordable model
monitor patients and remotely manage                                                            Medicare and Medicaid health IT incentives
care. See: www.intel.com/healthcare/ps/      focused on efficient collaboration across all
                                                                                                could add up significantly for hospitals. Using
healthguide/index.htm                        points of the system with more effective
                                                                                                a tool on the Healthcare Information and
                                             patient care and improved outcomes.
                                                                                                Management Systems Society (HIMSS) Web
                                                                                                site, one hospital CIO calculated potential
                                             Healthcare and Stimulus Funding
                                                                                                awards over a four-year period. He found that a
                                             Enacted in February 2009, the American
                                                                                                75-bed hospital could get up to USD 3.5 million,
                                             Recovery and Reinvestment Act (ARRA)
                                                                                                a 250-bed hospital would have the potential
                                             provides a unique opportunity to apply IT
                                                                                                to earn almost USD 6 million, and a 750-bed
                                             technology more effectively to improve
                                                                                                hospital could qualify for nearly USD 12 million.6
                                             healthcare systems. ARRA specifically
                                             allocates USD 19 billion in Medicare and           Stimulus funding presents a tremendous
                                             Medicaid incentives over five years to help        opportunity to transform healthcare and
                                             physicians purchase and implement health           ignite innovation. The window of opportunity,
                                             IT systems. A key element in the program is        however, is brief: five years. Consequently,
                                             the widespread adoption and use of uniform         providers should move fast to take advantage
                                             electronic standards that will enable various      of this once-in-a-lifetime funding. Remember,
                                             health IT systems to communicate with each         too, that this is not just a matter of installing
                                             other. ARRA required the Department of Health      new technology. Accountability is key, and
                                             and Human Services (HHS) to develop such           the task will require a great deal of process
                                             standards by December 31, 2009. Beginning          re-engineering. Providers will be responsible
                                             in 2011, Medicare physicians who implement         for demonstrating outcomes that meet ARRA




2
BUILDING THE INTELLIGENT
    HEALTH NETWORK
    A major reason for the slow adoption of
    patient information sharing is the high cost                                                Health Information Network Core                                      Intel® Certified Ecosystem

    of proprietary data and integration services.                                    Record Locator Services                    Medical Terminology Services

    To address this, Intel worked with hundreds
    of healthcare leaders around the world on
                                                                                            Patient Portal                      Master-Person Index Services
    ways to significantly improve and streamline
    information flow, while enhancing the
    quality, cost, and efficiency of patient care.
    The result is the Intel® Service-Oriented
                                                                                                                 Intel® SOA
    Architecture Expressway for Healthcare                                                                      Expressway
                                                                                                               for Healthcare

    (Intel® SOAE-H).
                                                                Clinic           Intel® SOA                                                        Intel® SOA        Hospital
                                                                                Expressway                                                        Expressway
    This supplier-neutral platform provides a                                  for Healthcare                                                    for Healthcare


    high-performance solution for translating,              Clinical Systems                             Intelligent                                                Clinical Systems

    processing, and connecting multiple data
                                                                                                       Health Network
                                                                 Lab             Intel® SOA
                                                                                                        Common Information Model
                                                                                                                                                   Intel® SOA
                                                                                                                                                                  Pharmaceutical
    formats across a healthcare environment.                                    Expressway                                                        Expressway         Network
                                                                               for Healthcare                                                    for Healthcare

    It can be used to construct large multi-site
                                                            Clinical Systems                                     Intel® SOA                                         Clinical Systems
    health networks using its unique healthcare                                                                 Expressway
                                                                                                               for Healthcare
    environment developer kit (HDK), or it can
    be a base platform to augment healthcare
    supplier product offerings. In either case,
    it helps accelerate computable healthcare                                                                  Clinical Systems
                                                                                                                  Payer
    information across disparate health
    environments such as hospitals, integrated
    delivery networks, clinics, payer networks,
    labs, and pharmaceutical networks.



objectives. A good first step is to contact          infrastructure that enables electronic medical                        to market across a breadth of industries. Our
your nearest Health Information Technology           records, electronic prescriptions and information                     status as a foundational technology supplier
Extension Program Regional Center for guidance,      exchanges, as well as mobile point-of-care                            results in a neutral approach that enables us
once they are in place sometime in 2010.             solutions that deliver patient histories, diagnostic                  to collaborate with manufacturers, software
                                                     information, and decision support in real time. What                  developers, and healthcare providers to create
Taking a Collaborative Approach                      the healthcare industry needs now are partners.                       mutually beneficial standards and solutions.
to Health
                                                     As a global technology innovator, Intel is in a                       For healthcare IT, Intel is collaborating with
The healthcare industry now has the financial
                                                     unique position to help. We have a long record                        healthcare leaders to accelerate the shift to a
incentive to invest in an interoperable healthcare
                                                     of bringing technologies, systems, and solutions                      more cost-efficient, proactive wellness model




                                                                                                                                                                                                 3
of care as well as healthcare IT systems to                                         Conclusion
                                                                                           improve quality, cost, and accessibility. We’re                                     Intel innovation enabled the shift from mainframe
                                                                                           developing new technology platforms that allow                                      to open-platform computing. A similar shift needs
               LEADING THE WAY TO                                                          healthcare facilities to combine technology with                                    to occur today in healthcare. As the healthcare
               A STANDARDS-BASED                                                           medical expertise to achieve major clinical and
               INFORMATION EXCHANGE                                                                                                                                            industry adopts new IT innovations, it will see the
                                                                                           business goals. We’re supplying the foundational                                    proven cost benefits IT has shown for industries
               Intel has established and held
                                                                                           technology components for many healthcare                                           such as finance, banking, retail, and others, and it
               membership in numerous industry
                                                                                           IT solutions, providing common building blocks                                      will also see improved care and patient outcomes.
               organizations that are developing
                                                                                           that help ensure interoperability and efficiencies
               standards critical to technological                                                                                                                             For a complex initiative such as healthcare reform
                                                                                           throughout the system.
               progress in healthcare. In alliances                                                                                                                            to succeed, the industry needs imagination,
               such as HL7, Continua, Dossia,                                              Intel’s broad technology portfolio includes a                                       system-wide collaboration, and transformative
               Healthcare Information Technology                                           network of relationships with key technology                                        changes in the market incentives that currently
               Standards Panel (HITSP), AIG,                                               suppliers. We work with more than 1,000                                             exist. ARRA provides the needed push to drive
               Certification Commission for Health                                         hardware, software, and service providers to                                        such collaboration and change. Intel is providing
               Information (CCHIT), and American                                           create robust, interoperable solutions. We also                                     the foundational architecture for healthcare
               Health Information Community (AHIC),                                        support rigorous standards and policies, working                                    innovation with processors, platform definition,
               Intel is working to bring together                                          with more than 250 standards and industry                                           system architecture, and reference designs,
               leaders across the healthcare industry                                      groups worldwide to pioneer technological                                           which will enable the industry to realize lower
               to accelerate the adoption of open                                          advances that both establish and maintain the                                       costs and a higher quality of care for patients.
               and interoperable systems for the                                           highest level of standards-based innovation.
                                                                                                                                                                               For more information, visit http://ipip.intel.com/go
               benefit of all.                                                             These relationships enable Intel to help healthcare
                                                                                                                                                                               and complete the Contact Us form, or e-mail us
                                                                                           organizations remove technology roadblocks,
                                                                                                                                                                               directly at admin@ipip.intel.com.
                                                                                           accelerate change, mitigate risks, and realize
                                                                                           the full value of their technology investments.



     For more about the Intel’s role in healthcare IT solutions, visit www.intel.com/healthcare.




	1
   	“The	Cost	Conundrum.”	The	New	Yorker;	June	1,	2009.
	 2	
       “Trends:	U.S.	Health	Care	Expenditures	Projections	for	2004-2014”	Health	Affairs;	February	23,	2005.
	 3	
       “What	Kerry	Health-care	Plan	Means	to	You.”	Philadelphia	Daily	News;	September	21,	2004.
	 4	
       Ibid.
	 5	
       For	a	more	complete	description	of	how	this	program	will	work,	see:	www.allscripts.com/resources/docs/stimulus/Stimulus%20101.pdf.
	 6	
       “ARRA	Opportunities	and	Risks.”	Radiology	Business	Journal;	May	2009.
	 	INFORMATION	IN	THIS	DOCUMENT	IS	PROVIDED	IN	CONNECTION	WITH	INTEL®	PRODUCTS.	NO	LICENSE,	EXPRESS	OR	IMPLIED,	BY	ESTOPPEL	OR	OTHERWISE,	TO	ANY	INTELLEC-
   TUAL	PROPERTY	RIGHTS	IS	GRANTED	BY	THIS	DOCUMENT.	EXCEPT	AS	PROVIDED	IN	INTEL’S	TERMS	AND	CONDITIONS	OF	SALE	FOR	SUCH	PRODUCTS,	INTEL	ASSUMES	NO	LIABIL-
   ITY	WHATSOEVER,	AND	INTEL	DISCLAIMS	ANY	EXPRESS	OR	IMPLIED	WARRANTY,	RELATING	TO	SALE	AND/OR	USE	OF	INTEL	PRODUCTS	INCLUDING	LIABILITY	OR	WARRANTIES	
   RELATING	TO	FITNESS	FOR	A	PARTICULAR	PURPOSE,	MERCHANTABILITY,	OR	INFRINGEMENT	OF	ANY	PATENT,	COPYRIGHT	OR	OTHER	INTELLECTUAL	PROPERTY	RIGHT.	UNLESS	
   OTHERWISE	AGREED	IN	WRITING	BY	INTEL,	THE	INTEL	PRODUCTS	ARE	NOT	DESIGNED	NOR	INTENDED	FOR	ANY	APPLICATION	IN	WHICH	THE	FAILURE	OF	THE	INTEL	PRODUCT	
   COULD	CREATE	A	SITUATION	WHERE	PERSONAL	INJURY	OR	DEATH	MAY	OCCUR.
	 	Copyright	©	2010	Intel	Corporation.	All	rights	reserved.	Intel	and	the	Intel	logo	are	trademarks	of	Intel	Corporation	in	the	U.S.	and	other	countries.
	 *	Other	names	and	brands	may	be	claimed	as	the	property	of	others.	               Printed	in	USA	                0310/PB/KC/PDF	                          	Please	Recycle	          322455-001US

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Healthcare intel it 448558 448558

  • 1. SOLUTION BRIEF Stimulus Funding Healthcare Improving Health and Healthcare with Technology Stimulus funding will speed adoption of new digital technologies for more proactive, patient-focused care and improvements in healthcare quality, cost, and accessibility. Achieving Better Outcomes efficiency and quality of patient care. About with Technology 25 percent of all healthcare costs are spent Containing costs while improving health and on preparing, submitting, calculating, paying, delivery of services is critical to patients, and collecting medical bills.3 One medical administrators, and healthcare providers transaction can cost USD 25, while one banking at every level. Healthcare costs consume transaction costs less than a penny.4 more than one of every six dollars we earn.1 Healthcare costs will continue to increase unless we find better methods for reducing administrative costs and delivering care. By AMERICAN RECOVERY AND 2015, it’s estimated that healthcare costs will REINVESTMENT ACT (ARRA) reach USD 4 trillion per year and account for HEALTHCARE FUNDING PROGRAMS nearly 20 percent of the U.S. economy.2 USD 48.8 Billion In addition to unsustainably high costs, the Seeks to help physicians purchase and implement Medicare and Medicaid health healthcare system faces challenges that IT systems. include an aging population, epidemics in USD 1.2 billion chronic conditions like diabetes, inferior patient Supports the deployment of broadband outcomes in comparison to many countries, infrastructure in rural areas. limited access due to lack of insurance, and Up to USD 44,000 or USD 64,000 inefficiencies throughout the system. Incentive payments over a five-year period to physicians who demonstrate meaningful use of electronic health Paradoxically, the U.S. healthcare industry, one records (EHRs). Starts in 2011. of the world’s most technologically advanced For more information, see: in medical equipment, has been slow to adopt http://healthit.hhs.gov IT solutions that could improve both overall
  • 2. Effective reform requires a new healthcare and report meaningful use of electronic health IT infrastructure that enables efficiency, records (EHRs) will be eligible for an initial collaboration, and improved care. It requires incentive payment of up to USD 18,000. standards-based interoperable systems Incentives under the Medicaid program are designed to provide timely, accurate information available for physicians, hospitals, federally delivery and electronic record keeping across qualified health centers, rural health clinics, the continuum of care. It requires IT systems and other providers. Physicians cannot take that improve quality of patient care by enabling advantage of the incentive payment programs improved healthcare delivery, workflow, patient under both Medicare and Medicaid programs; safety, clinical decision making, and cost they must choose one. Eligible pediatricians performance. (non-hospital based), with at least 20 percent Intel innovation will play a major role in Medicaid patient volume, could receive up to enabling IT systems for improving the future USD 44,000, and other physicians (non-hospital INTEL HEALTH GUIDE of healthcare. Through our leadership and based), with at least 30 percent Medicaid patient A remote patient monitoring (RPM) solution combines an in-home patient device and unique market position, Intel offers the volume, could receive up to USD 64,000 over a the Intel Health Guide PHS6000 with the foundational IT architecture, a standards- five-year period.5 Intel® Health Care Management Suite—an based approach, and corporate leadership to online interface that allows clinicians to According to Radiology Business Journal, the transform healthcare to an affordable model monitor patients and remotely manage Medicare and Medicaid health IT incentives care. See: www.intel.com/healthcare/ps/ focused on efficient collaboration across all could add up significantly for hospitals. Using healthguide/index.htm points of the system with more effective a tool on the Healthcare Information and patient care and improved outcomes. Management Systems Society (HIMSS) Web site, one hospital CIO calculated potential Healthcare and Stimulus Funding awards over a four-year period. He found that a Enacted in February 2009, the American 75-bed hospital could get up to USD 3.5 million, Recovery and Reinvestment Act (ARRA) a 250-bed hospital would have the potential provides a unique opportunity to apply IT to earn almost USD 6 million, and a 750-bed technology more effectively to improve hospital could qualify for nearly USD 12 million.6 healthcare systems. ARRA specifically allocates USD 19 billion in Medicare and Stimulus funding presents a tremendous Medicaid incentives over five years to help opportunity to transform healthcare and physicians purchase and implement health ignite innovation. The window of opportunity, IT systems. A key element in the program is however, is brief: five years. Consequently, the widespread adoption and use of uniform providers should move fast to take advantage electronic standards that will enable various of this once-in-a-lifetime funding. Remember, health IT systems to communicate with each too, that this is not just a matter of installing other. ARRA required the Department of Health new technology. Accountability is key, and and Human Services (HHS) to develop such the task will require a great deal of process standards by December 31, 2009. Beginning re-engineering. Providers will be responsible in 2011, Medicare physicians who implement for demonstrating outcomes that meet ARRA 2
  • 3. BUILDING THE INTELLIGENT HEALTH NETWORK A major reason for the slow adoption of patient information sharing is the high cost Health Information Network Core Intel® Certified Ecosystem of proprietary data and integration services. Record Locator Services Medical Terminology Services To address this, Intel worked with hundreds of healthcare leaders around the world on Patient Portal Master-Person Index Services ways to significantly improve and streamline information flow, while enhancing the quality, cost, and efficiency of patient care. The result is the Intel® Service-Oriented Intel® SOA Architecture Expressway for Healthcare Expressway for Healthcare (Intel® SOAE-H). Clinic Intel® SOA Intel® SOA Hospital Expressway Expressway This supplier-neutral platform provides a for Healthcare for Healthcare high-performance solution for translating, Clinical Systems Intelligent Clinical Systems processing, and connecting multiple data Health Network Lab Intel® SOA Common Information Model Intel® SOA Pharmaceutical formats across a healthcare environment. Expressway Expressway Network for Healthcare for Healthcare It can be used to construct large multi-site Clinical Systems Intel® SOA Clinical Systems health networks using its unique healthcare Expressway for Healthcare environment developer kit (HDK), or it can be a base platform to augment healthcare supplier product offerings. In either case, it helps accelerate computable healthcare Clinical Systems Payer information across disparate health environments such as hospitals, integrated delivery networks, clinics, payer networks, labs, and pharmaceutical networks. objectives. A good first step is to contact infrastructure that enables electronic medical to market across a breadth of industries. Our your nearest Health Information Technology records, electronic prescriptions and information status as a foundational technology supplier Extension Program Regional Center for guidance, exchanges, as well as mobile point-of-care results in a neutral approach that enables us once they are in place sometime in 2010. solutions that deliver patient histories, diagnostic to collaborate with manufacturers, software information, and decision support in real time. What developers, and healthcare providers to create Taking a Collaborative Approach the healthcare industry needs now are partners. mutually beneficial standards and solutions. to Health As a global technology innovator, Intel is in a For healthcare IT, Intel is collaborating with The healthcare industry now has the financial unique position to help. We have a long record healthcare leaders to accelerate the shift to a incentive to invest in an interoperable healthcare of bringing technologies, systems, and solutions more cost-efficient, proactive wellness model 3
  • 4. of care as well as healthcare IT systems to Conclusion improve quality, cost, and accessibility. We’re Intel innovation enabled the shift from mainframe developing new technology platforms that allow to open-platform computing. A similar shift needs LEADING THE WAY TO healthcare facilities to combine technology with to occur today in healthcare. As the healthcare A STANDARDS-BASED medical expertise to achieve major clinical and INFORMATION EXCHANGE industry adopts new IT innovations, it will see the business goals. We’re supplying the foundational proven cost benefits IT has shown for industries Intel has established and held technology components for many healthcare such as finance, banking, retail, and others, and it membership in numerous industry IT solutions, providing common building blocks will also see improved care and patient outcomes. organizations that are developing that help ensure interoperability and efficiencies standards critical to technological For a complex initiative such as healthcare reform throughout the system. progress in healthcare. In alliances to succeed, the industry needs imagination, such as HL7, Continua, Dossia, Intel’s broad technology portfolio includes a system-wide collaboration, and transformative Healthcare Information Technology network of relationships with key technology changes in the market incentives that currently Standards Panel (HITSP), AIG, suppliers. We work with more than 1,000 exist. ARRA provides the needed push to drive Certification Commission for Health hardware, software, and service providers to such collaboration and change. Intel is providing Information (CCHIT), and American create robust, interoperable solutions. We also the foundational architecture for healthcare Health Information Community (AHIC), support rigorous standards and policies, working innovation with processors, platform definition, Intel is working to bring together with more than 250 standards and industry system architecture, and reference designs, leaders across the healthcare industry groups worldwide to pioneer technological which will enable the industry to realize lower to accelerate the adoption of open advances that both establish and maintain the costs and a higher quality of care for patients. and interoperable systems for the highest level of standards-based innovation. For more information, visit http://ipip.intel.com/go benefit of all. These relationships enable Intel to help healthcare and complete the Contact Us form, or e-mail us organizations remove technology roadblocks, directly at admin@ipip.intel.com. accelerate change, mitigate risks, and realize the full value of their technology investments. For more about the Intel’s role in healthcare IT solutions, visit www.intel.com/healthcare. 1 “The Cost Conundrum.” The New Yorker; June 1, 2009. 2 “Trends: U.S. Health Care Expenditures Projections for 2004-2014” Health Affairs; February 23, 2005. 3 “What Kerry Health-care Plan Means to You.” Philadelphia Daily News; September 21, 2004. 4 Ibid. 5 For a more complete description of how this program will work, see: www.allscripts.com/resources/docs/stimulus/Stimulus%20101.pdf. 6 “ARRA Opportunities and Risks.” Radiology Business Journal; May 2009. INFORMATION IN THIS DOCUMENT IS PROVIDED IN CONNECTION WITH INTEL® PRODUCTS. NO LICENSE, EXPRESS OR IMPLIED, BY ESTOPPEL OR OTHERWISE, TO ANY INTELLEC- TUAL PROPERTY RIGHTS IS GRANTED BY THIS DOCUMENT. EXCEPT AS PROVIDED IN INTEL’S TERMS AND CONDITIONS OF SALE FOR SUCH PRODUCTS, INTEL ASSUMES NO LIABIL- ITY WHATSOEVER, AND INTEL DISCLAIMS ANY EXPRESS OR IMPLIED WARRANTY, RELATING TO SALE AND/OR USE OF INTEL PRODUCTS INCLUDING LIABILITY OR WARRANTIES RELATING TO FITNESS FOR A PARTICULAR PURPOSE, MERCHANTABILITY, OR INFRINGEMENT OF ANY PATENT, COPYRIGHT OR OTHER INTELLECTUAL PROPERTY RIGHT. UNLESS OTHERWISE AGREED IN WRITING BY INTEL, THE INTEL PRODUCTS ARE NOT DESIGNED NOR INTENDED FOR ANY APPLICATION IN WHICH THE FAILURE OF THE INTEL PRODUCT COULD CREATE A SITUATION WHERE PERSONAL INJURY OR DEATH MAY OCCUR. Copyright © 2010 Intel Corporation. All rights reserved. Intel and the Intel logo are trademarks of Intel Corporation in the U.S. and other countries. * Other names and brands may be claimed as the property of others. Printed in USA 0310/PB/KC/PDF Please Recycle 322455-001US