CASE STUDY Acquiring an EHR System Valley Practice provides patient care services at three locations, all within a fifteen-mile radius, and serves nearly 100,000 patients. Valley Practice is owned and operated by seven physicians; each physician has an equal partnership. In addition to the physicians, the practice employs nine nurses, fifteen support staff, a business officer manager, an accountant, and a chief executive officer (CEO). During a two-day strategic planning session, the physicians and management team created a mission, vision, and set of strategic goals for Valley Practice. The mission of the facility is to serve as the primary care “medical home” of individuals within the community, regardless of the patients' ability to pay. Valley Practice wishes to be recognized as a “high-tech, high-touch” practice that provides high-quality, cost-effective patient care using evidence-based standards of care. Consistent with its mission, one of the practice's strategic goals is to replace its current paper-based medical record with an EHR system. Such a system should enable providers to care for patients using up-to-date, complete, accurate information, anywhere, anytime. Dr. John Marcus, the lead physician at Valley Practice, asked Dr. Julie Brown, the newest partner in the group, to lead the EHR project initiative. Dr. Brown joined the practice two years ago after completing an internal medicine residency at an academic medical center that had a fully integrated EHR system available in both the hospital and its ambulatory care clinics. Of all the physicians at Valley Practice, Dr. Brown has had the most experience using an EHR. She has been a vocal advocate for implementing an EHR and believes it is essential to enabling the facility to achieve its strategic goals. Dr. Brown contacted the Regional Extension Center (REC) in the community for assistance with the initiative. Dr. Brown agreed to chair the project steering committee. She invited other key individuals to serve on the committee, including Dr. Renee Ward, a senior physician in the practice; Mr. James Rowls, the CEO; Ms. Mary Matthews, RN, a nurse; and Ms. Sandy Raymond, the business officer manager. Dr. Brown suggested that the committee work with the REC to guide committee members through the system acquisition process. The physician partners approved this request, and the committee made arrangements for a representative from the REC to work with them on the selection process. After the project steering committee was formed, Dr. Marcus met with the committee to outline its charge and deliverables. Dr. Marcus expressed his appreciation to Dr. Brown and all of the members of the committee for their willingness to participate in this important initiative. He assured them that they had his full support and the support of the entire physician team. Dr. Marcus reviewed with the committee the mission, vision, and strategic goals of the practice as well as the committee's charge..

1. CASE STUDY
Acquiring an EHR System
Valley Practice provides patient care services at three locations,
all within a fifteen-mile radius, and serves nearly 100,000
patients. Valley Practice is owned and operated by seven
physicians; each physician has an equal partnership. In addition
to the physicians, the practice employs nine nurses, fifteen
support staff, a business officer manager, an accountant, and a
chief executive officer (CEO).
During a two-day strategic planning session, the physicians and
management team created a mission, vision, and set of strategic
goals for Valley Practice. The mission of the facility is to serve
as the primary care “medical home” of individuals within the
community, regardless of the patients' ability to pay. Valley
Practice wishes to be recognized as a “high-tech, high-touch”
practice that provides high-quality, cost-effective patient care
using evidence-based standards of care. Consistent with its
mission, one of the practice's strategic goals is to replace its
current paper-based medical record with an EHR system. Such a
system should enable providers to care for patients using up-to-
date, complete, accurate information, anywhere, anytime.
Dr. John Marcus, the lead physician at Valley Practice, asked
Dr. Julie Brown, the newest partner in the group, to lead the
EHR project initiative. Dr. Brown joined the practice two years
ago after completing an internal medicine residency at an
academic medical center that had a fully integrated EHR system
available in both the hospital and its ambulatory care clinics. Of
all the physicians at Valley Practice, Dr. Brown has had the
most experience using an EHR. She has been a vocal advocate
for implementing an EHR and believes it is essential to enabling

2. the facility to achieve its strategic goals. Dr. Brown contacted
the Regional Extension Center (REC) in the community for
assistance with the initiative.
Dr. Brown agreed to chair the project steering committee. She
invited other key individuals to serve on the committee,
including Dr. Renee Ward, a senior physician in the practice;
Mr. James Rowls, the CEO; Ms. Mary Matthews, RN, a nurse;
and Ms. Sandy Raymond, the business officer manager. Dr.
Brown suggested that the committee work with the REC to
guide committee members through the system acquisition
process. The physician partners approved this request, and the
committee made arrangements for a representative from the
REC to work with them on the selection process.
After the project steering committee was formed, Dr. Marcus
met with the committee to outline its charge and deliverables.
Dr. Marcus expressed his appreciation to Dr. Brown and all of
the members of the committee for their willingness to
participate in this important initiative. He assured them that
they had his full support and the support of the entire physician
team.
Dr. Marcus reviewed with the committee the mission, vision,
and strategic goals of the practice as well as the committee's
charge. The committee was asked to fully investigate and
recommend the top three EHR products available in the vendor
community. He stressed his desire that the committee members
would focus on EHR vendors that have experience and a solid
track record in implementing systems in physician practices
similar to theirs and that have Office of the National
Coordinator for Health Information Technology (ONC)-certified
EHR products. He expressed concern that there is a flurry of
vendors offering EHR-type products without a solid track
record.

3. Dr. Marcus felt strongly that the EHR system needed to enable
providers to access patient information from any of Valley
Practice's three sites and from their homes. He also spoke of the
need for the system to provide health maintenance reminders,
drug interactions, and access to clinical practice guidelines or
standards of care. The practice also intends to take advantage of
the CMS EHR Incentive Program and achieve meaningful use.
Dr. Marcus is interested in exploring what opportunities are
available for health information exchange within the region. He
envisions that the practice may eventually partner with
specialists, hospitals, and other key stakeholders in the
community to provide coordinated care across the continuum.
Under the leadership of Dr. Brown, the members of the project
steering committee established five project goals and the
methods they would use to guide their activities. Ms. Moore, the
consultant, assisted them in clearly defining these goals and
discussing the various options for moving forward. They agreed
to consider EHR products from only those vendors that had five
or more years of experience in the industry and had a solid track
record of implementations (which they defined as having done
twenty-five or more). Dr. Ward, Mr. Rowls, and Ms. Matthews
assumed leadership roles in verifying and prioritizing the
requirements expressed by the various user groups.
The five project goals were based on Valley Practice's strategic
goals. These project goals were circulated for discussion and
approved by the CEO and the physician partners. Once the goals
were agreed upon, the project steering committee appointed a
small task group of committee members to carry out the process
of defining system functionality and requirements. Because
staff time was limited, the task group conducted three separate
focus groups during the lunch period—one with the nurses, one
with the support staff, and a third with the physicians. Ms.
Moore, the consultant, conducted the focus groups, using a
semistructured nominal group technique.

4. Concurrently with the requirements definition phase of the
project, Mr. Rowls and Dr. Brown, with assistance from Ms.
Moore, screened the EHR vendor marketplace. They reviewed
the literature, consulted with colleagues in the state medical
association, and surveyed practices in the state that they knew
used an EHR system. Mr. Rowls made a few phone calls to chief
information officers (CIOs) in surrounding hospitals who had
experience with ambulatory care EHR to get their advice. This
initial screening resulted in the identification of eight EHR
vendors whose products and services seemed to meet Valley
Practice's needs.
Given the fairly manageable number of vendors, Ms. Moore
suggested that the project steering committee use a short-form
request for proposal (RFP). This form had been developed by
her consulting firm and had been used successfully by other
physician practices to identify top contenders. The short-form
RFPs were sent to the eight vendors; six responded. Each of
these six presented an initial demonstration of its EHR system
on site. Following the demonstrations, the practice staff
members completed evaluation forms and ranked the various
vendors. After reviewing the completed RFPs and getting
feedback on the vendor presentations, the committee determined
that three vendors had risen to the top of the list.
Dr. Brown and Dr. Ward visited four physician practices that
used EHR systems from these three finalists. Mr. Rowls
checked references and prepared the final vendor analysis. A
detailed cost-benefit analysis was conducted, and the three
vendors were ranked. All three vendors, in rank order, were
presented in the final report given to Dr. Marcus and the other
physician partners.
Dr. Marcus, Dr. Brown, and Mr. Rowls spent four weeks
negotiating a contract with the top contender. It was finalized
and approved after legal review and after all the partners agreed

5. to it.
NTR 2280 Foodand Culture IndividualCountry Project~
100 Points
The instructor will randomly assign a cultural group
to the student after the class drop period. Please
check the due date for the project in the
Syllabus.
Submitting this Project:
Student shall submit this before the due date using
Turn-it-in.com.Turn-it-in.com is an Internet-
based plagiarism-detectionservice. Students with a
similarity index of 50% or more will
receive a 0. Students with a similarity index of
25-49% will get 50% credit. You are
encouraged to finish the project earlyso you
can see your similarity index. If you notice
that it is too
high you will have time to make someadjustments in
order not to lose any credit.
GOALS:
• Learn and communicate the history, common foods,
how to prepare a cultural dish, major
religions, health beliefs, and social challenges
about a specific culture
• Explain how foods are used by the culture
• To demonstrate your own thinking
• To writecaptivating, energetic sentences and link them in

6. paragraphs that unfold in a
dynamic way
• Locate, interpret, evaluate and use professional
literature (find credible, timely and relevant
source material)
• To learnhow to use validreference materials in a
report
• Demonstrate use current information technologies
• To make your essay interesting to readers
and share the information you have learned
with
the instructor and your cyber-classmates
ACEND Requirements for Didactic Program (KDRN
standards met)
• Demonstrate an understanding of cultural
competence/sensitivity (KDRN 2.6)
• Demonstrate written communication skills sufficient
for entryinto professional practice
(KDRN 2.1)
• Students are able to locate, understand and apply
established nutrition guidelines. (KDRN
1.1)
REQUIREMENTS:
You will be writing a report on a specific
country and culture that is assigned to you.

7. Below are the
design/grammatical requirements
FORMAT
• The report should be at least 5-7 pages in
length (not including works cited, title page or
pictures), double-spaced, numbered, with one-inch
margins and 12-point font saved as a
Microsoft Word or PDF document and submitted on
Turn it In (link available on Blackboard
under Country Report tab). Reports going over
suggested length will not be marked down
(however try to keep it less than 10 pages).
• Follow APA or MLA format for in-text citation
and a Works Cited page. An abstract is
not
necessary.
• Make clear and accurate use of source material,
and cite all source material, whether the
material is quoted, paraphrased or summarized.
• References MUST accompany statements of
fact. This is an academic paper, and you are
expected to use your own words to reflect on
your research (see more details below and
postson Country Report). If you struggle with these
please contact instructor.
• Follow sample essay format on page 5
GRADING ANDCONTENT GUIDE

8. Each subheading should be 2-3 paragraphs
dependingon total points, required information,
detail
and relevance to your thesis. The introduction and
conclusion should be one paragraph each, as
standard. Basic grammar, quality of academic writing
and proper citation method is assessed.
Introduction (5 points)
• Begin with an attention grabber and end the
paragraph with your thesis statement
History of the Assigned Country’s Culture (5 points)
• Describe general history of the country
including political, geographical, cultural and
otherinteresting information you feel is relevant.
This should be concise, relevant, and
precise.
Uniqueness of the Assigned Country’s Culture (5
points)
• Include details of what makes your assigned
country’s culture unique. Make sure to
address:
• What makes this culture different?
• How are they different than their neighbors?
• Does geography, climate, and/or political
conditions influence this culture?
• What did you find most unique about the

9. culture?
Major Religions of the Culture (5 points)
• Discuss basicreligion demographics and statistics. Make
mention of all religions
practiced and percent of population that practices
each.
• Choose one of the religions and discuss how food is
used as: symbols of the religions,
how the food is used in ceremonies, and how is
food used by the culture during religious
events.
Common Foods Used by the Assigned Country’s Culture
(10 points)
• Discuss staple foods from all major food groups
(grains, fruits, vegetables, proteins and
dairy).
• Discuss common ingredients/small staple items
such as spices, fats, side dishes, sauces,
beverages…etc.
• Identify and describe at least two of the following:
national dishes, foods eaten during
national holidays, celebrations, prestigious foods
etc.
• TIP: Cookbooks from specific cultures are

10. wonderful resources for this information.
Reputable bogs can be ok as well.
Meal Patterns and Etiquette (5 points)
• Discuss dailymeal patterns. For example, how oftenand
when do they typically eat?
What are somecommon food items for meals
breakfast, lunch, dinner...etc.? Is snacking
common?
• Discuss the role of food and etiquette in your
assigned country’s society. For example,
table matters (use of utensils, table setting,
environment, order of seating…etc.) and
degree of importance of eating together as a
family.
Cultural FoodTasting Experience (10 points)
• Obtain an authentic recipe from your assigned country
(or region) then prepare the
recipe. The recipe should be somewhat of a
challenge to make and part of a meal.
No
beverages or single ingredient recipes. Include recipe
in your report (either within the
report or as an appendix). Consider inserting a
jpeg of recipe in order to keep similarity
index low.
• Describe the cooking methods, taste, textures,
colors and aroma of the food in at least
two paragraphs (~100 words)

11. • Insert at least TWO pictures of YOUR
finished food product into the report. One
picture should be of you preparing the dish. The
otherpicture should include a picture
of the dish with an index card containing the
following information: Class, Name, Date
and Name of Dish. Pictures of otherprepared
recipes not made from you are
unacceptable.
• Make sure to reference where you obtained the
recipe (into the Works Cited page
following proper reference format)
Nutrition Guidance System (10 points)
• Briefly summarize one of the governmental
nutrition guidance systems used in your
assigned country. For example, in the United States
the main food guidance system is
Choose MyPlate.
• Describe how the food and lifestyle habits of
the population from your assigned country
meet or do not meet the food guidance system you
chose. This should be referenced
with a peer review article or acceptable
statistics.
• If your country does not have it’s own guidance system,
find one from a nearby region
that is similar or use an International Guidance
System like from the World Health
Organization. You can also look up various Food

12. Pyramids, see this link (for example)
and use those as your country’s guidance system.
• Must use at least one peer review reference for
this section.
Health Beliefs (5 points)
• Describe role of environment, food and lifestyle
choices on your country’s specific
chronic diseases. For example, access to food and
water, quality of healthcare, political
climate…etc.
• Identify two foods, herbs or supplements used
for healing in your assigned country.
• Discuss how the foods or herbs are used and
give two examples and their medicinal
uses.
1. This is a greatsearch term to try on CPP
Library database or Google Scholar: “foods
herbs used medicinally in COUNTRY X”
• Must use at least one peer review reference for
this section.
History and Cultural Challenges in the United

13. States (5 points)
• Discuss current demographics and socioeconomic status
of your assigned cultural group
in the United States. If your cultural group
does not have a largepresence in the United
States, compare to a nearby region or similar
cultural group or infer based on your
research what potential challenges this group would
have if livedin the United States.
• Describe the potential or current cultural and
social challenges and someof the cultural
problems your assigned culture might have/has in
the US.
Compare and Contrast Two Cultures (10 points)
• Compare and contrast your personal culture with
the culture of your assigned country.
• Copy and Paste and Complete this table for your
report. Then follow with a small
paragraph commentary/reflection of the similarities
and differences.
Twosimilarities between
my culture and assigned
country
Two differences Between
my culture and assigned
country

14. Geography/Environment
Population (people, diversity,
language(s) spoken…etc.)
Religion
Staple FoodItems
Health Beliefs
Conclusion(s) About the Culture (5 points)
• Please writea concluding paragraph about the
culture. This should highlight and
summarize the major conclusions in your paper.
Works Cited/References (15 points) (5 points
for using valid/required references; 5
points for correct in-text citations, 5 points
for Bibliography format) PLEASE review links
on BlackBoard under Country Report that detail
how to find referencesand references
that are valid:
• Use a minimum of:
1. (2) Peer-Reviewed Journal Articles (These must be
from journals that are peer-
reviewed and relevant to the culture)
2. (2) Book references(One of thesecan be a
cookbook)
3. (1) Valid Internet source (If you are not
sure as to the validity of the site, send

15. me a message in Blackboard)
• If you don’t cite information under each section,
you will receive a '0' for the section
without substantiation of your statement.
• Additionally, you may use interviews, lectures, more
than the above references, &
personal experiences in addition to the requirements
above-but they must be properly
referenced.
• Be consistent in your referencing of facts. Use
MLA or APA format for your citations.
Spelling and Grammar: (5 points)
• Spelling, grammar, timeliness, proper use of
references, completeness in the above
relative contents and subject matter are grade
considerations.
Required Format for Essay (can copy and pasteand
use for your essay format)
The Title of Your Essay Goes Here
Epigraphs [optional] go here --authors of epigraphs go
here
Text begins here................. start with your introduction.
Then continue with each section with

16. subheadings for each section
History of the Culture
Uniqueness of the Culture
Major Religions of the Culture
Common Foods Used by the Culture
Meal Patterns and Etiquette
Cultural FoodTasting Experience
Nutrition Guidance System
Health Beliefs
History and Cultural Challenges in the United
States
My culture comparison compared to Assigned
Country
End with your conclusion (no subheading required
here).
Works Cited Page (follow APA or MLA format)
Note: All papers will be checked for plagiarism.
Ultimately, it is the students' choice to follow
directions...however; grading will be based on

17. following the above directions. Skipping a section,
simply mentioning that you were not able to
find information-without following the directions above or
not contacting the instructor well in
advance of the due date, failure to cite references
after facts, may result in point
deductions....and possibly result in a failing
grade. If thereis any part of the directions
that is
not clear, let the instructor know. She will be
happy to provide assistance or suggestions
where
the student may obtain or find additional information.