Defining - and implementing - meaningful use has the potential to dramatically impact the use of electronic health records in the US. At this early stage, it is critical ask if the end goals are being served by the approach. This paper introduces the concept and considers how to implement such significant change in the context of the American health care system.
Written for a course on Quality and Performance Measurement for Brandeis University.
The Role of Collaborative Arrangements on Quality Perception in Ambulatory CareBruno Agnetti
Il pronto intervento italiano aveva posto un accento particolare sulla promozione di nuove modalità organizzative. Alcuni studi hanno analizzato il loro impatto sulla percezione della qualità. Con l'obiettivo di esaminare i clienti 'e medici' in cura ambulatoriale all'interno dei diversi modelli organizzativi, abbiamo studiato 96 pazienti (di età compresa tra i 18-80 anni) e 22 medici (M = 50,33 anni).
Determinants of Strategic Implementation of Devolved Health Services in Trans...paperpublications3
Abstract: Many organizations, including those in the public health sector, are experiencing and managing change which may be either planned or emergent. The performance of Trans Nzoia County has been reproached particularly in the wake of go-slows and strikes of the health labour force in recent times. The broad objective of the study was to assess the factors influencing the strategic implementation of devolved health services in Trans Nzoia County. The study was guided by the following specific objectives: To establish the effect of budgetary support on strategic implementation of health services, to examine the effect of health policy on strategic implementation of health services, to determine the effect of health legislation on strategic implementation of health services, and to determine how management support affects strategic implementation of health services. The study was guided by both Ansoffian theory and management theory. The study adopted a cross-sectional survey research design. The target population was the 1240 employees working with Trans Nzoia County. A sample of 89 respondents was drawn from the target population using stratified random sampling method. Primary data was collected using a structured questionnaire. The instrument was pilot tested before its use to collect data for the main study. The study assessed both validity and reliability of the instrument. The collected data was processed and analyzed with the aid of the Statistical Package for Social software. The data was analyzed using both descriptive and inferential statistics. The results indicated that budgetary support has a positive significant effect on strategic implementation of health services. Health policy had a significant positive effect on strategic implementation of health services. The study found a positive significant effect of health legislation on strategic implementation of health services in Trans Nzoia County. Management support had a positive and significant effect on strategic implementation of health services in Trans Nzoia County. It was therefore concluded that budgetary support, health policy, legislation on health care, and management support what are the factors that determine strategic implementation of devolved healthcare services.
Keywords: Budgetary support, health policy, legislative process, management support and strategic implementation.
Title: Determinants of Strategic Implementation of Devolved Health Services in Trans Nzoia County
Author: Buchunju, Phoebe, Dr. Iravo, Mike, Mr. Okwaro, Fredrick
ISSN 2349-7807
International Journal of Recent Research in Commerce Economics and Management (IJRRCEM)
Paper Publications
Engines of Success for U.S. Health Reform?
Eric B. Larson, MD, MPHVice President for Research, Group Health Executive Director, Group Health Research Institute
The Role of Collaborative Arrangements on Quality Perception in Ambulatory CareBruno Agnetti
Il pronto intervento italiano aveva posto un accento particolare sulla promozione di nuove modalità organizzative. Alcuni studi hanno analizzato il loro impatto sulla percezione della qualità. Con l'obiettivo di esaminare i clienti 'e medici' in cura ambulatoriale all'interno dei diversi modelli organizzativi, abbiamo studiato 96 pazienti (di età compresa tra i 18-80 anni) e 22 medici (M = 50,33 anni).
Determinants of Strategic Implementation of Devolved Health Services in Trans...paperpublications3
Abstract: Many organizations, including those in the public health sector, are experiencing and managing change which may be either planned or emergent. The performance of Trans Nzoia County has been reproached particularly in the wake of go-slows and strikes of the health labour force in recent times. The broad objective of the study was to assess the factors influencing the strategic implementation of devolved health services in Trans Nzoia County. The study was guided by the following specific objectives: To establish the effect of budgetary support on strategic implementation of health services, to examine the effect of health policy on strategic implementation of health services, to determine the effect of health legislation on strategic implementation of health services, and to determine how management support affects strategic implementation of health services. The study was guided by both Ansoffian theory and management theory. The study adopted a cross-sectional survey research design. The target population was the 1240 employees working with Trans Nzoia County. A sample of 89 respondents was drawn from the target population using stratified random sampling method. Primary data was collected using a structured questionnaire. The instrument was pilot tested before its use to collect data for the main study. The study assessed both validity and reliability of the instrument. The collected data was processed and analyzed with the aid of the Statistical Package for Social software. The data was analyzed using both descriptive and inferential statistics. The results indicated that budgetary support has a positive significant effect on strategic implementation of health services. Health policy had a significant positive effect on strategic implementation of health services. The study found a positive significant effect of health legislation on strategic implementation of health services in Trans Nzoia County. Management support had a positive and significant effect on strategic implementation of health services in Trans Nzoia County. It was therefore concluded that budgetary support, health policy, legislation on health care, and management support what are the factors that determine strategic implementation of devolved healthcare services.
Keywords: Budgetary support, health policy, legislative process, management support and strategic implementation.
Title: Determinants of Strategic Implementation of Devolved Health Services in Trans Nzoia County
Author: Buchunju, Phoebe, Dr. Iravo, Mike, Mr. Okwaro, Fredrick
ISSN 2349-7807
International Journal of Recent Research in Commerce Economics and Management (IJRRCEM)
Paper Publications
Engines of Success for U.S. Health Reform?
Eric B. Larson, MD, MPHVice President for Research, Group Health Executive Director, Group Health Research Institute
Design Research and Healthcare Reform - Mayo Clinic ProceedingsChristine Chastain
Meaningful health reform in the United States must improve the health of the population while lowering costs. In an effort to provide a framework for doing so, the Institute of Health Care Improvement created the triple aim, which encompasses the goals of (1) improv- ing individual health and experience with the health care system, (2) improving population health, and (3) decreasing the rate of per capita health care costs. Current reform efforts have focused on the development of Patient-Centered Medical Homes (an innovative team-based model of care that facilitates a partnership between the patient's personal physician coordinating care throughout a pa- tient's lifetime to maximize health outcomes), but these relatively narrow efforts are focused on office practice and payment methods and are not generally oriented toward community needs. We sought to apply design research in assessing a community opportunity to apply the triple aim as a strategy to transform health care delivery.
Recent advances in the evidence base for technology-based behavioral health applications have provided clinicians a better understanding and guidance on the integration of these tools into clinical care. Participants will learn about research findings on current technologies in use in clinical practice, such as audio conferencing, video conferencing, and virtual reality, in addition to tools available for use between patients, such as the use of websites and mobile applications and wearable sensors.
Physical activity prediction using fitness data: Challenges and issuesjournalBEEI
In the new healthcare transformations, individuals are encourage to maintain healthy life based on their food diet and physical activity routine to avoid risk of serious disease. One of the recent healthcare technologies to support self health monitoring is wearable device that allow individual play active role on their own healthcare. However, there is still questions in terms of the accuracy of wearable data for recommending physical activity due to enormous fitness data generated by wearable devices. In this study, we conducted a literature review on machine learning techniques to predict suitable physical activities based on personal context and fitness data. We categorize and structure the research evidence that has been publish in the area of machine learning techniques for predicting physical activities using fitness data. We found 10 different models in behavior change technique (BCT) and we selected two suitable models which are fogg behavior model (FBM) and trans-theoretical behavior model (TTM) for predicting physical activity using fitness data. We proposed a conceptual framework which consists of personal fitness data, combination of TTM and FBM to predict the suitable physical activity based on personal context. This study will provide new insights in software development of healthcare technologies to support personalization of individuals in managing their own health.
Adoption of Integrated Healthcare Information System in Nairobi County: Kenya...Editor IJCATR
Health care information systems are aimed at facilitating the smooth running and interoperability of the health care
delivery processes to ensure efficiency and effectiveness; however, the complexity, heterogeneity and diversity of the health care
sector especially in Kenya poses serious challenges especially in relation to integration of the systems. There is a large disconnect
between the public and private health care delivery systems characterized by fragmentation of services, locally within hospitals
(among primary, secondary and tertiary health care settings) and across different health care centers. This research is aimed at
examining the adoption of integrated healthcare information system in Nairobi County; Kenyatta National Hospital represents the
public sector and The Mater Hospital the private sector. A sample size of 100 users on information system from the two hospitals
picked from the primary secondary and tertiary levels were selected and questionnaires administered to them. Data was analyzed
through descriptive statistics with the aid of SPSS. The results of the study indicated that there was a huge disparity between
healthcare information system adoption in the public and private sectors with the private sector’s adoption being at an advanced
stage. The major barriers to adoption including social political barriers, financial constraints and technical/technological barriers
also presented.
This workshop will explore strategies to increase employment among people who have been chronically homeless and are disabled. Speakers will describe community partnerships and programs that increase employment skills and job opportunities.
Discussions1.Electronic Health RecordsElectronic healt.docxlefrancoishazlett
Discussions
1.
Electronic Health Records
Electronic health records (EHRs) are at the center stage of the effort to improve health care quality and control costs. In addition to allowing medical practitioners to access and record clinical documentation at much faster rates, EHRs are also positively influencing care delivery and nurse-patient interaction. Yet despite the potential benefits of EHRs, their implementation can be a formidable task that has broad-reaching implications for an entire health care organization.
In this Discussion, you appraise strategies for obtaining the benefits and overcoming the challenges of implementing and using electronic health records.
To prepare
Review the implementation of EHRs in an organization. Reflect on the various approaches used.
If applicable, consider your own experiences with implementing EHRs. What were some positive aspects of the implementation? What suggestions would you make to improve the process?
Reflect on the reactions of others during the implementation process. Were concerns handled effectively?
If you have not had any experiences with an EHR implementation, talk to someone who has and get his or her feedback on the experience.
Search and indicate examples of effective and poor implementation of EHRs.
RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 15, “The Electronic Health Record and Clinical Informatics”
This chapter describes the crucial parts of an electronic health record system and explores the benefits of implementing one.
Bates, D. W. (2010). Getting in step: Electronic health records and their role in care coordination. Journal of General Internal Medicine, 25(3), 174–176.
The author of this editorial critically analyzes current applications of electronic health records (EHRs) and their impact on cost, quality, and safety of health care delivery. The author describes a study on the use of vendor-developed EHRs in clinical practice settings, the results of which pinpointed the benefits and drawbacks of EHRs.
Cresswell, K., & Sheikh, A. (2009). The NHS Care Record Service: Recommendations from the literature on successful implementation and adoption. Informatics in Primary Care, 17(3), 153–160.
This article defines the United Kingdom’s National Health Service’s Care Record Service (NHS CRS) as a standard electronic health record system. The article describes the challenges associated with implementing this new information technology and provides recommendations for overcoming those challenges.
Fickenscher, K., & Bakerman, M. (2011). Change management in health care IT. Physician Executive, 37(2), 64–67.
This article offers strategies for health care leaders to successfully implement change programs in their organizations, especially with regard to the new standards for electronic health records (EHRs). The article provide.
Design Research and Healthcare Reform - Mayo Clinic ProceedingsChristine Chastain
Meaningful health reform in the United States must improve the health of the population while lowering costs. In an effort to provide a framework for doing so, the Institute of Health Care Improvement created the triple aim, which encompasses the goals of (1) improv- ing individual health and experience with the health care system, (2) improving population health, and (3) decreasing the rate of per capita health care costs. Current reform efforts have focused on the development of Patient-Centered Medical Homes (an innovative team-based model of care that facilitates a partnership between the patient's personal physician coordinating care throughout a pa- tient's lifetime to maximize health outcomes), but these relatively narrow efforts are focused on office practice and payment methods and are not generally oriented toward community needs. We sought to apply design research in assessing a community opportunity to apply the triple aim as a strategy to transform health care delivery.
Recent advances in the evidence base for technology-based behavioral health applications have provided clinicians a better understanding and guidance on the integration of these tools into clinical care. Participants will learn about research findings on current technologies in use in clinical practice, such as audio conferencing, video conferencing, and virtual reality, in addition to tools available for use between patients, such as the use of websites and mobile applications and wearable sensors.
Physical activity prediction using fitness data: Challenges and issuesjournalBEEI
In the new healthcare transformations, individuals are encourage to maintain healthy life based on their food diet and physical activity routine to avoid risk of serious disease. One of the recent healthcare technologies to support self health monitoring is wearable device that allow individual play active role on their own healthcare. However, there is still questions in terms of the accuracy of wearable data for recommending physical activity due to enormous fitness data generated by wearable devices. In this study, we conducted a literature review on machine learning techniques to predict suitable physical activities based on personal context and fitness data. We categorize and structure the research evidence that has been publish in the area of machine learning techniques for predicting physical activities using fitness data. We found 10 different models in behavior change technique (BCT) and we selected two suitable models which are fogg behavior model (FBM) and trans-theoretical behavior model (TTM) for predicting physical activity using fitness data. We proposed a conceptual framework which consists of personal fitness data, combination of TTM and FBM to predict the suitable physical activity based on personal context. This study will provide new insights in software development of healthcare technologies to support personalization of individuals in managing their own health.
Adoption of Integrated Healthcare Information System in Nairobi County: Kenya...Editor IJCATR
Health care information systems are aimed at facilitating the smooth running and interoperability of the health care
delivery processes to ensure efficiency and effectiveness; however, the complexity, heterogeneity and diversity of the health care
sector especially in Kenya poses serious challenges especially in relation to integration of the systems. There is a large disconnect
between the public and private health care delivery systems characterized by fragmentation of services, locally within hospitals
(among primary, secondary and tertiary health care settings) and across different health care centers. This research is aimed at
examining the adoption of integrated healthcare information system in Nairobi County; Kenyatta National Hospital represents the
public sector and The Mater Hospital the private sector. A sample size of 100 users on information system from the two hospitals
picked from the primary secondary and tertiary levels were selected and questionnaires administered to them. Data was analyzed
through descriptive statistics with the aid of SPSS. The results of the study indicated that there was a huge disparity between
healthcare information system adoption in the public and private sectors with the private sector’s adoption being at an advanced
stage. The major barriers to adoption including social political barriers, financial constraints and technical/technological barriers
also presented.
This workshop will explore strategies to increase employment among people who have been chronically homeless and are disabled. Speakers will describe community partnerships and programs that increase employment skills and job opportunities.
Discussions1.Electronic Health RecordsElectronic healt.docxlefrancoishazlett
Discussions
1.
Electronic Health Records
Electronic health records (EHRs) are at the center stage of the effort to improve health care quality and control costs. In addition to allowing medical practitioners to access and record clinical documentation at much faster rates, EHRs are also positively influencing care delivery and nurse-patient interaction. Yet despite the potential benefits of EHRs, their implementation can be a formidable task that has broad-reaching implications for an entire health care organization.
In this Discussion, you appraise strategies for obtaining the benefits and overcoming the challenges of implementing and using electronic health records.
To prepare
Review the implementation of EHRs in an organization. Reflect on the various approaches used.
If applicable, consider your own experiences with implementing EHRs. What were some positive aspects of the implementation? What suggestions would you make to improve the process?
Reflect on the reactions of others during the implementation process. Were concerns handled effectively?
If you have not had any experiences with an EHR implementation, talk to someone who has and get his or her feedback on the experience.
Search and indicate examples of effective and poor implementation of EHRs.
RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 15, “The Electronic Health Record and Clinical Informatics”
This chapter describes the crucial parts of an electronic health record system and explores the benefits of implementing one.
Bates, D. W. (2010). Getting in step: Electronic health records and their role in care coordination. Journal of General Internal Medicine, 25(3), 174–176.
The author of this editorial critically analyzes current applications of electronic health records (EHRs) and their impact on cost, quality, and safety of health care delivery. The author describes a study on the use of vendor-developed EHRs in clinical practice settings, the results of which pinpointed the benefits and drawbacks of EHRs.
Cresswell, K., & Sheikh, A. (2009). The NHS Care Record Service: Recommendations from the literature on successful implementation and adoption. Informatics in Primary Care, 17(3), 153–160.
This article defines the United Kingdom’s National Health Service’s Care Record Service (NHS CRS) as a standard electronic health record system. The article describes the challenges associated with implementing this new information technology and provides recommendations for overcoming those challenges.
Fickenscher, K., & Bakerman, M. (2011). Change management in health care IT. Physician Executive, 37(2), 64–67.
This article offers strategies for health care leaders to successfully implement change programs in their organizations, especially with regard to the new standards for electronic health records (EHRs). The article provide.
Transforming Nursing and Healthcare through TechnologyDiscussion.docxturveycharlyn
Transforming Nursing and Healthcare through Technology
Discussions
1. Electronic Health Records
Electronic health records (EHRs) are at the center stage of the effort to improve health care quality and control costs. In addition to allowing medical practitioners to access and record clinical documentation at much faster rates, EHRs are also positively influencing care delivery and nurse-patient interaction. Yet despite the potential benefits of EHRs, their implementation can be a formidable task that has broad-reaching implications for an entire health care organization.
In this Discussion, you appraise strategies for obtaining the benefits and overcoming the challenges of implementing and using electronic health records.
To prepare
Review the implementation of EHRs in an organization. Reflect on the various approaches used.
If applicable, consider your own experiences with implementing EHRs. What were some positive aspects of the implementation? What suggestions would you make to improve the process?
Reflect on the reactions of others during the implementation process. Were concerns handled effectively?
If you have not had any experiences with an EHR implementation, talk to someone who has and get his or her feedback on the experience.
Search and indicate examples of effective and poor implementation of EHRs.
RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 15, “The Electronic Health Record and Clinical Informatics”
This chapter describes the crucial parts of an electronic health record system and explores the benefits of implementing one.
Bates, D. W. (2010). Getting in step: Electronic health records and their role in care coordination. Journal of General Internal Medicine, 25(3), 174–176.
The author of this editorial critically analyzes current applications of electronic health records (EHRs) and their impact on cost, quality, and safety of health care delivery. The author describes a study on the use of vendor-developed EHRs in clinical practice settings, the results of which pinpointed the benefits and drawbacks of EHRs.
Cresswell, K., & Sheikh, A. (2009). The NHS Care Record Service: Recommendations from the literature on successful implementation and adoption. Informatics in Primary Care, 17(3), 153–160.
This article defines the United Kingdom’s National Health Service’s Care Record Service (NHS CRS) as a standard electronic health record system. The article describes the challenges associated with implementing this new information technology and provides recommendations for overcoming those challenges.
Fickenscher, K., & Bakerman, M. (2011). Change management in health care IT. Physician Executive, 37(2), 64–67.
This article offers strategies for health care leaders to successfully implement change programs in their organizations, especially with regard to the new standards for electronic health ...
The National Academies Health and Medicine DivisionAbout U.docxdennisa15
The National Academies
Health and Medicine Division
About UsPublicationsActivitiesMeetings
Announcement
Crossing the Quality Chasm: The IOM Health Care Quality Initiative
In 1996, after releasing America's Health in Transition: Protecting and Improving Quality, the IOM launched a concerted, ongoing effort focused on assessing and improving the nation's quality of care.
The first phase of this Quality Initiative documented the serious and pervasive nature of the nation's overall quality problem, concluding that "the burden of harm conveyed by the collective impact of all of our health care quality problems is staggering" (Chassen et al., 1998).
IOM Definition of Quality
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
This phase built on an intensive review of the literature conducted by RAND to understand the scope of this issue (Schuster) and a framework was established that defined the nature of the problem as one of overuse, misuse and underuse of health care services (Chassen et al). More specifically, the report Ensuring Quality Cancer Care (1999) documented the wide gulf that exists between ideal cancer care and the reality many Americans with cancer experience.
During the second phase, spanning 1999-2001, the Committee on Quality of Health Care in America, laid out a vision for how the health care system and related policy environment must be radically transformed in order to close the chasm between what we know to be good quality care and what actually exists in practice. The reports released during this phase—To Err is Human: Building a Safer Health System(1999) and Crossing the Quality Chasm: A New Health System for the 21st Century(2001)—stress that reform around the margins is inadequate to address system ills.
The series of IOM quality reports have included a number of metrics that illustrate how wide the quality chasm is and how important it is to close this gulf, between what we know is good quality care and what the norm is in practice.
To Err is Human put the spotlight on how tens of thousands of Americans die each year from medical errors and effectively put the issue of patient safety and quality on the radar screen of public and private policymakers. The Quality Chasm report described broader quality issues and defines six aims—care should be safe, effective, patient-centered, timely, efficient and equitable—and 10 rules for care delivery redesign.
Phase three of the IOM's Quality Initiative focuses on operationalizing the vision of a future health system described in the Quality Chasm report. In addition to the IOM, many others are working to create a more patient responsive 21st century health system, including clinicians/ health care organizations, employers/consumers, foundations/research, government agencies, and quality organizations. This collection of efforts focus reform a.
Analytics-Driven Healthcare: Improving Care, Compliance and CostCognizant
In the face of skyrocketing costs, the healthcare industry is addressing inefficiencies by improving data sharing and collaboration across the industry value chain and applying analytics to improve operations and patient outcomes.
Evolution of Health Care Paper and TimelineThere are specifi.docxSANSKAR20
Evolution of Health Care Paper and Timeline
There are specific trends from manual to electronic operations in the health care facilities, healthcare providers and similar businesses operators. The evolution has taken place within the health care providers, administrative data and the insurance plans as well. The health care industries have automated several procedures such as the supply of drugs and accurate record keeping (Loker 2012). Electronic health care uses sophisticated technology unlike the manual one; this advanced technology has been applied in the provision of health care all over the world hence saving both time and cost It has also widened and perfected the scope of operation.
How has this change impacted the quality of care?
The change to electronic medical records has proven to be successful and helpful in providing quality patient care. Some ways that it has helped is improving patient care, increasing patient participation, improved care coordination, improved diagnostic and patient outcomes, and practice efficiencies and cost savings. (HealthIT.gov). Patients are able to be more involved in the patient care process and are able to access to their records which was not possible in the past. The transporting of records from one physician to another is much quicker now because it can be done by a click of a button. When needing to send a patient to a specialist or when getting an authorization for a patient’s recommended treatment can be done a lot quicker as well. This is speeding up the process in being able to provide quick and quality care so the patient does not need to wait as long as they would have had to in the past.
Percentage of physicians whose electronic health records provided selected benefits
(HealthIT.gov)
Electronic medical records has proven to be a good thing for both the medical provider as well as the patient and it has decreased the wait times to results or any potential errors and enhanced patient care.
Did Societal beliefs and values influence this change? Why or why not?
The health care delivery system in our country has its roots in the beliefs and values of the people (Shi & Singh, 2012). The firm belief in technological innovations leads to higher expectations of people, which has fueled the growth in technological innovations. The culture of individualism has led the medical practice to keep the individual healthy. Patients tend to evaluate the institutions by their acquisition of advanced technology. The expectation of Americans on what technology can do to cure illness is higher compared to the Canadians and Germans (Shi & Singh, 2012, p. 168). The societal beliefs and values impact not only the structure of health care delivery but also the training of health care providers.
The use of EHRs provided access to patients’ records on demand and have improved the quality of health care (Shi & Singh, 2012). Although the EHRs were to improve the quality of health care delivery, many ...
Similar to Meaningful use - Will the end result be meaningful? (20)
A Bicycle Built for Two: 10 Lessons Learned on Integrating Social Media and H...Jodi Sperber
Ten lessons learned about integrating social media into health, with an eye towards shared decision making (SDM). Presented at the 2011 Dartmouth Summer Institute on Shared Decision Making.
You 2.0: An introduction to social media and health, and making it work for y...Jodi Sperber
Originally presented for CHNA (Community Health Network Area) 18, a local coalition of public, non-profit, and private sectors working together to build healthier communities in Massachusetts through community-based prevention planning and health promotion
This workshop was designed to help familiarize participants with how social media (such as Facebook, Twitter, YouTube, and blogs) is being used on a routine basis to bolster existing communication and engagement strategies.
An overview of Twitter as a tool, how it is used, and why you should be taking advantage of it. Presented to Brandeis University students, faculty, and staff on behalf of Career Services.
An updated introduction to Twitter, with lots of examples and basic information to help understand what it is, how it is used, and why it has become a powerful tool. Original PPT has animation - drop me a note if you want this version.
Getting to know others with a shared interest has always been an important part of one’s professional life. With social media on the rise, there are new and effective ways to engage. This session will review ways to help build your personal brand, giving you a jump on making a splash in your career of choice!
Presentation made in conjunction with Career Services at the Heller School at Brandeis University.
Donating money via text is easy from a donor perspective, but it it efficient? Originally written for a class at The Heller School, Brandeis University.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- 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
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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
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The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
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In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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Meaningful use - Will the end result be meaningful?
1. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
Meaningful
Use:
Will
the
end
result
be
meaningful?
With
the
cost
of
health
care
in
the
United
States
continuously
increasing,
significant
efforts
are
being
made
to
make
systemic
improvements
that
save
on
cost
without
negatively
impacting
quality
of
care.
Moreover,
the
true
goal
is
to
contain
spending
while
at
the
same
time
making
improvements
to
quality.
This
endeavor
has
numerous
components
to
be
considered,
given
the
complexity
of
the
American
health
care
system.
Over
the
past
10
years,
health
information
technology
has
increasingly
been
viewed
as
a
vital
factor
in
health
reform
efforts.
To
this
end,
the
American
Recovery
and
Reinvestment
Act
(ARRA)
of
2009,
commonly
known
as
the
stimulus
bill,
included
a
provision
called
the
Health
Information
Technology
for
Economic
and
Clinical
Health
(HITECH)
Act.
Provisions
of
this
act
involve
a
number
of
regulations
and
programs
aimed
to
support
the
improvement
of
health
care
systems
and,
ultimately,
help
to
increase
the
health
of
Americans
(Blumenthal,
2010;
Centers
for
Medicare
and
Medicaid,
2006;
Glaser,
2010;
Halamka,
2010b).
Of
primary
interest
within
HITECH
is
the
development
and
utilization
of
electronic
health
records
(EHRs)
as
a
normative
part
of
the
American
health
care
experience.
As
a
part
of
this
effort,
the
federal
government
is
interested
in
boosting
the
use
of
Page 1
2. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
EHRs
among
providers
receiving
payments
from
Medicare
and
Medicaid
in
ways
that
are
considered
to
be
“meaningful.”
How
meaningful
use
gets
defined
is
of
great
significance,
as
new
financial
incentives
rest
upon
providers
and
hospitals
meeting
minimum
standards
set
forth.
As
of
this
paper’s
writing,
no
final
decisions
have
been
issued
–
the
initial
proposed
rule
of
meaningful
use
was
issued
in
December
2009,
and
public
comments
on
the
proposed
rule
were
accepted
until
March
15
(Department
of
Health
&
Human
Services,
2009;
HHS
Press
Office,
2009).
These
comments
are
currently
under
review.
For
the
purposes
of
studying
meaningful
use
in
more
detail,
it
is
worth
taking
a
moment
to
delineate
electronic
medical
records
(EMR)
and
EHRs,
two
terms
that
are
often
conflated.
Though
frequently
used
interchangeably
they
are,
technically,
distinct.
As
defined
by
the
recently
disbanded
National
Alliance
for
Health
Information
Technology
(NAHIT),
EMRs
refer
to
the
“electronic
record
of
health-‐
related
information
on
an
individual
that
is
created,
gathered,
managed,
and
consulted
by
licensed
clinicians
and
staff
from
a
single
organization
who
are
involved
in
the
individual's
health
and
care.”
EHRs
refer
to
the
“aggregate
electronic
record
of
health-‐related
information
on
an
individual
that
is
created
and
gathered
cumulatively
across
more
than
one
health
care
organization
and
is
managed
and
consulted
by
licensed
clinicians
and
staff
involved
in
the
individual's
health
and
care”
(Neal,
2008).
Page 2
3. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
Therefore,
while
an
EMR
may
be
very
useful
for
capturing
and
organizing
information
within
a
single
practice
or
for
a
single
patient,
an
EHR
can
be
utilized
to
compare
commonalities
and
difference
across
populations,
making
it
a
more
robust
mechanism
to
spot
trends,
highlight
outliers,
and
support
evidence
based
treatment.
Using
these
definitions,
an
EHR
can
be
viewed
as
an
EMR
with
the
capability
of
integrating
into
multiple
systems,
making
it
a
much
more
powerful
tool
for
measuring
quality.
Thus,
the
federal
government
is
interested
in
incentivizing
practitioners
who
meet
EHR
standards
aimed
at
improving
quality
for
patients
even
as
they
move
around
within
the
larger
health
care
system.
Despite
both
private
and
public
actions
to
date,
and
consensus
that
the
use
of
health
information
technology
will
likely
lead
to
more
efficient,
safer,
and
higher-‐quality
care,
the
adoption
of
EHRs
in
the
US
has
been
slow.
Lethargy
in
EHR
adoption
has
been
a
topic
of
discussion
amongst
researchers,
health
providers,
consumers,
and
policy
makers
for
some
time.
At
present,
less
than
20%
of
physicians
currently
use
an
electronic
records
system.
Such
systems
are
generally
found
in
larger
care
settings
including
hospitals
and
large
practices,
while
smaller
practices
rarely
have
such
systems
in
place
(DesRoches,
et
al.,
2008;
Jha,
et
al.,
2009;
Jha,
et
al.,
2006).
Within
the
federal
government,
IT
modernization
efforts
are
an
integral
part
of
the
Health
Information
Technology
Framework.
The
US
Department
of
Health
and
Human
Services
listed
health
information
technology
as
a
priority
for
quality
Page 3
4. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
measurement
and
data
collection,
indicating
that
interoperable
electronic
records
should
be
available
“to
patients
and
their
doctors
anytime,
anywhere”
(Centers
for
Medicare
and
Medicaid,
2006).
To
both
ease
and
encourage
the
transition
to
EHRs,
the
proposed
meaningful
use
definitions
and
goals
for
EHRs
are
broken
into
three
separate
stages,
scheduled
to
be
rolled
out
in
sequence
between
2011
and
2015.
Each
stage
builds
upon
the
previous,
with
financial
incentives
available
at
each
new
stage.
Stage
1,
which
begins
in
2011,
focuses
primarily
on
basic
EHR
capabilities,
naming
25
modules
for
eligible
professionals
(EPs)
and
23
modules
for
eligible
hospitals
that
must
be
met
to
be
deemed
a
meaningful
EHR
user.
Stage
2
expands
Stage
1
criteria
in
the
areas
of
disease
management,
clinical
decision
support,
medication
management,
support
for
patient
access
to
their
health
information,
transitions
in
care,
quality
measurement
and
research,
and
bi-‐directional
communication
with
public
health
agencies.
Stage
3
focuses
on
achieving
improvements
in
quality,
safety
and
efficiency,
focusing
on
decision
support
for
national
high
priority
conditions,
patient
access
to
self
management
tools,
access
to
comprehensive
patient
data,
and
improving
population
health
outcomes
(US
Department
of
Health
and
Human
Services,
2010).
Page 4
5. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
Each
module
within
the
meaningful
use
definition
contains
a
specific
objective
and
measurable
goal
that
must
be
met
for
disbursement
of
the
associated
financial
incentive.
Sample
hospital
objectives/measures
include:
1. Objective:
Use
of
computerized
physician
order
entry
(CPOE)
for
orders
(any
type)
directly
entered
by
authorizing
provider
(for
example,
MD,
DO,
RN,
PA,
NP)
Measure:
CPOE
is
used
for
at
least
10
percent
of
all
orders
2. Objective:
Implement
drug-‐drug,
drug-‐allergy,
drug-‐
formulary
checks
Measure:
The
eligible
hospital
has
enabled
this
functionality
3. Objective:
Maintain
active
medication
list.
Measure:
At
least
80
percent
of
all
unique
patients
admitted
by
the
eligible
hospital
have
at
least
one
entry
(or
an
indication
of
“none”
if
the
patient
is
not
currently
prescribed
any
medication)
recorded
as
structured
data.
4. Objective:
Record
demographics.
Measure:
At
least
80
percent
of
all
unique
patients
admitted
to
the
eligible
hospital
have
demographics
recorded
as
structured
data
5. Objective:
Generate
lists
of
patients
by
specific
conditions
to
use
for
quality
improvement,
reduction
of
disparities,
research,
and
outreach
Measure:
Generate
at
least
one
report
listing
patients
of
the
eligible
hospital
with
a
specific
condition.
Similar
measures
and
objectives
have
been
created
for
providers
who
do
not
work
within
a
hospital
system
(Beaudoin,
2009a,
2009b).
On
its
face,
each
module
appears
relatively
straightforward.
However,
as
evidenced
by
the
lack
of
EHR
adoption
within
the
US
and
the
lively
discussion
that
is
taking
place
with
the
initial
definition
released,
it
is
clear
that
there
is
room
for
debate
on
the
viability
of
the
current
federal
strategy.
Page 5
6. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
One
would
be
hard
pressed
to
find
a
provider
who
is
not
interested
in
providing
quality
(however
they
define
the
word)
care.
At
the
same
time,
a
wide
range
of
studies
have
suggested
that
EHRs
are
an
important
factor
of
quality
improvement
strategies
(Chen,
Garrido,
Chock,
Okawa,
&
Liang,
2009;
MW
Friedberg,
et
al.,
2009;
M
Friedberg,
et
al.,
2009;
Orszag,
2008).
With
this
in
mind,
it
is
reasonable
to
inquire
why
all
health
care
providers
have
not
already
embraced
meaningful
use
of
EHRs
as
an
automatic
member
of
the
overall
care
approach.
Research
to
date,
as
well
as
comments
from
experts
in
the
field,
consistently
underscore
that
it
is
not
the
mere
presence
of
an
EHR
that
makes
a
difference,
but
rather
the
use
of
the
information
contained
as
a
decision
support
device
that
improves
quality
(Dexheimer,
Talbot,
Sanders,
Rosenbloom,
&
Aronsky,
2008;
Ford,
Menachemi,
Peterson,
&
Huerta,
2009;
M
Friedberg,
et
al.,
2009;
Poon,
et
al.,
2010;
Sequist,
et
al.,
2005).
This
distinction
is
at
the
heart
of
the
challenge
of
universal
EHR
adoption;
crossing
the
divide
between
the
presence
of
an
EHR
and
the
proactive
use
of
an
EHR
is
where
strategy,
creativity,
and
technological
savvy
meet.
This
paper
does
attempt
to
tackle
the
myriad
facets
of
EHR
creation
and
adoption;
to
do
so
would
require
volumes
as
an
entire
industry
is
devoted
to
this
pursuit.
Instead,
focus
is
placed
specific
elements
underlying
the
possibility
of
adoption
and
widespread
use
of
such
tools,
with
an
eye
towards
the
overarching
question
of
Page 6
7. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
whether
or
not
EHRs
will
in
fact
impact
the
quality
of
health
care
in
the
United
States.
These
elements
include
design,
interoperability,
and
patient
access
to
data.
The
three
elements
named
are
at
the
heart
of
moving
from
EHRs
being
viewed
as
impediments
to
EHRs
being
seen
as
tools
to
positively
impact
quality
of
care
for
all
patients,
regardless
of
geographic
location
or
health
status.
Justification
for
slow
adoption
rates
are
complex,
involving
cost,
variability
in
EHR
platforms,
culture
within
each
practice,
a
lack
of
incentives,
and
a
lack
of
resources
to
install,
train,
and
maintain
such
systems.
While
the
current
meaningful
use
standards
and
incentives
are
limited
to
Medicare
and
Medicaid
patients,
it
is
important
to
remember
that
providers
for
these
patients
are
situated
within
the
larger
context
of
the
American
health
care
system,
which
at
its
core
is
based
in
a
competitive
business
model.
The
business
of
EHRs
is
a
part
of
this,
with
a
number
of
individual
vendors
vying
to
gain
market
share.
This
has
only
increased
with
the
possibility
of
financial
incentives
from
the
federal
government.
For
evidence
of
this,
one
needs
to
look
no
further
than
the
most
recent
Healthcare
Information
and
Management
Systems
Society
(HIMSS)
conference
that
took
place
in
early
March
of
this
year.
Per
feedback
from
attendees,
there
was
a
surge
in
attendance
from
EMR
and
EHR
vendors,
and
everyone
was
talking
about
meaningful
use
(Dillon,
2010;
Halamka,
2010a).
Page 7
8. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
At
present,
there
is
no
industry
standard
on
core
elements
that
should
be
included
within
an
EMR,
and
many
EHR
providers
are
striving
to
set
the
standard
(or
have
enough
market
share
that
they
are
by
default
the
standard).
This
means
there
is
a
long
list
of
EHR
providers
to
choose
from
–
a
quick
web
search
resulted
in
over
200
distinct
vendors,
each
offering
variations
on
the
general
idea
of
an
EHR
("EMR
and
EHR
Matrix,"
2010;
John,
2006).
For
smaller
offices,
most
of
who
do
not
have
IT
staff
knowledgeable
about
EHRs,
the
task
can
seem
overwhelming
to
the
point
of
being
impossible.
It
is
here
that
design
and
interoperability
must
be
carefully
considered,
as
they
play
a
critical
role
in
the
ability
to
effectively
use
an
EHR.
With
each
company
striving
to
stand
out
from
the
pack,
there
is
a
lack
of
uniformity
within
current
systems.
Each
has
a
unique
user
interface,
meaning
there
is
a
learning
curve
for
providers
switching
from
one
vendor
to
another.
Even
within
vendors,
there
is
variability
of
design,
as
each
individual
implementation
is
generally
customized
based
on
the
purchaser’s
needs.
Thus,
if
a
provider
has
worked
with
a
particular
vendor’s
system
at
Hospital
A,
there
is
no
guarantee
that
the
same
vendor’s
EHR
will
look
similar
if
the
provider
takes
on
a
new
job
at
Hospital
B.
This
can
be
frustrating,
and
a
deterrent
for
adoption
of
the
technology.
A
frequent
concern
voiced
by
physicians
is
that
EHRs
are
designed
to
suit
the
needs
of
administrators,
rather
than
reflecting
the
flow
of
clinical
interactions
(Loomis,
Page 8
9. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
Ries,
Saywell,
&
Thakker,
2002;
McDonald,
1997;
Smith
&
Zastrow,
1994).
As
a
result,
the
user
interface
is
not
well
suited
for
efficient
entry
from
a
clinical
perspective.
Similar
to
the
learning
curve
encountered
when
learning
a
new
system,
the
inability
to
enter
data
in
an
intuitive
fashion
is
seen
largely
as
a
deterrent
and
inefficient
use
of
time,
as
opposed
to
being
helpful
for
patient
care.
Customization,
while
reasonable
from
an
individual
practice
perspective,
also
leads
to
interoperability
challenges,
as
there
is
generally
more
focus
on
tailoring
the
interface
than
forethought
on
core
elements
that
should
be
carried
through
to
other
practices.
What
is
often
neglected
along
the
way
is
attention
put
towards
having
a
patient’s
medical
record
live
anywhere
but
the
place
in
which
it
originates.
Thus,
using
the
same
Hospital
A/Hospital
B/same
vendor
scenario
above,
it
is
possible
that
a
patient
can
change
providers
and
not
have
their
record
travel
electronically
with
them,
even
if
both
systems
utilize
an
EHR
from
the
same
company.
Interoperability
is
not
only
of
concern
for
providers,
but
patients
as
well.
Patients
are
increasingly
interested
in
the
ability
to
access
their
own
medical
information
on
an
on
demand
basis.
Personal
health
records
(PHRs)
are
patient-‐facing
interfaces
designed
to
handle
this
task,
and,
like
EHRs,
come
in
many
different
forms.
Ideally
PHRs
are
a
subset
of
EHR
data,
with
the
capability
of
being
augmented
by
the
patient
and/or
multiple
data
sources
to
create
a
more
complete
health
picture.
Large
organizations
such
as
Kaiser
Permanente
have
invested
heavily
in
this
type
of
Page 9
10. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
tool,
most
recently
partnering
with
Microsoft
to
transfer
data
between
internal
systems
and
Microsoft’s
HealthVault,
and
online
data
platform
(Press
Release,
2008a,
2008b).
Kaiser
is
unique,
however,
in
having
the
resources
and
willingness
to
adopt
this
type
of
approach.
The
ability
of
patients
to
access
their
information
from
EHRs
as
an
element
of
improving
quality
of
care
was
a
topic
covered
within
the
public
comments
on
the
meaningful
use
proposed
definition.
Notably,
Google,
Microsoft,
and
Dossia
(a
consortium
of
Fortune
500
companies
striving
to
aggregate
health
information
into
a
web-‐based
platform)
submitted
joint
testimony
highlighting
the
significance
of
including
PHRs
in
meaningful
use
criteria.
In
their
joint
comments,
they
requested
that
HHS
“clarify
that
patients
have
the
right
to
direct
EPs
and
eligible
hospitals
to
electronically
transmit
such
information
to
a
destination
of
their
choice
and…
require
that
at
least
80%
of
all
unique
patients
seen
by
the
EP
are
provided
timely
electronic
access
to
their
health
information”
(Dossia,
Google,
&
Microsoft,
2010).
Even
with
the
aforementioned
concerns
in
mind,
there
is
a
strong
case
to
be
made
for
the
federal
government’s
efforts
to
define
meaningful
use
and
promote
adoption
of
EHRs
via
the
use
of
financial
incentives.
The
staged
approach
was
established
intentionally
to
allow
time
for
debate
and
development,
and
incentives
are
not
tied
to
quality
improvement
until
the
final
stage.
Still,
without
establishing
core
Page 10
11. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
principles
early
on,
it
is
possible
that
the
efforts
will
fail
to
meet
the
ultimate
goal
of
quality
improvement.
One
of
the
central
principles
that
should
be
established
is
the
creation
of
a
core
set
of
data
points
should
be
determined
for
all
EHRs,
and
structured
such
that
these
data
elements
can
be
transferred
between
all
EHRs
eligible
for
meaningful
use
certification.
These
data
elements
could
include
aspects
such
as
demographics,
allergies,
immunizations,
and
medication
lists.
A
second,
and
more
controversial,
consideration
is
to
allow
EHRs
utilizing
the
use
of
an
open
application
programming
interface
(Open
API)
to
qualify
for
certification
(only
EHRs
certified
by
the
Certification
Commission
for
Health
Information
Technology
(CCHIT)
are
eligible
for
financial
incentives
as
proposed
in
the
stimulus
package).
An
Open
API
entails
a
set
of
technologies
that
enable
websites
to
interact
with
one
another
in
a
more
seamless
fashion.
This
generally
presumes
web-‐based
applications
(in
contrast
to
software
installed
on
a
local
hard
drive),
although
that
is
not
required.
The
benefit
of
such
systems
is
that
it
allows
for
a
vast
and
vibrant
ecosystem
of
smaller
programs
to
develop
and
work
together
to
deliver
a
more
robust
overall
product.
For
example,
a
design
specialist
could
work
on
a
malleable
user
interface,
while
an
engineer
can
implement
the
back
end
data
elements
into
software.
It
would
not
be
necessary
that
these
two
workers
be
with
the
same
company.
Alternatively,
a
small
company
could
create
a
solution
to
store
and
track
Page 11
12. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
data
related
to
a
unique
set
of
conditions,
which
could
then
be
read
within
the
patient’s
EHR.
At
present
this
approach
is
highly
uncommon,
and
there
is
some
debate
over
whether
this
is
due
simply
to
a
lack
of
lobbying
power
(Blankenhorn,
2009;
Douglas,
2009).
However,
with
cloud
computing
becoming
more
prevalent,
and
with
an
increasing
shift
towards
democratizing
application
development
(see
the
success
of
Firefox’s
add-‐ons
as
a
challenger
to
Microsoft
Internet
Explorer
for
an
example
of
this
approach)
it
is
likely
that
certification
will
have
to
address
the
possibility
of
Open
API
in
the
future.
Overall,
the
development
of
meaningful
use
standards
is
a
step
in
the
right
direction.
EHRs,
when
utilized
in
a
systematic
and
purposeful
fashion,
can
have
a
tremendous
impact
on
quality
measures.
At
present
the
possibilities
are
tempered
by
consensus
on
how
to
best
define
meaningful
use,
a
lack
of
core
standards
across
all
EHRs,
and
a
general
hesitancy
within
the
provider
community.
By
coupling
a
transparent
and
open
process
with
financial
incentives,
however,
large-‐scale
change
should
be
seen
over
the
next
five
years.
Tremendous
opportunity
for
quality
improvement
exists
if
people
can
remain
patient
and
persistent
throughout
the
process.
Page 12
13. Jodi
Sperber
Quality
and
Performance
Measurement
in
Health
Care
March
31,
2010
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Performance
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in
Health
Care
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31,
2010
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