This document provides an overview and analysis of 3 mid-sized healthcare information system (HIS) vendors: athenahealth, eClinicalWorks, and Meditech. It discusses their annual revenues, product lines, client bases by hospital size, recent acquisitions and developments, and future prospects. Athenahealth has over $1 billion in annual revenue and offers both physician practice and hospital information systems. eClinicalWorks generates $490 million annually from its electronic health records for small physician practices but faced legal issues in 2017. Meditech has a long history and three distinct HIS products serving over 1,000 hospitals, and its prospects are positive with a new physician system and cloud offerings.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. Mid-Range Vendors
• After last week’s review of the top 3 vendors by revenue, we
now delve into the details of 3 vendors in the middle of the HIS
market with from ≈$.5B to ≈$1.5 B in annual revenue each:
• These vendors generally target small to mid-size community
hospitals from <25-bed CAH up to 300 beds in size, although it’s
unlikely they’d ever turn down a large AMC or IDN prospect!
• This episode covers their:
- Annual revenue: for 2017 and previous
years as far back as we have tracked it.
- Product lines and client base by bed size
- M & As and other recent developments
- Candid assessment of future prospects
3. Top 10 HIS Vendors for 2018
• To put the mid 3 in perspective, here’s all the Top 10 based on
2017 revenue figures come from 10-Ks or vendor info. Estimates
had to be made for companies that have many divisions (e.g.:
Harris Healthcare), or are privately held (e.g.: Medhost).
4. • Ranked # 4 in terms of 2017 revenue is athenahealth, a leading
player in the physician practice market for decades before
buying their way into the HIS market with the acquisition of
RazorInsights in 2015. Their growth to over $1B is shown below:
• Razor had ≈20
CAH clients and
≈$2M in revenue.
• athena was
founded way
back in 1997 and
these HI$-torical
revenue #s show
their impressive
$ growth over
the past decade:
#4:
5. athena Products & Packaging
• Founder Jonathan Bush deserves credit for the ingenious
pricing that has led to their success among MD practices:
– Instead of the large up-front capital fees for hardware and
software license fees that most vendors charge,
– athena charges a % of cash collections; little up-front
capital is an attractive proposition to cash-strapped MDs,
although challenging for larger hospitals’ cash flow…
• Other stats:
- 106K provider clients
- 5,282 FTEs
- 90+ hospital sales.
• athena joined Carequality
interoperability, competing
with Cerner’s CommonWell.
6. athena’s HIS Product
• athena’s HIS system was first acquired from RazorInsights:
– Formed in 2010 by 3 ex-McKesson gurus, Razor’s “One” HIS was a real-
time “cloud” HIS targeting CAH hospitals with its self-developed EHR.
– After athena acquired Razor in 2015, they then signed 4 CAH hospitals
to pilot “athenaOne” integrated with their physician practice system.
• Another major coup was signing Toledo Medical Center, a 250-
bed AMC, as pilot for a vastly up-scaled “athenaOne” based on
BIDMC’s “WebOMR” designed for much large facilities.
• Downside: four hospitals that tried to convert in 2016 to One
gave up after troubled implementations and went back to CPSI:
e.g.: Jackson (AL), Veterans (IA), Kimball (NE), Appleton (MN).
• Jonathon Bush claims athena has retained 95% of hospitals it
brought live, for a total or 56 mostly small (under 100 beds).
7. • Another recent entrant into the HIS market is physician practice
giant eClinicalWorks, with $490M in annual revenue in 2017.
Founded in 1999 in Westborough, Mass., eCW targeted small to
mid-size practices of under 50 MDs, on their cloud-based “10e.”
• We added
them to our
list last year
after they
announced
their “10i”
HIS, fully
integrated
with their
"10e” MD
system.
#5:
8. • Despite solid $ growth, eCW sure
had a rough year in the news:
- In May, the Department of Justice filed a False Claims Act suit
claiming eCW misrepresented the capabilities of its software in its
EHR attestation, as well as allegations they paid kickbacks to
customers for promoting products. Truth is probably that their
greatest sin was getting caught! Odds are many of the attestations
filed by over 1K vendors (≈700 MD and ≈300 HIS) had similar
exaggerations about functionality, and many vendors “reimburse”
their clients for providing demos or hosting prospect site visits…
Ouch!
- In November eCW got hit by a $999M (at
least it’s not $1B…) putative class-action
lawsuit filed in NY by the survivors of a
deceased patient claiming they “failed to
maintain the integrity of patient records.”
9. • Amazing how well eCW did financially in spite of that bad news.
Per 10Ks, their revenue by quarter jumped consistently:
– 2nd Qtr = $120M, 3rd Qtr = $130M, and 4th Qtr = $140M
• with a 2017 total of $490M per their CFO. The bad news might
impact future sales, but again, most HIS vendors are as
optimistic answering questions on EHR certifications as they are
answering RFP feature checklists: “yes, yes, yes, yes, yes, yes…”
eCW Future Prognosis
• At their 2017 user conference eCW
claimed to have the 2nd largest EHR client
base (mainly MDs), with this chart
showing where their new clients were
coming from. They claim 20 letters of
intent for their new 10i HIS system, so we
are guardedly optimistic about them…
10. • Ranked # 6 in terms of 2017 revenue is Medical Information
Technology, 49 years since their humble beginnings in 1969. They
entered the LIS market in the ‘70s at Cape Cod Hospital, gradually
expanding to a full HIS in the ‘80s. Revenue last year was $481M,
a nice $
increase
after 4
years of $
decrease.
Credit
goes to
Release 6
sales to
clients on
older HIS
products…
#6:
11. • Meditech actually has 3 distinct HIS products & client bases:
– Magic – first developed in the 1970s as Meditech’s version of
MUMPS (aka “MIIS”), there were over 700 hospitals using it
during it’s heyday, probably down to under 500 today...
– “Client/Server” - the quotes are from their contract, as it’s
merely a Windows front-end to MAGIC – a vastly-improved
GUI, but hardly a true C/S like Allscript’s Paragon. C/S sold
very well during the 90s, with ≈500 clients, since dropping.
– Release 6.x – originally known as Focus and MAT (Meditech
Advanced Technology), this is the latest & greatest product.
Three Meditechs
• Still a proprietary data base, but far more
modern than Magic or C/S, it is more of an
“Append” data base than B-trieve like the
older technologies, and easily the most
feature-rich, with ≈400 sites & growing.
12. • If Meditech were ever to go public, we’d buy the stock:
– They could still sell to some mid-sized Siemens clients on
Invision and Medseries4, as well as some of the Healthland
clients on Classic, Centriq & AHN...
Meditech Prospects
- Plus they have almost 1,000 clients
currently on Magic & C/S to sell
Release 6 thru access to C-suites…
• Another recent major development that should help sales:
– They now offer an integrated physician system within Release
6 with Practice Management (Reg, Sched, & BL) and an EHR.
– With several pilots live and scores of sales, this should help
them compete with athenahealth, eClinicalWorks, etc.
• In addition, they now offer “MAAS” (Meditech As A Service) for
small CAH hospitals, via the Cloud with subscription pricing.
13. • Here’s an update to last week’s table of which vendors product
are being marketed or “supported” for which hospital bed size:
Products by Bed Size
14. Next Week
• Our final episode next week covers the remaining four HIS
vendors, with less than $300M in 2017 annual revenue:
– Their client bases consists mostly of mid-size and small
(under 100 bed) community hospitals, including CAH (Critical
Access Hospitals), of which there are over 1,200 in the US:
7. CPSI (Evident) – CAH leader before acquiring Healthland
8. Harris Healthcare (QuadraMed) – with many acquisitions
9. Medhost (HMS) – EDIS leader with many chain HIS clients
10. Cantata (NTT Data) – spun off after $3B Dell acquisition
• With the HIS industry being so complex, we must have gotten
something wrong, so if you’d like, have your attorneys contact:
- vciotti@hispros.com eames@hispros.com
505.466.4958 413.329.6925
