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Electronic Health ecords
The state of today's technology has transformed many of the methods and systems society uses to live and interact with one another. In the medical community, technology has also become a much larger part of how healing and the healing processes are carried out by health care professionals on a day-to-day basis. The purpose of this essay is to discuss how one piece of technology as represented by Electronic Health ecords, has changed and modified the delivery of health care. To help understand this argument, this subject will be approached from the aspect of society's beliefs and values and how this affected this evolution of practical medicine.
Growth Of Technology
The ability to compress data in small, electronic packages has changed the world in many ways. Electronic health records (HE) have manifested in the medical community because of this technology that allows the compression of data into…
Menachemi, N., & Collum, T.H. (2011). Benefits and drawbacks of electronic health record systems. Risk management and healthcare policy, 4, 47.
Thede, L. (2010). Informatics: Electronic Health Records: A Boon or Privacy Nightmare?. OJIN: The Online Journal of Issues in Nursing, 15(2).
Electronic Health Records
Since the introduction of electronic health records, the U.S. government, information systems developers and associations of healthcare providers have worked toward establishing a uniform, integrated system of electronic health records. This collaboration is designed to significantly enhance patient safety and treatment, as well as effectively assist in the management of public health issues such as disease. hile some health practitioners report difficulties in dealing with electronic health records, it appears that continued efforts and refinements are gradually solving problems of computerization and are improving healthcare.
Characteristics and Components of Efficient EHR
In 2003, the Institute of Medicine released a report called Key capabilities of an electronic health record system. In this consensus report, the Institute stated that an electronic health records system should consist of:
"a longitudinal collection of electronic health information for and about persons;
2. [immediate] electronic access to person- and population-level information by authorized…
Institute of Medicine. (2003). Key capabilities of an electronic health record system. Washington, DC: National Academies Press.
National Research Council. (2004). Patient safety: Achieving a new standard for care. Washington, DC: National Academies Press.
Open Clinical. (2011). Electronic medical records. Retrieved on February 10, 2012 from OpenClinical.com Web site: http://www.openclinical.org/emr.html
Electronic Health ecords
The advent of technology has had an impact on almost every facet of our lives. Today, thanks to technology, the maintenance of patient records is becoming increasingly easy and efficient. In this text, I will concern myself with electronic health records (EH). In so doing, I will amongst other things take into consideration the effect of EHs on health care and the implications of adopting this technology from a privacy and security perspective. Further, I will highlight HIPAA privacy and security rules and how they relate to EHs.
Electronic Health ecords (EHs): An Overview
Electronic health record according to Kirch (2008) "describes a longitudinal (lifetime) record of a patient's health and health care." However, a more comprehensive definition of EH has three key components. According to the Institute of Medicine - IOM (as cited in Niles, 2010), these components are "the collection of longitudinal data on a…
Health Resources and Services Administration -- HRSA (2012). What are the HIPAA Privacy and Security Rules? Retrieved August 2, 2012, from the HRSA website: http://www.hrsa.gov/healthit/toolbox/HealthITAdoptiontoolbox/PrivacyandSecurity/hipaarules.html
Iyer, P.W., Levin, B.J. & Shea, M.A. (2006). Medical Legal Aspects of Medical Records. Tucson, AZ: Lawyers & Judges Publishing Company.
Kirch, W. (Ed.). (2008). Encyclopedia of Public Health: Volume 1: A - H Volume 2: I -- Z. New York, NY: Springer.
Niles, N.J. (2010). Basics of the U.S. Health Care System. Sudbury, MA: Jones & Bartlett Learning.
Electronic Health ecords
The medical community has begun using electronic health records (EH) as an alternative to paper records (Gunter & Terry, 2005). While there are many benefits to this, there are also concerns with hacking and security. Another concern is how patients get copies of these records, because they want to make sure that they are able to access information that is rightfully theirs. It should also be able to be transferred to other doctors and hospitals easily, and provided to people who are legitimately allowed to have it -- such as family members or friends that a person has specifically authorized to view his or her medical information. Doctors and hospitals that like having the EHs prefer them because the information can be sent to another person so quickly and accessed almost anywhere, making it convenient during emergencies (Gunter & Terry, 2005). These EHs also reduce the need…
Ackerman, M.J. (2007). The personal health record. Journal of Medical Practice Management, 23(2): 84 -- 5.
Agarwal, R., & Angst, C.M. (2006). Technology-enabled transformations in U.S. health care: early findings on personal health records and individual use, In Galletta G, Zhang P, (Eds.), Human-Computer Interaction and Management Information Systems: Applications (Vol. 5). NY: M.E. Sharpe, Inc.
Gunter T.D., & Terry N.P. (2005). The emergence of national electronic health record architectures in the United States and Australia: Models, costs, and questions. Journal of Medical Internet Research, 7(1): e3.
Kierkegaard, P. (2011). Electronic health record: Wiring Europe's healthcare. Computer Law & Security Review, 27(5): 503 -- 515.
Health Systems Management and Electronic Health ecords
Healthcare is an essential factor or tool in relation to the American society. The society of America has no national socialized healthcare system. In this research paper, the focus will be on the Medicare healthcare system in the context of the United States. The paper will focus on illustration of the concepts of the Medicare healthcare system, various management challenges, problems, and opportunities in relation to the organizational impact of the policies governing the system.
Healthcare is an essential factor or tool in relation to the American society. The society of America has no national socialized healthcare system. This forces the citizens to adopt and integrate various ways of paying for their healthcare needs. In the context of the United States, various systems provide healthcare services to the rich and less fortunate society members. In this research paper, the focus will be on…
Altman, S.H. (2012). The Lessons of Medicare's Prospective Payment System Show That the Bundled Payment Program Faces Challenges. Health Affairs, 31(9), 1923-1930.
Carpenter, C.E. (2011). Medicare Advantage: Where It's Been; Where Is It Headed?. Journal Of
Financial Service Professionals, 65(4), 23-26.
The other dimension is related but is definitely separate. Some end-users are not only uninformed on how to administer electronic health records, they may actively resist and otherwise undermine the setup and these people need to be identified or even removed if they will not play along. It cannot be denied that, when done properly, electronic health records allows for such a seamless and beautiful result. As such, people that are intentionally or unconsciously undermining the setup need to be fleshed out and corrected (Bates, 2010).
The last sentence of the proper paragraph is very important in the medical context because life and death decisions are made (or not made) based on the contents and accuracy of the data in electronic health records. For example, if a drug allergy is known in one set of data but it never makes it to the central repository for this patient, the results…
Bates, D. (2010). Getting in Step: Electronic Health Records and their Role in Care Coordination. Journal of General Internal Medicine, 25(3), 174-176.
Murphy, J. (2010). The Journey to Meaningful Use of Electronic Health Records. Nursing Economics, 28(4), 283-286.
Due to the need to solve the issues that emerge in the workplace, various problem solving approaches have emerged and are used to help in finding solution to the issues. egardless of the utilized or adopted problem-solving model, the process generally involves several stages (Hicks, 2004, p.35). However, it's not necessary to strictly adhere to the stages in a particular problem-solving model in order to be effective in finding the solution to the problem.
An example of a current issue in the workplace setting is the lack of motivation by the employees in their work that contributes to the ineffective or poor delivery of services. This issue can be solved through the use of a problem-solving model that incorporates seven important stages. These stages are identification of the underlying problem or issues, understanding people's interests, listing potential solutions, evaluating options, choosing the best possible option, recording agreements, and agreeing on…
"Electronic Health Records and Meaningful Use." (2011, September 2). The Office of the National Coordinator for Health Information Technology. Retrieved U.S. Department of Health and Human Services website: http://healthit.hhs.gov/portal/server.pt?open=512&objID=2996&mode=2
Hicks, M.J. Problem solving and decision making: hard, soft, and creative approaches (2nd ed.).
North Yorkshire: Thomson Learning
All three systems typically require a practice to install the EH software onto on-site servers, although they all appear to require only standard "off-the-shelf" hardware, and all of them also offer Application Service Provider (ASP) access as an option. (McKesson, 2010, General Electric Corporation, 2010, Sage 2010). Because all three systems are applications that reside on the practice's hardware, back-up of the server data seems to fall on the shoulders of the practice itself to manage this process (Compliant Backup, 2010).
Among special additional features, Practice Partner offers "BrightNote" technology allowing physicians to dictate patient information, which then populates discrete data in different parts of the patient's chart automatically (McKesson, 2010). GE Centricity offers a Medical Quality Improvement Consortium that allows a practice to consolidate and benchmark quality of care measures (General Electric Corporation, 2010). Sage Intergy includes a set of online "marketing" tools that allow a practice to send…
Adler, K.G. (2005). How to Select an Electronic Health Record System. Family Practice Management, 12 (2). Retrieved from http://www.aafp.org/fpm/2005/0200/p55.html
Compliant Backup (2010). Centricity Backup: Are You Backing Up Your Centricity Data? Retrieved April 7, 2010 from the Compliant Backup website http://centricitypractice.gehealthcare.com/public/requirements.htm
Garets, D. & Davis, M. (2006). Electronic Medical Records vs. Electronic Health Records: Yes, There Is a Difference, A HIMSS AnalyticsTM White Paper. Retrieved from the Health Information and Management Systems Society (HIMSS) website http://www.himssanalytics.org/docs/wp_emr_ehr.pdf
General Electric Company (2010). GE Centricity. Retrieved April 7, 2010 from the GE Healthcare website https://www2.gehealthcare.com/portal/site/usen/menuitem.e8b305b80b84c1b4d6354a1074c84130/?vgnextoid=5bb454fbded30210VgnVCM10000024dd1403RCRD&productid=4bb454fbded30210VgnVCM10000024dd1403
It might seem like great convenience that patient data, such as weight or blood sugar readings can be sent directly to a nurse or healthcare provider daily. But will self-reported data really be an effective replacement for human contact? The patient could report inaccurate information if he or she is embarrassed about his or her weight or misread the device used to record the data. And the human contact between nurse and patient is often very important for the elderly and chronically ill. While systems such as the Zuri are presented as an enhancement to face-to-face medical treatment, it is not hard to envision a 'nightmare' scenario where they are used to replace it.
These devices are not covered by HIPAA, although the FTC has proposed a rule that requires vendors of personal health information "to notify the owner of the personal health information within 60 days and prescribes a…
FTC issues notice of rule regarding breach of security of personal health records. (2009, April
22). Holland and Hart Healthcare. Retrieved March 26, 2010 at http://www.hollandharthealthcare.com/healthcare/2009/04/internet-medicine-part-iii-ftc-issues-notice-of-rule-regarding-breach-of-security-of-personal-health.html#more
Wangness, Lisa (2009, April 13). Electronic health records raise doubt. The Boston Globe.
Retrieved March 26, 2010 at http://www.boston.com/news/nation/washington/articles/2009/04/13/electronic_health_records_raise_doubt/
Staff must be trained to use Electronic Health ecords in a way that optimizes the potential benefits of the new technology, while avoiding sloppy habits that not only reduce effectiveness but are even potentially detrimental to the quality of health care (Hartzband & Groopman, 1998). There are literally hundreds of Electronic Health ecords applications and products available on the market today. It is up to each organization to choose the product that suits their user environment, but they should also select a product that is well designed to promote good clinical and practices.
For example, check-box style systems force a practitioner to interact with the computer screen more than the patient, and limit a doctor's ability to customize a chart to capture unique or individual information relevant to that patient. Thus systems that allow for at least some amount of free-text entry are preferable (Hartzband & Groopman, 1998). At the…
CCHIT: Find Products. Retrieved March 30, 2010 from the Certification Commission for Health Information Technology's website: http://www.cchit.org/products
Hartzband, P. & Groopman, J. (1998). Avoiding the Pitfalls of Going Electronic. New England Journal of Medicine, (16)358, 1656-1658.
Lohr, S. (2007). Risks and Rewards; Who Pays for Efficiency. The New York Times. Retrieved from http://www.nytimes.com/2007/06/01/business
Lorenzi, N.M., Kouroubali, A., Detmer, D.E., & Bloomrosen, M. (2009). How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings. BMC Medical Informatics and Decision Making, (15)
In so doing, the EH alerts the physician of any potential conflicts thus requiring the physician to prescribe an alternative drug. For drugs that have been recalled due to health risks or other issues, the EH will also alert the physician of any problems that the drug may cause thus also requiring the physician to prescribe an alternative drug Sidorov, 2006()
EH systems also prevent physicians from overdosing, under-dosing or giving their patients the incorrect medication for their diagnosis. Since the EH system collects all relevant information about the patient such as laboratory tests conducted and results and other tests such as X-ray, MI, etc., the system prevents physicians from giving patients the incorrect medication for the diagnosis Pagliari, Don, & Singleton, 2007()
Electronic health record systems can help in the quick and systematic identification of operational issues and adverse effects from a certain drug. For example when the system…
Laerum, H., Ellingsen, G., & Faxvaag, a. (2001). Doctors' Use of Electronic Medical Records Systems in Hospitals: Cross Sectional Survey. BMJ: British Medical Journal, 323(7325), 1344-1348.
Pagliari, C., Don, D., & Singleton, P. (2007). Potential of electronic personal health records. BMJ: British Medical Journal, 335(7615), 330-333.
Sidorov, J. (2006). It Ain't Necessarily So: The Electronic Health Record and the Unlikely Prospect of Reducing Health Care Costs. Health Affairs, 25(4), 1079-1085. doi: 10.1377/hlthaff.25.4.1079
U.S. Food and Drug Administration. (2012a). Hospira Announces a Nationwide Recall of Three Lots of Propofol Due to Glass Vial Defect Retrieved October 8th, 2012, from http://www.fda.gov/Safety/Recalls/ucm315719.htm
Electronic Health ecords
I trouble starting project. I write electronic health records ( company's NextGen), create a multi-step Strategic Marketing Analysis: Marketing Plan, a strategic analysis, recommended actions. This project emulates steps a marketer real world determines a company respond operating environment, providing offering customer .
Electronic Health ecords
As a market player in the healthcare sector, NextGen is indeed facing some of the greatest opportunities and challenges that confront the other market players in the field. In this regard, the company is certainly obliged to put measures through which it can take advantage of these opportunities and address some of the challenges that it realizes in the course of its operations. One of the ways through which NextGen is seeking to enhance its operational efficiency concerns its health records management. Electronic health records are becoming increasingly popular in the healthcare sector as ways through which efficiency and productivity is…
Kotler, P. (2001). Principles of marketing (5th ed.). Englewood Cliffs, N.J: Prentice Hall.
Mallen, B.E. (2007). Principles of marketing channel management: interorganizational distribution design and relations. Lexington, Mass: Lexington Books.
Randall, G. (2001). Principles of marketing (2nd ed.). London: Thomson Learning.
Tanner, J.F., & Raymond, M.A. (2011). Principles of marketing. Irvington, N.Y.: Flat World Knowledge.
The electronic health records mandate comes from the federal government and is described by the Office of the National Coordinator for Health Information Technology. The objective of the program is to "enable the secure collection and exchange of vast amounts of health data about individuals" (ONC, 2011). Electronic health records (EHs) are one of the key technologies in the plan. The mandate is therefore to convert the U.S. medical system to electronic health records. This will reduce errors, enable the provision of information quickly across multiple health providers and thereby improve health care outcomes for Americans.
There are five strategic goals that come within this mandate. They are to achieve rapid learning and technological advancement; to empower individuals with health IT to improve their health and the health care system; to inspire confidence and trust in health IT; to improve care, improve population health and reduce health care…
Davies, N. (2006). Making IT happen: Strategies for implementing EMR-EHR HIMSS. Retrieved October 22, 2013 from http://www.himss.org/files/HIMSSorg/content/files/davies/Davies_WP_Implementation.pdf
Hanson, S. (2013). Provider age, aversion to tech remain EHR obstacles. Physicians Practice. Retrieved October 22, 2013 from http://www.physicianspractice.com/blog/provider-age-aversion-tech-remain-ehr-obstacles
ONC. (2011). Federal health information technology strategic plan 2011-2015. Office of the National Coordinator for Health Information Technology. Retrieved October 22, 2013 from http://www.healthit.gov/sites/default/files/utility/final-federal-health-it-strategic-plan-0911.pdf
Rouse, M. (2013). EHR implementation plan. Health IT. Retrieved October 22, 2013 from http://searchhealthit.techtarget.com/definition/EHR-implementation-plan
They also claim to have worked on more than 1,400 mobile applications. (www.babelmedia.com)
Beta Breakers is a relatively new entrant into the market but has achieved $7.7 million in revenues. Their focus is games and multi-media testing, but they seem to be focused primarily on PC and Mac games (not console), as well as peripheral device testing. Their rapid growth could be attributable to a dedicated focus on this particular niche of the market, where they appear to have made significant headway. (www.betabreakers.com)
Game Instinct (a division of Testing 1-2-3) is a game-industry specific division of larger software testing firm Testing 1-2-3. Game instinct has revenues of $2.25 million. Their services tend more towards the hardware side of the business with a focus on TC checks/compatibility testing, localization testing, black box/crash testing. But they also do standard functionality testing, playability testing, localization testing, and offer beta administration services (helping a…
Crook, J 2009, 'Mobile gaming to reach $18B by 2014: study', Mobile Marketer, 11 August, 2009. Retrieved 27 April, 2010 from http://www.mobilemarketer.com/cms/news/research/3892.html
DFC Intelligence 2004, the business of computer and video games. San Diego, CA: DFC Intelligence, March 2004.
Hertzlich, P 2009, Ovum Consulting report, as cited in Red Orbit, 'Software testing market continues to rise', 11 March, 2009. Retrieved 27 April, 2010 from http://www.redorbit.com/news/technology/1652726/software_testing_market_continues_to_rise/
Ivan, T 2009, 'Online gaming sees significant U.S. growth', Edge, 1 July, 2009. Retrieved from http://www.edge-online.com/news/online-gaming-sees-significant-us-growth
At the moment, oral macrolides continue to be the best option for an anti-inflammatory treatment. Various other drug-based treatments, including the use of mucolytics to break up thick, viscous sputum and the use of osmotic agents to keep airways moist, are well established in CF treatment protocols, but research continues in order to refine and improve on these approaches as well.
A novel therapeutic method being tried for CF is "the modulation of non-CFT ion channels in epithelial cells." (Jones & Helm, 2009). The drug Lancovutide (Milil901, duramycin) "activates an alternative chloride channel in epithelial cells by elevating intracellular calcium levels, and thus, may potentially compensate for CFT deficiency in the airway epithelium." (Jones & Helm, 2009). These agents have reached the clinical trial stage, and, if successful, will be able to offer a new category of treatment option for CF patients.
Gene therapies, which seek to correct "the underlying…
Cystic Fibrosis Foundation (n.d.). Retrieved 15 April 2010 from the Cystic Fibrosis Foundation website, http://www.cff.org/
Deleu, S. et al., (2009). Human cystic fibrosis embryonic stem cell lines derived on placental mesenchyman stromal cells. Reproductive BioMedicine Online, 18(5), pp. 704-716.
Jones, A.M. & Helm, J.M. (2009). Emerging Treatments in Cystic Fibrosis. Drugs 69 (14), pp. 1903-1910.
Kids Health (n.d.). What is Cystic Fibrosis, Retrieved 15 April 2010 from the Kids Health website http://kidshealth.org/parent/medical/lungs/cf.html
There may be specific circumstances for specific customers where these substitute options become more attractive, but as a whole, they exert little threat.
Barriers to Entry. Barriers to entry are modest. There are no significant technologies to acquire or license, no research and development investment, or expensive equipment needed. Existing firms do not possess patents that prevent other entrants from operating effectively. Some companies may choose to invest in more advanced service offerings for customers, including refrigerated storage, storage for boats/Vs and other larger items to enhance competitiveness, but depending on the individual market, these options are not required.
In fact, a large portion of the industry is made up of small, independent operators who were able to launch their businesses with only a modest investment in real estate, warehouse building construction/modification, and general start up costs. Particularly notable in demonstrating the low barrier to entry in this industry…
Curtis, D. (2007). Building for Money, or 'How to Marry Rich Customers. Inside Self-Storage. 1 September, 2007. Retrieved 25, April 2010 from http://www.insideself-storage.com/articles/conversions/78h1316144715396.html
First Research (2010). Self-Storage Services. Retrieved 24 April, 2010 from the First Research website, http://www.firstresearch.com/industry-research/Self-Storage-Services.html
ArticlesBase (2010). Help Protect Your Self-Storage Clients From Environmental Liability Claims. [Web log message, 21 April, 2010]. Retrieved from http://www.articlesbase.com/business-articles/help-protect-your-self-storage-facility-clients-from-environmental-claims-2198144.html#ixzz0m539TFUV
How Much Does Self-Storage Cost (2010). Cost Helper. Retrieved 25 April, 2010 from http://www.costhelper.com/cost/home-garden/self-storage.html
The most common treatment for hemophilia is replacement therapy, where concentrates of the clotting factors (factor VIII for hemophilia A or factor IX for hemophilia B) are administered to the patient. Clotting factors can be obtained from treated human blood sources or recombinant sources. (NHLBI, n.d.) ecombinant factors "are made by inserting the DNA encoding the human protein into mammalian cells grown in culture. They are purified and processed and are non-plasma derived products." (Hemophilia-Information, n.d.) Many patients take replacement therapy on a prophylactic (preventive) basis daily, others apply treatment only in the event of a bleeding event/injury (NHLBI, n.d.). Other treatment options, typically used for specific situations such as prior to dental surgery or to treat active bleeding, include:
Desmopressin (DDAVP), which is a man-made hormone that stimulates the release of stored factor VIII and vonWillebrand factor, while also increasing the level of these proteins in the blood stream,…
Hemophilia Genetics (n.d.). Retrieved 13 April, 2010 from the Hemophilia-Information.com web site. http://www.hemophilia-information.com/hemophilia-genetics.html
Mannucci PM. (2003). Hemophilia: treatment options in the twenty-first century. J Thromb Haemost 1(7) pp. 1349-55.
Medical News Today. (11 March 2010). Research Update: Gene Therapy for Hemophilia B. Enters New Development Phase. Retrieved from the National Hemophilia Association Web site http://www.hemophilia.org/NHFWeb/MainPgs/MainNHF.aspx?menuid=118&contentid=1490
NHLBI - National Heart, Lung and Blood Institute. (n.d.). How is Hemophilia Treated. Retrieved 13 April 2010 from http://www.nhlbi.nih.gov/health/dci/Diseases/hemophilia/hemophilia_treatments.html
). On the other hand, this asset liability matching [provoked] a move into bonds which, coupled with the low-interest rate environment, [meant] that pension funds [were] are also been forced to think harder about how to generate return." (6).
As a result, many pension funds, including many of those of non-profit companies that in the form of Defined Benefit plans, moved away from holding traditional equity portfolios. As Stewart explains,
"[r]ather than holding traditional equity portfolios, generating most of their return from 'beta' or market return (which can be easily and cheaply obtained via passive, index products), pension funds are increasingly rethinking their investment approach and searching for 'alpha' or excess return over the market. More absolute return mandates are being given to fund mangers, who are also allowed to go short as well as long. In addition, pension funds are progressively more prepared to invest in a broader range…
Barton, N. & Gose, B. "Executive Pay Outpaces Inflation." The Chronicle of Philanthropy. 2 Oct., 2009. Web. 22 April, 2010.
Boushey, H. "Family Income Free Fall." Center for American Progress. 10 Sept. 2009. Web. http://www.americanprogress.org/issues/2009/09/census_income.html
"Employee Retirement Income Security Act." Wikipedia. Web. 22 April, 2010. http://en.wikipedia.org/wiki/Employee_Retirement_Income_Security_Act#History
"How Will Pension Funds Manage." Towers Watson. Web. 22 April, 2010. http://www.watsonwyatt.com/europe/pubs/gim/render2.asp?id=15468
To establish the Scranton Sports Medicine Clinic in the regional market, careful branding of the clinic will establish it as a high-quality provider of the best of modern sports medicine treatment in a comfortable, family-friendly environment, To drive market awareness, marketing activities will include the following:
Logo and visual brand, with a website design that supports a quality, state-of-the-art clinic, yet warm and family-oriented.
Series of advertisements in the event programs at local sporting events.
Sponsorship of local pee wee league/little league and youth sports teams
Informational hand out to local coaches detailing the clinic's facilities, capabilities, services, and the expertise of our staff
Appendix A -- Financial Projections
Start up costs
X-ray machine and software
Equipment and fixtures for vital signs, diagnostic procedures, assessment tests
Operating room equipment and fixtures
6 Computer workstations, server/router $6,000
Electronic medical records system…
KeystoneEdge (2010). "Scranton Plan Maps out County's Future." Originally reported in the Times Leader, 3 March, 2010. Retrieved from: http://www.keystoneedge.com/inthenews/scrantonplan0304.aspx
Lehigh (2010). Lehigh Valley Health Network website, http://www.lvhn.org/ortho/Conditions_We_Treat%7C128#
Merritt Hawkins (2010). 2010 Physician Inpatient/Outpatient Revenue Survey. Retrieved 20, April 2010 from http://www.merritthawkins.com/pdf/2010revenuesurvey.pdf
Quinn, E., (2009). "Youth Sports and Overuse Injuries." In About.com. Retrieved 20 April, 2010 from http://sportsmedicine.about.com/od/children/a/overusekids.htm
(Starbucks Corporation: Public Company 1982-). This model continues to sustain Starbucks growth today.
An additional strategy Starbucks employs is licensing. Currently, the company has more than 900 licensed store locations at places including airports, Barnes & Noble bookstores, and grocery and mass-market retail chains such as Target, Albertson's, and Safeway stores. The company also has licenses with United Airlines and Marriott to exclusively serve Starbucks coffees. The benefit of this licensing strategy is to extend the Starbucks brand presence, but retain a higher degree of control than franchising. Starbucks charges a royalty on gross sales and a licensing fee to start up the business.
Finally, another critical component of the Starbucks strategy is product innovation. Its forays into books, movies and music demonstrate the company's continual search for ways to extend and enhance its product line, but with a careful eye to its brand and customer demographic. Yet it also…
Analysis of Starbucks. Knol. Retrieved 23 April 2010 from the World Wide Web: http://knol.google.com/k/analysis-of-starbucks#
Bowman, B. (2008). Starbucks as Demographic Indicator. Maynard Institute, 11 September, 2008. Retrieved 25 April, 2010 from the World Wide Web: http://www.mije.org/bobbibowman/starbucks
Groom, N. And Bertlein, L. (2008). "Starbucks steps back from music business." Reuters. 24 April 2008. Retrieved 23 April 2010 from the World Wide Web: http://www.reuters.com/article/idUSWNAS968120080424
Howard Schulz. Wikipedia. Retrieved 23 April 2010 from the World Wide Web: http://en.wikipedia.org/wiki/Howard_Schultz
However, with natural gas, production takes a long lead time -- drillers and processers cannot increase production capacity quickly to meet increased market demand, thus increased demand will start the price rising and keep it rising for a period of time until eventually supply catches up, or other market factors (such as a warm winter that reduces demand for heating gas) influence the price. Overall, prices for natural gas have been rising: between 1999 and 2008, natural gas prices in the U.S. more than doubled, from $6.69 per thousand cubic feet (Mcf) to $13.68 per Mcf. The increasing price reflects market conditions that have included:
Colder-than-normal weather for long periods during some heating seasons
Increasing use of natural gas for electric generation
Production disruptions from hurricane activity in the Gulf of Mexico
ecord-high crude oil prices over much of the last two years
Fluctuating net import levels" (U.S. Energy Information…
Alben, Alex. "Mediating the marriage of Comcast and NBC to protect consumers." Seattle Times. 28 January, 2010. Web. 3 May, 2010.
Morris, Frank. Monsanto GMO Ignites Big Seed War. National Public Radio. 12 January, 2010. Web. 3 May, 2010.
NaturalGas.Org. Industry and Market Structure. 2004. Web. 3 May, 2010.
U.S. Energy Information Administration. Natural Gas Prices. Web. 3 May, 2010.
" (American Experience, 2005). All of these aspects of Kinsey's life are important to understanding his own development, personal commitment to openness about sexual information and practice, and how he acted upon these beliefs, thus it would have been a disservice to the story if these elements had been altered by the filmmakers. Additionally, they are among the more fascinating, relatable and "marketable" parts of the story, so it is clear why they were retained intact by the filmmakers.
Many aspects of Kinsey's life and work, however, appear to have been, if anything, toned down rather than amplified or sensationalized to sell movie tickets and DVDs. Kinsey's "masochism" and his value-neutral approach to pedophiles was alluded to, but not given full air play in the movie. Kinsey reportedly experimented with many masochistic practices, inflicting pain on his body and genitals on multiple occasions (Flynn, 2004), much more so than the…
Alfred Kinsey. (n.d.). Wikipedia. Retrieved 12 April 2010 from http://en.wikipedia.org/wiki/Alfred_Kinsey
American Experience: Kinsey, 27 January 2005. Retrieved 12 April 2010 from PBS website, http://www.pbs.org/wgbh/amex/kinsey
Flynn, Daniel (2004). Kinsey Myths Perpetuated in New Movie. Accuracy in Media. Retrieved from http://www.aim.org/guest-column/kinsey-myths-perpetuated-in-new-movie/
An electronic health record (EHR) is a person's authentic health record that is shared among various agencies and offices (Hasanain, 2014). The role of EHRs is getting to be expanding persuasive as progressively tolerant data winds up computerized and bigger quantities of customers express a need to have portable access to their health records. It is an electronic form of a patient's paper record. EHRs offer the upside of making data about patient consideration accessible, in a protected way, to numerous approved clients (Kierkegaard, 2019). In spite of the fact that EHRs change in content and usefulness, they are regularly intended to incorporate the therapeutic and treatment accounts of the patient, just as the patient's findings, meds, vaccination dates, radiology pictures, and lab and test results, among other data. EHRs can possibly coordinate data from various sources and give a progressively thorough perspective on patient consideration despite the fact…
Unlike was the case a few decades ago, health care professionals are increasingly embracing mobile devices in clinical practice. In that regard, therefore, the utility of the said devices has been growing in a wide range of functions and settings including, but not limited to, health records access and maintenance, medical training and education, patient monitoring and management, time and information management, etc. It is, therefore, recommended we continue to harness the potential of mobile devices in the realm of health records access and maintenance. Towards this end, an assessment is made herein for a wireless hardware solution and vendors that render mobile devices to broaden, enhance, as well as supplement electronic health record (EHR) system accessibility.
The strategic leadership team has evaluated not only the specifications, but also the qualifications of vendors and the products in their portfolio so as to highlight entities that either meet or exceed the…
Allscripts Healthcare Solutions (2019). Who We Are. Retrieved from https://www.allscripts.com/about-allscripts
Cerner (2019). About Us. Retrieved from https://www.cerner.com/about
Flatiron (2019). Flatiron. Retrieved from https://flatiron.com/
Optum (2019). About Optum. Retrieved from https://www.optum.com/about.html
Quest Diagnostics (2019). Care360. Retrieved from https://www.ehrinpractice.com/care360-ehr-software-profile-196.html
EHR Database and Data Management
Electronic health record (EHR) has, in the recent past, emerged as a crucial element in the management of patient data/information. The emergence of this crucial element is fueled by the increased measures by policymakers, researchers, healthcare providers and professionals, patients, and health insurers to enhance the delivery of healthcare services, particularly enhanced management of patient information. The adoption of electronic health records in the modern healthcare setting is attributable to their numerous benefits in comparison to the conventional ways of managing patient data. However, the use of EHR in the clinical setting requires developing suitable databases and utilizing appropriate data management processes. This paper discusses EHR database and data management for obesity, which is a public health concern.
Brief Description of the Patient Problem
An example of a clinically-based patient problem that would benefit from the use of a database management approach is obesity. Obesity…
Abhyankar et al. (2014, January 2). Combining Structured and Unstructured Data to Identify a Cohort of ICU Patients Who Received Dialysis. Journal of the American Medical Informatics Association, 21(5), 801-807.
Agency for Healthcare Research and Quantity. (2015). Use of Electronic Health Records for Addressing Overweight and Obesity in Primary Care (Massachusetts). Retrieved September 25, 2017, from https://healthit.ahrq.gov/ahrq-funded-projects/use-electronic-health-records-addressing-overweight-and-obesity-primary-care
Wood et al. (2012, May 28). An Electronic Health Record-Enabled Obesity Database. BMC Medical Informatics and Decision Making, 12(45). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508953/
large number of changes in the healthcare industry, largely due to globalization and technological improvements. Much of the change has been the result of the cost of healthcare and its continual rise. For example, in 1990 the average cost of care per person was $2,800, in 2000 it was $4,700 and then in 2010 close to $8,000. One way to reduce these costs and improve efficiency is to allow healthcare professionals to spend more time with their patients rather than filling out redundant paperwork, to increase information accuracy, and to provide a way for medical professionals in Emergency Rooms or other health care facilities to have access to critical patient information. his can be accomplished through the use of Electronic Medical Record Systems, or ERM systems.
Diabetes is a group of metabolic diseases that surround the body's ability to produce and use sugars and efficiently process those sugars. Globally, there…
The conclusions reached seemed robust and showed that the use of EHRs, particularly in the primary care system improves both the process of care and outcomes. This suggests that organizations should immediately implement EHR systems so that decision support, patient care, timing of appointments and efficiency of recording of data and tracking medications and treatment options is actually far more efficient in both monetary and patient centered outcomes. Certainly, room for improvement exists, and as EHRs become more sophisticated, it stands to reason that efficiencies, outcomes and improvements in decision support will also become expected by stakeholders.
Herrin, J., et al. (2012). The Effectiveness of Implementing and Electronic Health Record on Diabetes Care and Outcomes. Health Services Research, 47(4), 1522-40. doi:10.1111/j.l475-6773-2011-01370.x
Health Care continues to undergo fundamental change. Legislation such as the affordable care act has created a much higher percentage of insured citizens. Patent legislation is now allowing for much more competition for popular drugs. Generic drugs in particularly which are cheaper for consumers and much more profitable for producers are now eroding the market share of popular products. Even the use of cloud computing is changing the way care is administered within a facility. Even with these innovations, facilities still struggle with bloated cost structures, inefficient behavior, and lack of staffing. MGH is not different in this regard. It suffers from a large influx of patients with the inability to provide timely care. Below is a description of the issues combined with possible real world solutions.
Describe the current process and identify the specific areas that slow the process.
The current process has is inadequate primarily due to staffing…
1) Roukema, J.; Los, RK; Bleeker, SE; Van Ginneken, AM; Van Der Lei, J; Moll, HA (2006). "Paper vs. Computer: Feasibility of an Electronic Medical Record in General Pediatrics." Pediatrics 117 (1): 15-21
EH Assessment and Evaluation to Support Healthcare Outcome Objectives
The outcome-related goals that the tertiary care hospital seeks to achieve include the following: 1) Strengthen adult admissions screening at intake for pain, depression, and adverse health behaviors such as smoking, excess alcohol intake, and body mass index (BMI) greater than 30; 2) implement comprehensive geriatric assessment for all adults 65 years of age and over who are hospitalized for more than seven days or readmitted within less than three days following discharge; and 3) promote care team performance. The electronic health record (EH) is the default system for adult admissions, and it includes documentation standards and structures such as SOAP and checklists. Hospital staff are provided periodic guidelines through educational venues or through referral to the electronic policy and procedure manual. Given this information, the data elements that should be included in the EH assessment and evaluation screens are as…
Lowry, S.Z., Quinn, M.T., Ramaiah, M., Schumacher, Gibbons, M.C., Patterson, E.S., North, R., Zhang, J., and Abbott, P. (2012, February 21). NISTIR 7804: Technical evaluation, testing and evaluation of the usability of electronic health records. Retrieved from http://www.emrandhipaa.com/emr-and-hipaa/2013/10/22/turf-an-ehr-usability-assessment-tool/
Electronic Medical ecords (E-SIHI) in King Khalid University Hospital on Patient Safety
The objective of this study is to demonstrate the impact of e-SIHI (Electronic Medical ecords) on patients with regards to their security and safety. The King Khalid University Hospital has implemented the e-SIHI since May 2015 for all departments. Two weeks after the implementation, QMD (Quality Management Department) conducted an audit to measure a compliance for the system and ascertain whether the e-SIHI can improve health and safety of patients. However, the QMD found that there are many areas requiring improvement in the system. The paper discusses the methodology used to evaluate the system to ascertain whether e-SIHI is beneficial to the patient.
The research methodology reveals research design discussing the method of data collection, sample population, sample size, and project tool.
Study Design: The team audits the e-SIHI using a checklist to verify whether the…
AlAswad, A.M. (2015). Issues Concerning the Adoption and Usage of Electronic Medical Records in Ministry of Health Hospitals in Saudi Arabia. School of Health and Related Research (ScHARR) the University of Sheffield.
Bowman, S. (2013). Impact of Electronic Health Record Systems on Information Integrity: Quality and Safety Implications. Perspectives in Health Information Management, 10.
Jang, J., Yu, S. H., Kim, C., Moon, Y. et al. (2013). "The effects of an electronic medical record on the completeness of documentation in the anesthesia record, International journal of medical informatics, 82(8):702-707.
Kazley, A. S. & Ozcan, Y. A. (2009). Electronic medical record use and efficiency: A DEA and windows analysis of hospitals, Socio-economic planning sciences, 43(3): 209-216.
Adoption Of the EH Technology Systems
In a contemporary health environment, nurses have long been using the computer technology to achieve the health outcomes such as the laboratory tests, however, the EH (electronic health records) has become a revolutionary innovative technology for the enhancement of the healthcare system. It is very critical for nurses to understand their roles as an agent of changes and influence other to change the tradition way of doing things. My role as a nursing facilitator of a small hospital in New York is to prepare the implementation plan of a new EH system for the hospital. While the decision has been finalized for the implementation of the EH, nevertheless, there is still a resistance from the nurses of the hospital.
The objective of this paper is to use the five qualities of the oger (2003) model for the implementation of the new system.
Evans, S. & Stemple, C. (2008). Electronic Health Records and the Value of Health IT. Journal of Managed Care Pharmacy JMCP. 14 (6):S16-S18.
Lee, T. (2004). Nurses' adoption of technology: Application of Rogers' Innovation-diffusion Model. Applied Nursing Research. 17(4): 231-238.
Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: Free Press.
Interoperability of Electronic Medical ecords
Electronic Health ecords (EHs) are patient-management tools that have been created in the health sector to help coordinate patient care. These tools or system focuses on capturing patient-generated health information from outside the clinical setting and incorporating it into the patient's medical history. Electronic health records were developed to help improve patient care through sharing patient information seamlessly. However, for EHs to have the ability to share patient information seamlessly, an interoperable health information technology environment should be established. This essentially means that an interoperable health IT environment is mandatory for electronic health records to be effective.
What is Interoperability?
Interoperability is a term used to refer to the level with which devices and systems can share data and interpret it (Healthcare Information and Management Systems Society, 2013). This means that two devices or systems are considered interoperable when they exchange data seamlessly and eventually…
Healthcare Information and Management Systems Society. (2013). What is Interoperability? Retrieved November 7, 2016, from http://www.himss.org/library/interoperability-standards/what-is-interoperability
Schiller, D. (2015, November 30). EHRs and Healthcare Interoperability: The Challenges, Complexities, Opportunities and Reality. Retrieved November 7, 2016, from http://www.healthcareitnews.com/blog/ehrs-healthcare-interoperability-challenges-complexities-opportunities-reality
Stroupe, M.P. (2011, May). What is EHR Interoperability and Why Should I Care? Retrieved November 7, 2016, from http://www.nethealth.com/wp-content/uploads/2013/11/What-is-EHR-Interoperability.pdf
Government Created a Committee
An electronic health record is a digital record of a patient's health information generated from every medical visit a patient makes. This information includes the patient's medical history, demographics, known drug allergies, progress notes, follow up visits, medications, vital signs, immunizations, laboratory data and radiological reports. The EH automates and streamlines a clinician's workflow. (Himss, 2009)
Due to the multiple advantages of an EH, health care agencies have been aiming to push up this technology. In 2004, the FDA approved of an implantable EH microchip into patients. Each microchip has a specific code which is identified through sensors. The device is implanted under the skin, in the back of the arm, requiring a twenty minute procedure, without needing the use of sutures. ("Fda approves computer," 2004)
According to the Center for Disease Control and Prevention, deaths due to preventable medical errors rank as the fifth most…
CDC. (2011, October 24). Deaths and mortality. Retrieved from http://www.cdc.gov/nchs/fastats/deaths.htm
Fda approves computer chip for humans. (2004, October 13). Retrieved from http://www.msnbc.msn.com/id/6237364/ns/health-health_care/t/fda-approves-computer-chip-humans/
Himss. (2009, September 2). Implanet using ibm software to protect patients in the event of medical device recalls. Retrieved from http://www.healthcareitnews.com/press-release/implanet-using-ibm-software-protect-patients-event-medical-device-recalls
Prutchi, D. (2011, December 30). Verimed's human-implantable verichip patient rfid. Retrieved from http://www.implantable-device.com/2011/12/30/verimeds-human-implantable-verichip-patient-rfid/
Health Care Situation: Medical Error Due to Doctors' Bad Handwriting
Identify a health care news situation that affects a health care organization such as a hospital, clinic or insurance company.
I have identified the following health care news situation as the topic of my paper: "Poor Handwriting of Doctors and its implied risks for the Patient, Hospital and Medical Malpractice Insurance." Poor handwriting of physicians resulting in poor legibility of entries into patients' medical records carries very dramatic risks for all above-mentioned interest bearers. It can result in severe health danger for the patient and - in extreme situations - even cause a patient's death. Doctors' bad penmanship has long been seen a problem within organized medicine and the patient safety movement. Three American Medical Association (AMA) policies dating back to 1992, urge doctors to "improve the legibility of handwritten orders for medications" and review all orders for accuracy and…
Berwick, Donald M. & Winickoff, David E. (1996). The truth about doctors' handwriting: a prospective study. BMJ Vol. 313 (21-28 December 1996). 1657-1658. www.bmj.com/content/313/7072/1657.full, accessed 21 August 2011.
Bruner, Anne & Kasdan, Morton.L. Handwriting Errors: Harmful, Wasteful and Preventable.
1-4. www.kyma.org/uploads/file/.../Harmful_wasteful_and_preventable.pdfSimilar, accessed 22 August 2011.
Gallant, Al. (22 November 2009). For a secure electronic health record implementation, user authentication is key. 1-2). searchhealthit.techtarget.com/.../User-authentication-is-critical-for-pl.., accessed 24 August 2011.
Health Information Technology (HIT) is technology that is used to help make health care easier for all stakeholders—both patients and care providers. Examples of HIT include electronic health records, personal health records, e-prescribing, and online communities. HIT allows information to be communicated, stored and shared among people in the industry, whether they are patients providing care givers with access to information or care givers sharing information with other care givers. HIT allows and enables the easy transfer of medical and health information in a way that substantially and significantly reduces the amount of time and energy that would conventionally be spent in transferring, recording, storing or sharing information.
HIT can impact all aspects of health care because information is needed every time a treatment is needed, a diagnosis is made, a prescription is given—information has to be recorded, stored and shared accordingly. The easier it is for information to be…
" (2004, p.159) Activities have included:
(1) Development and promotion of industry-wide standards;
(2) Funding of research for investigation of the impact of IT on quality;
(3) Provision of incentives that provide encouragement of investment in IT;
(4) Giving grants to investors in IT; and (5) Development of strategies to improve the flow of information across providers. (Report to Congress, June, 2004, p.159)
Stated additionally in the Report to Congress is that there are multiple functions that must be considered when purchase IT and hundreds of applications that various vendors offer. The various IT applications are stated to be within three categories including those of:
(1) Administrative and financial systems that facilitate billing, accounting and other administrative tasks;
(2) Clinical systems that facilitate or provide input into the care process; and (3) Infrastructure that supports both the administrative and clinical applications. (Report to Congress, June 2004, p.160)
The work published…
BC Medical Association. Getting IT Right: Patient Centered Information Technology [discussion paper]. Vancouver: BCMA. 2004:39-40.
Blum E. Paperless medical record not all it's cracked up to be AMNews; 17 February 2003. Online available at: www.ama-assn.org/sci-pubs/amnews/pick_03/bica0217.htm
Brookstone A, Braziller C. Engaging physicians in the use of electronic medical records. Electronic Healthcare 2003;2:23-27.
Brookstone, Alan. 2004. Electronic Medical Records: Creating the Environment for Change. BCMJ, Vol. 46, No. 5 June 2004. Online available at: http://www.bcmj.org/electronic-medical-records-creating-environment-change
Nursing Health Care Informatics
"…At the beginning of the 21st century, nursing informatics has become a part of our professional activities…[and has] advanced the field of nursing by bridging the gap from nursing as an art to nursing as a science…" (Saba, 2001, 177).
Nursing Health Care informatics relate to and address technology and other cutting edge issues of great interest in the healthcare field. According to the AMIA, Nursing Informatics is the "…science and practice (that) integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide." New and relevant knowledge presented in the genre of informatics helps to empower nurses and other healthcare practitioners to deliver the most effective patient-center care possible. This paper presents several informatics in the belief that applying healthcare technologies and practices that are genuinely progressive and helpful to today's nurse is…
AMIA (2009) Working Group Nursing Informatics. Retrieved March 9, 2014, from http://www.amia.org .
An, J.Y., Hayman, L.L., Panniers, T., and Carty, B. (2007). Theory Development in Nursing
And Healthcare Informatics. A Model explaining and Predicting Information and Communication Technology Acceptance by Healthcare Consumers. Advances in Nursing Science, 30(3), E37-E49.
Cipriano, P.F. (2011). The Future of Nursing and Health IT. Nursing Economics, 29(5).
Patient portals, electronic medical records, and personal monitoring devices are three of the most revolutionary technologies in the healthcare sector. Each of these technologies presents patients with the potential to empower themselves, taking control of their own healthcare outcomes, and taking part in their overall healthcare goals. These technologies also streamline healthcare administration and minimize medication and billing errors. However, each of these technologies is also constrained by a range of issues related to accessibility, with potent socioeconomic class disparities evident. Security and standardization of healthcare technologies are also proving problematic. Patient portals, electronic medical records, and personal monitoring devices are all technologies that have the potential to radically improve the quality of healthcare and patient outcomes, as well as improve overall patient experiences. Because of their abundant benefits, these technologies need to be embraced and promoted through effective public health policies. Otherwise, disparities will continue to threaten to exacerbate…
The healthcare industry has widely adopted IT solutions in the development and maintenance of information systems for this sector. These information system applications will go a long way in boosting medical care goals by reducing costs significantly, increasing efficiency in the process and achieving a zero error. With this, client satisfaction will be realized. At the core of this is the electronic medical records (EHR) which is representative of all the health information of an individual that is available in a database and can be shared across healthcare service providers (Rouse, 2016). Also integral to this system are two components; mobile health (mHealth) and telehealth (telemedicine). Though the two are interconnected, they have a slight difference. Telehealth includes home monitoring of health conditions through desktops, laptops and other online material (Terry, 2016), while mobile health is restricted to mobile devices.
Considering the impact of electronic medical records (EHR), it is…
Medicare Health Care eform
The Medicare is an American health program that is administered by the federal government and serves as a health insurance for people aged 65 years and above. The Medicare is also designed for people with disabilities and people diagnosed with the renal disease. (Davis, Cathy, & Stuart, 2013). The Medicare is currently being funded by the premiums, payroll tax, surtax from general revenue. In 2015, over 55 million American enrolled for the Medicare services where 46 million people are people aged 65 years and above and 9 million are young people. On the average, Medicare covers half of the health costs and the enrollees are to cover the remaining costs through a separate insurance, supplemental insurance, or out-of-pocket. Since the inception of the Medicare, the cost of funding the program continues to increase, and the rising costs of funding are becoming unbearable both for the current…
Blum, J. (2011). Improving Quality, Lowering Costs: The Role of Health Care Delivery System. Center for Medicare Management.
Davis, K. Cathy, S. & Stuart, G. (2013). Medicare Essential: An Option to Promote Better
Care and Curb Spending Growth, Health Affairs 32, no. 5: 901 -- 9.
Golberstein, E. Kayo, W. Yulei, H. et al. (2013). Supplemental Coverage Associated with More Rapid Spending Growth for Medicare Beneficiaries, Health Affairs, 32, no. 5. 873 -- 81.
Drawbacks that exist within the structure of healthcare institutions include the lack of universal implementation of the electronic health records, and the lack of consistency in service quality and delivery. Moreover, there are different systems for different classifications of patients depending on their insurance coverage. For instance, seniors on Medicare use different products and services within the system and may be processed differently at different institutions. The nature of healthcare insurance is also overly complicated. Because each state also has different rules, regulations, and healthcare issues, there is a potential for service disruptions and inconsistencies. Patients living in more than one state or who travel often will frequently encounter the inconveniences of the American health care system.
Not all healthcare institutions have the same structure, but many hospitals and other large healthcare organizations are structured similarly. Lack of consistency in healthcare is especially apparent among the elder population, which…
The Greatest Challenge to US Healthcare
The role is played by the government
The role played by the government in healthcare is a divisive issue. Many healthcare organizations executives do support the idea of extending healthcare coverage to the uninsured, however, who this is implemented is the cause of concern. There are numerous changes that are taking place in the healthcare industry and the government needs to catch up quickly. Policy development is the role of government and there is a need to ensure that there are timely and applicable policies in place to govern the provision of healthcare services to the masses. As it stands, healthcare is moving from fee-for-service to value outcomes and there should be policies in place to support this advanced move. Providers have been moving towards value-driven care and the government policies should be able to mirror this movement. While not all providers will be…
Hand-held devices and portable digital assistants (PDAs) are being integrated into the health care setting in the United States. It is important to understand which devices are being used, how they are being used, what they are being used for, and why. Understanding the role that hand-held devices and other portable electronics play in health care can help to inform organizational policy, and help health care administrators better implement electronic medical records.
History of use
The first documented PDA was the Newton MessagePad, issued by Apple in 1993. It was described as being "revolutionary" (Wiggins, 2004, p. 5). Palm, Inc. developed the next big handheld device: the Palm Pilot, in 1996. By the late 1990s, PDAs were equipped for Internet access, and memory capacity and other features improved with each product release. Microsoft also entered the portable electronic devices marketplace in the 1990s. The devices were not yet being…
Alerndar, H. & Ersoy, C. (2010). Wireless sensor networks for healthcare. Computer Networks 54(15): 2688-2710.
Fornell, D. (2008). PDAs bring hand-held solutions to healthcare. Acuity Care Technology. Retrieved online: http://www.soti.net/PDF/PDAsBringHandHeldSolutionsToHealthcare_Article.pdf
Garritty, C. & El Emam, K. (2006). Who's using PDAs? Journal of Medical Internet Research 8(2).
Huang, V.W. (n.d.). PDAs in medicine. Power Point Presentation Retrieved online: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&ved=0CF4QFjAB&url=http%3A%2F%2Fwww.cs.princeton.edu%2Fcourses%2Farchive%2Fspr02%2Fcs495%2Fpda.ppt&ei=xxqAUsq_NtTFqQG25IHwAQ&usg=AFQjCNE4Wf4YrX7slTbcdYJwxujV3rwgog&sig2=Uee9rvdDYwY0uYM33n1ZBg&bvm=bv.56146854,d.aWM
From personal experience it is clear that including the healthcare professionals' feedback in each of the five phases of the SDLC model leads to systems that better align to patient's needs and streamline information delivery and knowledge management. Personal experiences have provided a unique glimpse of how powerful this dynamics is when done well with full inclusion of stakeholders. In the majority of instances however stakeholders are often ignored or only provided what the healthcare systems can deliver with little if any customization or configuration (Buntin, Burke, oaglin, Blumenthal, 2011). This is because customization and configuration is expensive and time-consulting to complete and is one of the leading causes of nurses being ignored during each phase of the SDLC model (Buntin, Burke, oaglin, Blumenthal, 2011). When this occurs a system fails to align to an organization and a significant amount of time and money are wasted.
In the first phase…
Healthcare organizations that define their Health Information Technology (HIT) initiatives and plans from the perspective of the internal customer or user of the system first have significantly greater levels of system adoption, process improvements, greater impact on positive patient outcomes as well (Buntin, Burke, Hoaglin, Blumenthal, 2011). From personal experience it is clear that including the healthcare professionals' feedback in each of the five phases of the SDLC model leads to systems that better align to patient's needs and streamline information delivery and knowledge management. Personal experiences have provided a unique glimpse of how powerful this dynamics is when done well with full inclusion of stakeholders. In the majority of instances however stakeholders are often ignored or only provided what the healthcare systems can deliver with little if any customization or configuration (Buntin, Burke, Hoaglin, Blumenthal, 2011). This is because customization and configuration is expensive and time-consulting to complete and is one of the leading causes of nurses being ignored during each phase of the SDLC model (Buntin, Burke, Hoaglin, Blumenthal, 2011). When this occurs a system fails to align to an organization and a significant amount of time and money are wasted.
In the first phase of the SDLC Model, which is Requirements Analysis, is when a systems' functional specifications are defined and the system development frameworks are designed (Moore, Nolan, Gillard, 2006). When nurses aren't involved in this process, the entire foundation of a system will be incomplete and often based only on assumptions about what is needed; the system designers won't actually know what the requirements are because they haven't involved healthcare professionals. The rationalization sit hat inviting too much feedback from nurses will drive up customization costs (Buntin, Burke, Hoaglin, Blumenthal, 2011). In fact the opposite is true. Building the functional requirements and specifications of nursing professionals into requirements ensures each succeeding stage of the SDLC-driven development stays consistent.
The second stage of the SDLC model, which is design, is critical for ensuring a high degree of system adoption in that
Healthcare: Clinical Integration
What is clinical integration
History of clinical integration
Goals of clinical integration
Importance of clinical integration
New payment models
Barriers to clinical integration
Lack of practitioner alignment
Lack of interoperability
How to achieve success in clinical integration
The future of health care systems
Physician acquisitions vs. clinical integration
HIEs -- solution to clinical integration?
Policy makers are beginning to appreciate the fact that only systemic change can effectively change, for the better, the manner of health care delivery in the U.S.; and that anything less would only alter the system's edges - with little or no substantial effect on cost-control, innovation-promotion, effectiveness of reward incentive schemes, coordination and coverage (AHA, 2010). Clinical integration has been found to be crucial to the change needed for the achievement of the aforementioned goals (AHA, 2010). Despite…
AHA. Clinical Integration -- the Key to Real Reform. Trend Watch. Retrieved from [HIDDEN]
Athena Health. (2014). History of the Clinical Integration Model. Athena Health. Retrieved from https://www.athenahealth.com/knowledge-hub/clinical-integration/clinical-integration-model.php
eHealth Initiative. (2012). The Rise of the Private Health Information Exchange and Changing Role of Public Exchanges. eHealth Initiative. Retrieved from [HIDDEN]
Fridsma, D. (2013). Interoperability Vs Health Information Exchange: Setting the Record Straight. Health IT Buzz. Retrieved from http://www.healthit.gov/buzz-blog/meaningful-use/interoperability-health-information-exchange-setting-record-straight/
Healthcare in the New Millennium
The Future Trends of Healthcare Delivery
The objective of this work is to present a new and improved healthcare delivery system for the new millennium. Future trends in healthcare and how they affect disease management, financial management, technology and the social aspects of health care delivery will be given consideration as well as integration of personal knowledge of the historical, social, ethical, technological and financial aspects of health care service delivery expressed as a vision for health care delivery in the United States.
Never before at any time in history have the challenges for the delivery of healthcare been so great. Neither has history witnessed the rash of serious new diseases emerging on a daily basis. The provision of quality, cost-effective patient care while managing to balance the needs of employees and physicians as well as trustees is a monumental challenge faced by healthcare executives.…
Global Best Practices Among Themes at First Annual World Healthcare Innovations in Technology Congress Presented by the ENBC, PR Newswire 23, June 2004.
Healthcare's Top Business Issues and Responses for 2005 A Capgemini Forecast
Hunter, Derek (2004) New Data on Health Insurance, the Working Poor and the Benefits of Health care Tax Changes WebMemo #492-2004 Apr 12. Online available at http://www.heritage.org/Research/Healthcare/wm492.cfm
On the Minds of Americans: The Crisis of Skyrocketing Health Care Costs 2004 Online available at http://www.house.gove/georgemiller/middleclass/middleclass.html
HEALTHCAE & INFOMATION TECHNOLOGY
The state of healthcare in the United States is very much influenced and improved through the increased use of technology solutions. Whether it be the use of tablets, laptops, electronic healthcare records and some others, the use of technology has become more and more pervasive as the years and decades roll on. However, not everyone is sold on technology being a saving grace and those same people often think that technology solutions being added to healthcare actually do not help or that they make things worse rather than make them better. However, there is a cacophony of evidence that suggests and proves that electronic healthcare records, electronic administration and the use of information technology in a strategic and adept fashion actually makes things better over the long haul. This is true for patients, administrators, healthcare professionals and the wider network of providers that are typically also…
Bloomfield, G.S., Hogan, J.W., Keter, A., Holland, T.L., Sang, E., Kimaiyo, S., & Velazquez, E.J. (2014). Blood pressure level impacts risk of death among HIV
seropositive adults in Kenya: a retrospective analysis of electronic health records. BMC Infectious Diseases, 14(1), 1-20. doi:10.1186/1471-2334-14-284
Campbell, M. (2010). Technology in Healthcare: The Wave of the Future.
Ahdbonline.com. Retrieved 24 April 2015, from http://www.ahdbonline.com/issues/2008/may-2008-vol-1-no-4/350-article-350
HMS (healthcare management systems) and EMRs (electronic medical records) have been widely praised as significantly adding to patient safety and quality of care. They can permit healthcare institutions to keep more accurate databases on patients, all in one location, and can ensure that a patient’s full medical records are available, even if the patient is not responsive and the patient’s family is not available. Prior treatments, current and past medications, and patient allergies can all be easily accessed with a point and a click. But transitioning to such healthcare systems is not always without issues and often involves a significant investment of time and money.
First of all, from a staffing point of view, change management is needed to ensure that the transition is effective. One helpful way to view change of any kind within an organization is that of Lewin’s Change Management Model, which suggests that organizations must first…
We can compare the healthcare workplace to what is seen by a person when he/she looks through a kaleidoscope: since there are numerous different patterns that appear as the moments pass by. The shortage of nurses which has been publicized widely and the high turnover rates amongst the nurses are some of the unwanted patterns which have occurred. The dependence of healthcare institutions on the nurse-managers for the retention and recruitment of nurses is steadily increasing (Contino, 2004).
There are a number of routes through which the critical care nurses have become the leaders. Most of these routes don't have any educational or managerial training as a part of the process. There is a need for effective strategies for the care leaders who provide critical care in order to inspire the staff and manage the departmental operations in an effective manner to get positive results. One of the strategies…
Adams, J., Erickson, J., Jones, D., & Paulo, L. (2009). An evidence-based structure for transformative nurse executive practice, Nursing Administration Quarterly, 33(4), 280-87
Advisory Board Web site. (2004). Available at: http://www.advisory.com .
Ales, B.J. (1995). Mastering the art of delegation. Nurs Manage. August; 26: 32A, 32E.
American Organization of Nurse Executives (2005). AONE Nurse Executive Competencies. Nurse Leader, 3(1), 15-22.
Health policy issues are now becoming more contentious throughout the world. The advent of the internet has created a much needed awareness of human rights and liberties. No longer are countries able to fully sheath society from information. A critical component of this information relates directly to health care and the overall well-being of societies constituents. Policy issues relating to health are now becoming paramount to voters and decisions makers. The Affordable Care Act is one of many illustrations that detail the desire for universal healthcare for all. In addition, many countries are mandating a standard health care system for all of their citizens irrespective of socio-economic status. Although costly, it appears that many constituents are willing to pay for the ability to extend healthcare to all. Outside the universal healthcare within individual countries, many are now looking to address worldwide health epidemics. Aspects such as food shortages, proper treatment…
1) Bell, B, Thornton, K. (2011). From promise to reality achieving the value of an EHR. Healthcare Financial Management, 65(2),51-56
2) Jamoom, E., Patel, V., King, J., & Furukawa, M. (2012, August). National perceptions of ehr adoption: Barriers, impacts, and federal policies. National conference on health statistics.
3) Rosenberg, Charles E. The Care of Strangers: The Rise of America's Hospital System (1995) history to 1920 table of contents and text search
4) Pollack, A. (2015, September 20). Drug Goes From $13.50 a Tablet to $750, Overnight. Retrieved October 1, 2015, from http://www.nytimes.com/2015/09/21/business/a-huge-overnight-increase-in-a-drugs-price-raises-protests.html?_r=0
Health Policy Analysis for Maryland AC (Affordable Care) Act
McLaughlin, & McLaughlin (2014) rank 11 areas of health innovation based on their impact on costs and quality of healthcare delivery. The process improvement is the highest ranking item. However, the authors identify data analytics, disease management, "non-physician delivery alternatives," and "alternative to fee-for service" (McLaughlin, & McLaughlin, 2014 p 335) as other innovation items that can enhance quality and reduce costs. Additionally, the authors point out that innovation in electronic medical records, diagnosis, and pharmaceuticals can also assist with quality and cost.
Objective of this health policy paper is to evaluate the items that can play important role in the health policy process of Maryland's ACA (Affordable Care Act).
Healthcare items for Health Policy Process for in Maryland Affordable Care Act
The ACA (Affordable Care Act) is a federal government legislation focusing on healthcare coverage for small groups and individuals.…
Abrams, M. Nuzum, R. Mika, S. et al. (2011). Realizing Health Reform's Potential How the Affordable Care Act Will Strengthen Primary Care and Benefit Patients, Providers, and Payers. The Commonwealth Fund.
Chin, W.W. Hamermesh, R.G. Huckman, R.S. et al.(2012). 5 Imperatives Addressing Innovative Challenge. Harvard Business School.
McLaughlin, C.P. & McLaughlin, C.D. (2014). Health Policy Analysis: An Interdisciplinary Approach.(2nd Edition). Burlington, Jones & Bartlett Learning.
Resnik, D.B. (2007). Responsibility for Health: Personal, Social, and Environmental. J Med Ethics. 33(8): 444-445.
Health Organization Case Study
The mission of Banner Healthcare is to make a difference in the lives of people through excellent patient care. They achieve this by providing leadership for excellence in patient safety and clinical care. Traditionally, healthcare institutions focused on analyzing aggregate performance, questioning causation, monitoring scorecards and identifying gaps. Planning and managing stages at integral to the process of achieving Banner Healthcare's vision. Planning entails the development of standards, rules, and work teams necessary for the work. Concurrent management involves patient-oriented care and coordinated health care. Across the various work teams, care management efforts and the number of people are involved in making clinical improvements across the organization have been gradually increasing.
This occurs regardless of whether they are work groups, system wide teams, strategic initiatives, and special projects. The work is organized under functional teams. Besides the functional teams, initiative work groups and clinical consensus groups…
Wickramasinghe, N. & Sharma, S.K. (2010). Creating knowledge-based healthcare organizations. Hershey Penns: Idea Group Pub.
(Menzel, 1990, p. 3) Fisher, Berwick, & Davis alude to the idea of integration in health care, with providers linking as well as creating networks of electronic medical records and other cost improvement tactics.
The United States and other nations over the last twenty or so years, have begun a sweeping change in health care delivery, regarding the manner in which health information is input, stored and accessed. Computer use in the medical industry has greatly increased over the last thirty years the culmination of this is fully networked electronic medical record keeping. (Berner, Detmer, & Simborg, 2005, p. 3) the electronic medical record trend began in the largest institutions first, as hospitals and large care organizations attempted to reduce waste and improve patient care, while the adoption has been much slower among physician's practices and smaller medical institutions. (Hillestad, et al., 2005, pp. 1103-1104) Prior to this time medical…
Resources, and Utilization
isk Involved in Poor Chart Documentation: An Overview in Total Quality Management
Poor chart documentation in the behavioral health field is a concern for risk management and a critical area for total quality improvement. Poor chart documentation can lead to an audit by accrediting bodies and in severe circumstances lead to discharge. There are many legal ramifications associated with poor chart documentation. This paper will highlight the importance of poor chart documentation, the consequences of poor documentation, and suggest possible tools for resolving documentation errors. The best tool for eliminating chart documentation risk is developing a risk management system appropriate to the health care setting.
Poor chart documentation costs behavioral health providers thousands of dollars in malpractice costs every year. Errors related to chart documentation can be severe; a patient can suffer an untimely death for example. In fact, statistical evidence suggests that each year thousands of patients…
Aron, DC. & Headrick, L.A. (2002). Educating physicians prepared to improve care and safety is no accident: It requires a systematic approach. Quality and Safety in Health Care, 11, 168-173.
Burke, M., Boal, J., & Mitchell, R. (2004). Communicating for better care. American Journal of Nursing. 104(12), 40-47.
American Society of Healthcare Risk Management, American Hospital Association. (2004). The
growing role of the patient safety officer: Implications for risk manager. Chicago: American Hospital Association.
S. Department of Health and Human Services, 2011). Furthermore, subpart C explains the privileges and the protections of confidentiality that is attached to the patient's record along with much exception (U.S. Department of Health and Human Services, 2011).
The penalty for anyone who breaks confidentiality is imperative. In "November, 23, 2009" was increased to $11,000 (U.S. Department of Health and Human Services, 2011). This goes for anyone in the medical field or has access to this information. A person has to follow HIPAA precisely or face a huge fine. If one thought of this ahead of time, whether or not they own a business, then no issues would arise legally. However, sometimes this does occur, especially for those who want to harm another person, yet in the medical field the goal is not to do this to any individual, regardless, otherwise he or she could face losing their license in…
U.S. Department of Health and Human Services Civil Rights. (2011). Your health information privacy rights. Retrieved May 3, 2011, from U.S. Department of Health and Human
Services Civil Rights:
U.S. Department of Health and Human Services. (2011). Health information privacy. Retrieved May 3, 2011, from U.S. Department of Health and Human Services:
Electronic Certificates of Medical Necessity: A Proposal
Medical billing can now become a relatively painless process for the personal in a medical facility through the electronic filing of certificates of medical necessity (e-CMN). Manually filling out paperwork is very time consuming, and is not very cost effective. However, the technological advancements created in the area of medical billing are very efficient. While many offices now fax the CMN's, the incorporation of e-CMN's into the medical office and billing process, decreases overhead costs, reduces paperwork, and helps substantially with the on-going battle to comply with the ever-changing Medicare requirements. While each of the previous reasons is enticing enough to consider incorporating e-CMN's into the office routine, the increase of revenue is certainly a major benefit and is the direct result of the time reduction with the filing process.
Billy Tauzin, chairman of the U.S. House Committee on Energy and Commerce, clarified…
Bachenheimer, C. (2001, Aug. 1). Something out of nothing. Home Care Magazine. Retrieved April 13, 2004 at http://homecaremag.com/ar/medical_something_nothing/index.htm .
Business Wire. (2004, Feb. 13). American association for homecare and Trac Medical Solution agree on industry wide ecmn solution. ProQuest Document: 545984641 http://gateway.proquest.com/openurl-url_ver=Z39.882004&res_dat=xri:pqd&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&genre=article&rft_txri:pqd:did=000000545984641&svc_dat=xri:pqil:fmt
McClinton, D. (2001). E-CMN's. Home Care Magazine. Retrieved April 13, 2004, at http://homecaremag.com/ar/medical_ecmns/index.htm .
Each of these was included in the initial Senate bill, but was struck from the final Senate version. Despite the victories, the group isn't ready to pledge support for health reform bills. The AMA will not endorse any legislation unless Congress gets rid of the mandated payment cuts of more than $200 billion over 10 years in the government's Medicare program for the elderly. The cuts are part of Congressional action that was passed in 1997 in order to cut costs in the Medicare program, but have never gone into effect. There are also several hospitals, insurers, pharmaceutical manufacturers and advocacy groups that are withholding final support. Most of these groups have pledged support to health care reform in principle while working privately through lobbyists to protect their industries (Eaton and Pell, 2010).
Healthcare lobbyists range from very large companies and corporations to very small groups who are all looking…
BREAKING: Health care lobby invests in reform summit. (2010). Retrieved March 1, 2010, from Citizens for Responsibility and Ethics in Washington Web site:
Eaton, Joe and Pell, M.B. (2010). Lobbyists Swarm Capitol to Influence Health Reform.
Retrieved March 1, 2010, from the Center for Public Integrity Web site:
Stated to be barriers in the current environment and responsible for the reporting that is inadequate in relation to medical errors are:
Lack of a common understanding about errors among health care professionals
Physicians generally think of errors as individual that resulted from patient morbidity or mortality.
Physicians report errors in medical records that have in turn been ignored by researchers.
Interestingly errors in medication occur in almost 1 of every 5 doses provided to patients in hospitals. It was stated by Kaushal, et al., (2001) that "the rate of medication errors per 100 admission was 55 in pediatric inpatients. Using their figure, we estimated that the sensitivity of using a keyword search on explicit error reports to detect medication errors in inpatients is about 0.7%. They also reported the 37.4% of medication errors were caused by wrong dose or frequency, which is not far away from our result of…
Discussion Paper on Adverse Event and Error Reporting In Healthcare: Institute for Safe Medication Practices Jan 24, 2000
Patient Safety/Medical Errors Online at the Premiere Inc. page located at: http://www.premierinc.com/all/safety/resources/patient_safety/downloads/patient_safety_policy_position_2001.doc
Medstat / Shortell, S. Assessing the Impact of Continuous Quality Improvement on Clinical Practice: What It Will Take to Accelerate Progress.
Health Policy Monitor (2001) A Publication of the Council of State Governments Vol. 6, No. 1 Winter/Spring 2001 PO18-0101
Health Care Infrastructure
The Cooperative Health Care Clinic made by the Kaiser Foundation Health Plan is an illustration of a pioneering program for healthcare beneficiaries sponsored by a managed care plan. Under this program, the clinic employs a multidisciplinary team to extend care to groups of old aged patients who use the service more often than not and are laid up with chronic conditions. The alternative program comprises of medical care, patient education and health promotion. The measurement of result of the pilot study comprised contentment of the patient and satisfaction of the doctor as also quality and cost of care. (Werner, 1997)
In spite of the achievement of several of the managed care program in taking care for healthcare beneficiaries, some researchers have noted that health plans "might at the maximum be hesitant" regarding investing in care for the patient who is ill for a long period of time.…
Garson, Arthur. (1998) "The U.S. Healthcare System 2010: Problems, Principles, and Potential Solutions" American College of Cardiology. Retrieved from http://www.bcm.edu/pa/speech.htm Accessed on 16 December, 2004
Werner, Michael J. (1997) "Adapting a Successful Program to Meet New Challenges" American College of Physicians. Public Policy Paper no 2.Retrieved from http://www.acponline.org/hpp/pospaper/medref.htm Accessed on 16 December, 2004
None of the findings are not surprising to a lot of experts. Apart from large systems that are integrated, like Kaiser Permanente in California and the Veteran's Administration, a lot of doctor practices are adopting different EMs. Also in so many different situations they do not talk to one another (Sittig & Singh 2012). So, a doctor's record is not necessarily able to get access notes from his regional hospital if different systems were utilized. A lot of doctors in that condition could just re-order a test, instead of going through all of the changes of finding the records from the hospital.
Actually many experts make the point that the true power of digital records come when using a sole, unified system that can be retrieved by altered health sites. With the exclusion of large combined health arrangements, there sometimes can be fragmented EMs. Experts mention that perhaps with the…
Cook, P.J., Lawrence, B.A., Ludwig, J., & Miller, T.R. (1999). The medical costs of gunshot injuries in the United States. JAMA, 282(5), 447-54.
Eckman, B.A., Bennett, C.A., Kaufman, J.H., & Tenner, J.W. (2007). Varieties of interoperability in the transformation of the health-care information infrastructure. IBM Systems Journal, 46(1), 19-41.
Heselmans, a., Aertgeerts, B., Donceel, P., Geens, S., Van, d. V., & Ramaekers, D. (2012). Family physicians' perceptions and use of electronic clinical decision support during the first year of implementation. Journal of Medical Systems, 36(6), 3677-3684.
Simons, W.V., Mandl, K.D., & Kohane, I.S. (2005). The PING personally controlled electronic medical record system: Technical architecture. Journal of the American Medical Informatics Association, 12(1), 47-54.
Ethical Issues Surrounding the Adoption of Electronic Health Records (EHR) by Health Care Organizations and Meaningful Use
The objective of this work in writing is to examine why health care organizations are hesitant to adopt electronic health records (HER) in light of the potential of HER to improve quality, increase access, and reduce costs. This issue will be examined from a legal, financial, and ethical standpoint and in relation to 'meaningful use'.
The use of information technology in the health care field shows a great deal of potential toward improving quality, efficiency, and safety in medical care. (DeRoches, Campbell, and Rao, 2008, paraphrased; Frisse & Holmes, 2007, paraphrased; and Walker, et al., 2005, paraphrased) The American Recovery and Reinvestment Act (ARRA) of 2009 is reflective of the unprecedented interest of the Federal government in the area of bringing about increases in the use of IT in health care for system…
A New Hospital EMR Adoption assessment Tool (2012) HIMSS Analytics. Retrieved from: http://www.himss.org/content/files/EMR053007.pdf
American Recovery and Reinvestment Act of 2009. Available athttp://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h1enr.pdf. Accessed 5 August2010.
Daniel, J. And Goldstein, MM (2010) Consumer Consent Options for Electronic Health Information Exchange: Policy Considerations and analysis. 23 Mar 2010.
DesRoches CM, Campbell EG, Rao SR, et al. Electronic health records in ambulatory care -- a national survey of physicians. N Engl J. Med 2008; 359:50 -- 60.