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Chapter 18 Partners HealthCare System
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18 Partners HealthCare System
Thomas H. Davenport
Partners HealthCare System (Partners) is the single largest provider of healthcare in the Boston area. It consists of 12 hospitals, with morethan 7,000 affiliated physicians. It has 4 million outpatient visits and 160,000 inpatient admissions a year. Partners is a nonprofitorganization with almost $8 billion in revenues, and it spends more than $1 billion per year on biomedical research. It is a major teachingaffiliate of Harvard Medical School.
Partners is known as a “system,” but it maintains substantial autonomy at each of its member hospitals. While some information systems(the electronic medical record, for example) are standardized across Partners, other systems and data, such as patient scheduling, arespecific to particular hospitals. Analytical activities also take place both at the centralized Partners level and at individual hospitals such asMassachusetts General Hospital (MGH) and Brigham and Women’s Hospital (usually described as “the Brigham”). In this chapter, bothcentralized and hospital-specific analytical resources are described. The focus for hospital-specific analytics is the two major teachinghospitals of Partners—MGH and the Brigham—although other Partners hospitals also have their own analytical capabilities and systems.
Centralized Data and Systems at Partners
The basis of any hospital’s clinical information systems is the clinical data repository, which contains information on all patients, theirconditions, and the treatments they have received. The inpatient clinical data repository for Partners was initially implemented at theBrigham during the 1980s. Richard Nesson, the Brigham and Women’s CEO, and John Glaser, the hospital’s chief information officer,initiated an outpatient electronic medical record (EMR) at the Brigham in 1989.1 This EMR contributed outpatient data to the clinical datarepository. The hospital was one of the first to embark on an EMR, though MGH had begun to develop one of the first full-function EMRs asearly as 1976.
A clinical data repository provides the basic data about patients. Glaser and Nesson came to agree that in addition to a repository and anoutpatient EMR, the Brigham—and Partners after 1994, when Glaser became its first CIO—needed facilities for doctors to input onlineorders for drugs, tests, and other treatments. Online ordering (called CPOE, or Computerized Provider Order Entry) would not only solvethe time-honored problem of interpreting poor physician handwriting, but could also, if endowed with a bit of intelligence, check whether aparticular order made sense or not for a particular patient. Did a prescribed drug comply with best-known medical practice, and did thepatient have any adverse reactions in the past to it? Had the same test been prescribed six times before with no apparen ...
9/12/2018 Print
https://content.ashford.edu/print/McNeill.2947.17.1?sections=ch18,ch19,ch20,ch21&content=content&clientToken=3e86a398-8c91-136b-ab99-55495… 1/16
18 Partners HealthCare System
Thomas H. Davenport
Partners HealthCare System (Partners) is the single largest provider of healthcare in the Boston area. It consists of 12 hospitals, with more than 7,000
af�iliated physicians. It has 4 million outpatient visits and 160,000 inpatient admissions a year. Partners is a nonpro�it organization with almost $8
billion in revenues, and it spends more than $1 billion per year on biomedical research. It is a major teaching af�iliate of Harvard Medical School.
Partners is known as a “system,” but it maintains substantial autonomy at each of its member hospitals. While some information systems (the
electronic medical record, for example) are standardized across Partners, other systems and data, such as patient scheduling, are speci�ic to particular
hospitals. Analytical activities also take place both at the centralized Partners level and at individual hospitals such as Massachusetts General Hospital
(MGH) and Brigham and Women’s Hospital (usually described as “the Brigham”). In this chapter, both centralized and hospital-speci�ic analytical
resources are described. The focus for hospital-speci�ic analytics is the two major teaching hospitals of Partners—MGH and the Brigham—although
other Partners hospitals also have their own analytical capabilities and systems.
Centralized Data and Systems at Partners
The basis of any hospital’s clinical information systems is the clinical data repository, which contains information on all patients, their conditions, and
the treatments they have received. The inpatient clinical data repository for Partners was initially implemented at the Brigham during the 1980s.
Richard Nesson, the Brigham and Women’s CEO, and John Glaser, the hospital’s chief information of�icer, initiated an outpatient electronic medical
record (EMR) at the Brigham in 1989.1 (http://content.thuzelearning.com/books/McNeill.2947.17.1/sections/ch18#ch18end01) This EMR contributed outpatient data to the
clinical data repository. The hospital was one of the �irst to embark on an EMR, though MGH had begun to develop one of the �irst full-function EMRs as
early as 1976.
A clinical data repository provides the basic data about patients. Glaser and Nesson came to agree that in addition to a repository and an outpatient
EMR, the Brigham—and Partners after 1994, when Glaser became its �irst CIO—needed facilities for doctors to input online orders for drugs, tests, and
other treatments. Online ordering (called CPOE, or Computerized Provider Order Entry) would not only solve the time-honored problem of
interpreting poor physician handwriting, but could also, if endowed with a bit of intelligence, check whether a particular order made sense or not for a
particular patient. Did a prescribed drug comply with best-known medical practice, and did the pa.
Remote Patient Monitoring System at Mayo ClinicPeachy Essay
The Remote Patient Monitoring (RPM) system at Mayo Clinic allows doctors to monitor patients' health from a distance. It involves collecting biometric data from patients through mobile devices and transmitting it to medical practitioners. Mayo Clinic developed its RPM system to address issues like rising patient admissions, high emergency room visits, and the need to improve access to specialty care. The system is managed by the Center for Connected Care and involves training for medical staff. Strict security and privacy measures protect patient data collected by the RPM system.
Pg2 Beginning in 1991, the IOM (which stands for the Institute o.docxrandymartin91030
Pg2 Beginning in 1991, the IOM (which stands for the Institute of Medicine of the National Academies) sponsored studies and created reports that led the way toward the concepts we have in place today for electronic health records. Originally, the IOM called them computer-based patient records.1 During their evolution, the EHR have had many other names, including electronic medical records, computerized medical records, longitudinal patient records, and electronic charts. All of these names referred to essentially the same thing, which in 2003, the IOM renamed as the electronic health records, or EHR.
Note: EHR
The acronym EHR is commonly used as shorthand for Electronic Health Records, and will be used in the remainder of this book.
Institute of Medicine (IOM)
The IOM report2 put forth a set of eight core functions that an EHR should be capable of performing:
Health information and data
This function provides a defined data set that includes such items as medical and nursing diagnoses, a medication list, allergies, demographics, clinical narratives, and laboratory test results. Further, it provides improved access to information needed by care providers when they need it.
Result management
Computerized results can be accessed more easily (than paper reports) by the provider at the time and place they are needed.
· Reduced lag time allows for quicker recognition and treatment of medical problems.
· The automated display of previous test results makes it possible to reduce redundant and additional testing.
· Having electronic results can allow for better interpretation and for easier detection of abnormalities, thereby ensuring appropriate follow-up.
· Access to electronic consults and patient consents can establish critical links and improve care coordination among multiple providers, as well as between provider and patient
Order management
Computerized provider order entry (CPOE) systems can improve workflow processes by eliminating lost orders and ambiguities caused by illegible handwriting, generating related orders automatically, monitoring for duplicate orders, and reducing the time required to fill orders.
· CPOE systems for medications reduce the number of errors in medication dose and frequency, drug allergies, and drug–drug interactions.
· The use of CPOE, in conjunction with an EHR, also improves clinician productivity.
Decision Support
Computerized decision support systems include prevention, prescribing of drugs, diagnosis and management, and detection of adverse events and disease outbreaks.
· Computer reminders and prompts improve preventive practices in areas such as vaccinations, breast cancer screening, colorectal screening, and cardiovascular risk reduction.
Electronic communication and connectivity
Electronic communication among care partners can enhance patient safety and quality of care, especially for patients who have multiple providers in multiple settings that must coordinate care plans.
· Electronic co.
The New Focus on Quality and OutcomesIntroductionIn 1999, the .docxoreo10
The New Focus on Quality and Outcomes
Introduction
In 1999, the Institute of Medicine (IOM) published a groundbreaking analysis of the impact of medical errors on the health care delivery system and the patients it serves. The analysis, published as "To Err is Human: Building a Safer Healthcare System," concluded that medical errors resulted in up to 98,000 patient deaths in American hospitals every year. This report hit the national press and participants in the health care system and the political system with the force of a large bomb. Since that time, hospitals and other health care entities have refocused their attention on quality, errors, and patient safety in an unprecedented way, urged on by public outcry and by federal and state efforts to compel improvements in the health care system. Such entities as the Institute for Healthcare Improvement (www.ihi.org) the National Quality Forum (www.qualityforum.org), and the Institute of Medicine (www.iom.edu) have all emerged as champions of quality and safety initiatives, offering training, resources, access to best practices, and data collection strategies to move the cause of quality and safety for patients forward.
History
The IOM report had a huge impact on the discussion of quality and safety in the health care field. Aspects of quality care have always been present in hospitals, typically focused around the quality assurance or quality management departments. They historically collected data on department indicators and monitored them as part of accreditation. However, departmental data was typically focused on operational performance in the departments in question, and not a great deal was collected on issues of medical errors and near-misses. The litigious legal climate caused most hospitals to fear collecting and sharing data that could potentially be used against them in a legal action. However, the IOM report caused a national demand to know what health care institutions were doing to protect their patients from injury caused by errors. A climate of increased transparency has begun to emerge, although it is still a very long way from the concept of full openness on standardized reporting of indicators. The Centers for Medicare and Medicaid Services (CMS) weighed in with publication of their never-events, as explored further below.
Finally there has been an increased push for public reporting of data on individual hospital performance on selected indicators. While some progress has been made, there is a large range of indicators that is not yet publically reported, and medical errors are not publically reported at all at this point, although those with great potential to cause harm must be reported to their relevant state licensing agency.
What Is Happening Now
Out of all this push has come an increasing focus on patient safety as a critical aspect of health care quality. Hospitals and other health care institutions are experimenting with the creation of cultures of quality, wherein ...
This document discusses pharmacy informatics, which encompasses healthcare technologies that improve medication safety and outcomes. It describes how informatics pharmacists use information systems and their medication expertise to enhance patient care. Current technologies like CPOE, CDSS, and bar coding are reviewed. The document also addresses challenges like alert fatigue, nearly universal order review, and the need for informatics education and training. Overall it provides an overview of the field of pharmacy informatics and its goal of using technology to improve the medication use process from prescribing to patient outcomes.
Post marketing studies of drug effects must then generally include at least 10,000 exposed persons in a cohort study, or enroll diseased patients from a population of equivalent size for a case–control study. A study of this size would be 95% certain of observing at least one case of any adverse effect that occurs with an incidence of 3 per 10 000 or greater (see Chapter 3). However, studies this large are expensive and difficult to perform. Yet, these studies often need to be conducted quickly, to address acute and serious regulatory, commercial, and/or public health crises. For all of these reasons, the past two decades have seen a growing use of computerized databases containing medical care data, so called “automated databases,” as potential data sources for pharmacoepidemiology studies.
- Home-based medication therapy management (MTM) services were integrated into a large urban health system between September 2012 and December 2013. A pharmacist provided 74 home visits to 53 patients.
- Most referrals (66%) came from the internal medicine clinic, with about half from physicians and 23% from pharmacists. The top reasons for referral were nonadherence, transportation barriers, and the need for medication reconciliation with home care nurses.
- On average, patients had 3 medication-related problems identified during the home visits. The most common problem was non-compliance, affecting 40% of patients. Home-based MTM allowed for direct assessment of factors influencing medication use and improved care coordination.
9/12/2018 Print
https://content.ashford.edu/print/McNeill.2947.17.1?sections=ch18,ch19,ch20,ch21&content=content&clientToken=3e86a398-8c91-136b-ab99-55495… 1/16
18 Partners HealthCare System
Thomas H. Davenport
Partners HealthCare System (Partners) is the single largest provider of healthcare in the Boston area. It consists of 12 hospitals, with more than 7,000
af�iliated physicians. It has 4 million outpatient visits and 160,000 inpatient admissions a year. Partners is a nonpro�it organization with almost $8
billion in revenues, and it spends more than $1 billion per year on biomedical research. It is a major teaching af�iliate of Harvard Medical School.
Partners is known as a “system,” but it maintains substantial autonomy at each of its member hospitals. While some information systems (the
electronic medical record, for example) are standardized across Partners, other systems and data, such as patient scheduling, are speci�ic to particular
hospitals. Analytical activities also take place both at the centralized Partners level and at individual hospitals such as Massachusetts General Hospital
(MGH) and Brigham and Women’s Hospital (usually described as “the Brigham”). In this chapter, both centralized and hospital-speci�ic analytical
resources are described. The focus for hospital-speci�ic analytics is the two major teaching hospitals of Partners—MGH and the Brigham—although
other Partners hospitals also have their own analytical capabilities and systems.
Centralized Data and Systems at Partners
The basis of any hospital’s clinical information systems is the clinical data repository, which contains information on all patients, their conditions, and
the treatments they have received. The inpatient clinical data repository for Partners was initially implemented at the Brigham during the 1980s.
Richard Nesson, the Brigham and Women’s CEO, and John Glaser, the hospital’s chief information of�icer, initiated an outpatient electronic medical
record (EMR) at the Brigham in 1989.1 (http://content.thuzelearning.com/books/McNeill.2947.17.1/sections/ch18#ch18end01) This EMR contributed outpatient data to the
clinical data repository. The hospital was one of the �irst to embark on an EMR, though MGH had begun to develop one of the �irst full-function EMRs as
early as 1976.
A clinical data repository provides the basic data about patients. Glaser and Nesson came to agree that in addition to a repository and an outpatient
EMR, the Brigham—and Partners after 1994, when Glaser became its �irst CIO—needed facilities for doctors to input online orders for drugs, tests, and
other treatments. Online ordering (called CPOE, or Computerized Provider Order Entry) would not only solve the time-honored problem of
interpreting poor physician handwriting, but could also, if endowed with a bit of intelligence, check whether a particular order made sense or not for a
particular patient. Did a prescribed drug comply with best-known medical practice, and did the pa.
Remote Patient Monitoring System at Mayo ClinicPeachy Essay
The Remote Patient Monitoring (RPM) system at Mayo Clinic allows doctors to monitor patients' health from a distance. It involves collecting biometric data from patients through mobile devices and transmitting it to medical practitioners. Mayo Clinic developed its RPM system to address issues like rising patient admissions, high emergency room visits, and the need to improve access to specialty care. The system is managed by the Center for Connected Care and involves training for medical staff. Strict security and privacy measures protect patient data collected by the RPM system.
Pg2 Beginning in 1991, the IOM (which stands for the Institute o.docxrandymartin91030
Pg2 Beginning in 1991, the IOM (which stands for the Institute of Medicine of the National Academies) sponsored studies and created reports that led the way toward the concepts we have in place today for electronic health records. Originally, the IOM called them computer-based patient records.1 During their evolution, the EHR have had many other names, including electronic medical records, computerized medical records, longitudinal patient records, and electronic charts. All of these names referred to essentially the same thing, which in 2003, the IOM renamed as the electronic health records, or EHR.
Note: EHR
The acronym EHR is commonly used as shorthand for Electronic Health Records, and will be used in the remainder of this book.
Institute of Medicine (IOM)
The IOM report2 put forth a set of eight core functions that an EHR should be capable of performing:
Health information and data
This function provides a defined data set that includes such items as medical and nursing diagnoses, a medication list, allergies, demographics, clinical narratives, and laboratory test results. Further, it provides improved access to information needed by care providers when they need it.
Result management
Computerized results can be accessed more easily (than paper reports) by the provider at the time and place they are needed.
· Reduced lag time allows for quicker recognition and treatment of medical problems.
· The automated display of previous test results makes it possible to reduce redundant and additional testing.
· Having electronic results can allow for better interpretation and for easier detection of abnormalities, thereby ensuring appropriate follow-up.
· Access to electronic consults and patient consents can establish critical links and improve care coordination among multiple providers, as well as between provider and patient
Order management
Computerized provider order entry (CPOE) systems can improve workflow processes by eliminating lost orders and ambiguities caused by illegible handwriting, generating related orders automatically, monitoring for duplicate orders, and reducing the time required to fill orders.
· CPOE systems for medications reduce the number of errors in medication dose and frequency, drug allergies, and drug–drug interactions.
· The use of CPOE, in conjunction with an EHR, also improves clinician productivity.
Decision Support
Computerized decision support systems include prevention, prescribing of drugs, diagnosis and management, and detection of adverse events and disease outbreaks.
· Computer reminders and prompts improve preventive practices in areas such as vaccinations, breast cancer screening, colorectal screening, and cardiovascular risk reduction.
Electronic communication and connectivity
Electronic communication among care partners can enhance patient safety and quality of care, especially for patients who have multiple providers in multiple settings that must coordinate care plans.
· Electronic co.
The New Focus on Quality and OutcomesIntroductionIn 1999, the .docxoreo10
The New Focus on Quality and Outcomes
Introduction
In 1999, the Institute of Medicine (IOM) published a groundbreaking analysis of the impact of medical errors on the health care delivery system and the patients it serves. The analysis, published as "To Err is Human: Building a Safer Healthcare System," concluded that medical errors resulted in up to 98,000 patient deaths in American hospitals every year. This report hit the national press and participants in the health care system and the political system with the force of a large bomb. Since that time, hospitals and other health care entities have refocused their attention on quality, errors, and patient safety in an unprecedented way, urged on by public outcry and by federal and state efforts to compel improvements in the health care system. Such entities as the Institute for Healthcare Improvement (www.ihi.org) the National Quality Forum (www.qualityforum.org), and the Institute of Medicine (www.iom.edu) have all emerged as champions of quality and safety initiatives, offering training, resources, access to best practices, and data collection strategies to move the cause of quality and safety for patients forward.
History
The IOM report had a huge impact on the discussion of quality and safety in the health care field. Aspects of quality care have always been present in hospitals, typically focused around the quality assurance or quality management departments. They historically collected data on department indicators and monitored them as part of accreditation. However, departmental data was typically focused on operational performance in the departments in question, and not a great deal was collected on issues of medical errors and near-misses. The litigious legal climate caused most hospitals to fear collecting and sharing data that could potentially be used against them in a legal action. However, the IOM report caused a national demand to know what health care institutions were doing to protect their patients from injury caused by errors. A climate of increased transparency has begun to emerge, although it is still a very long way from the concept of full openness on standardized reporting of indicators. The Centers for Medicare and Medicaid Services (CMS) weighed in with publication of their never-events, as explored further below.
Finally there has been an increased push for public reporting of data on individual hospital performance on selected indicators. While some progress has been made, there is a large range of indicators that is not yet publically reported, and medical errors are not publically reported at all at this point, although those with great potential to cause harm must be reported to their relevant state licensing agency.
What Is Happening Now
Out of all this push has come an increasing focus on patient safety as a critical aspect of health care quality. Hospitals and other health care institutions are experimenting with the creation of cultures of quality, wherein ...
This document discusses pharmacy informatics, which encompasses healthcare technologies that improve medication safety and outcomes. It describes how informatics pharmacists use information systems and their medication expertise to enhance patient care. Current technologies like CPOE, CDSS, and bar coding are reviewed. The document also addresses challenges like alert fatigue, nearly universal order review, and the need for informatics education and training. Overall it provides an overview of the field of pharmacy informatics and its goal of using technology to improve the medication use process from prescribing to patient outcomes.
Post marketing studies of drug effects must then generally include at least 10,000 exposed persons in a cohort study, or enroll diseased patients from a population of equivalent size for a case–control study. A study of this size would be 95% certain of observing at least one case of any adverse effect that occurs with an incidence of 3 per 10 000 or greater (see Chapter 3). However, studies this large are expensive and difficult to perform. Yet, these studies often need to be conducted quickly, to address acute and serious regulatory, commercial, and/or public health crises. For all of these reasons, the past two decades have seen a growing use of computerized databases containing medical care data, so called “automated databases,” as potential data sources for pharmacoepidemiology studies.
- Home-based medication therapy management (MTM) services were integrated into a large urban health system between September 2012 and December 2013. A pharmacist provided 74 home visits to 53 patients.
- Most referrals (66%) came from the internal medicine clinic, with about half from physicians and 23% from pharmacists. The top reasons for referral were nonadherence, transportation barriers, and the need for medication reconciliation with home care nurses.
- On average, patients had 3 medication-related problems identified during the home visits. The most common problem was non-compliance, affecting 40% of patients. Home-based MTM allowed for direct assessment of factors influencing medication use and improved care coordination.
Pharmaceutical companies have been slow to adopt digital technologies and engage directly with consumers, unlike other industries that have transformed to business-to-consumer models. However, the healthcare system is shifting towards value-based care and consumers are taking a more active role in their healthcare decisions by researching options online. To remain competitive in this new environment and understand consumer needs, pharmaceutical companies will need to leverage real-world data from multiple sources, including electronic health records, social media, claims data, and patient-reported data. Partnerships that allow for integrated analysis of these diverse data sources will help pharmaceutical companies develop effective segmenting and targeting strategies aimed at consumers.
Please follow instructions carefully. Thank you so kindly. Ass.docxmattjtoni51554
The document discusses key changes in quality management and patient safety in the healthcare industry. It outlines several major developments that have advanced this area, including a 1999 IOM report that found medical errors resulted in up to 98,000 deaths per year. This prompted increased focus on quality, errors, and transparency from hospitals and regulators. It also discusses ongoing challenges like the need for standardized quality measures and electronic medical records to further improve outcomes.
The document discusses personal health records (PHRs) and examines their types, benefits, and challenges through various case studies and examples. It summarizes a case study of HealthSpace, a PHR implemented in the UK, which had low adoption rates due to unsuitable design, flawed concepts, and impractical implementation. Different types of PHRs are described, including institution-centered, standalone, self-managed, and linked/tethered records, with linked PHRs seen as most beneficial when integrated with electronic health records. Potential benefits of PHRs include improved disease management, prevention, self-management, and patient-provider communication, though privacy and consent remain ethical considerations.
Computer Technology’S Effect On The Practice Of Nursing EssayJessica Deakin
Computer technology has significantly impacted the practice of nursing. At one hospital, nurses use electronic documentation to record patient information and chart vital signs, medications, and other care. Computerized systems integrate various functions like lab results, prescribing medications, and patient tracking. While this hospital currently uses paper charting, it plans to implement online computerized documentation and physician order entry within a year to further improve patient care.
This document provides a summary of recent literature on electronic health records (EHRs), personal health records (PHRs), and their role in health care reform. It discusses definitions of EHRs and PHRs, consumer acceptance and expectations of PHRs, strategies for implementing PHRs, accuracy of medical record documentation, and implications for using information therapy to address issues like data quality and patient engagement.
64 journal of law, medicine & ethicsDreams and Nightmare.docxevonnehoggarth79783
64 journal of law, medicine & ethics
Dreams and
Nightmares:
Practical and
Ethical Issues
for Patients and
Physicians Using
Personal Health
Records
Matthew Wynia and Kyle Dunn
Introduction and Definitions
The term “Electronic Health Records” (EHR) means
something different to each of the stakeholders in
health care, but it always seems to carry a degree of
emotional baggage. Increasingly, EHRs are advert-
ized as a nearly unmitigated good that will transform
medical care, improve safety and efficiency, allow
better patient engagement, and open the door to an
era of cheap, effective, timely, and patient-centered
care.1 Indeed, for some EHR proponents the ben-
efits of adopting them are so obvious that adoption
has become an end in itself.2 But for others — and
especially for a number of skeptical practitioners and
patients — EHR is a code word that portends the cor-
porate transformation of health care delivery, the loss
of patient privacy, the demand that patients bear more
responsibility in health care, and the unreflective take-
over of the health care system by people who do not
understand medical care or how health care relation-
ships unfold.3
For our purposes, we will consider EHRs impar-
tially, as a set of tools that can be used for a variety of
purposes. We define EHRs broadly as any electronic
means of storing and transferring health-related
information. We exclude from this definition the use
of the telephone and fax, arguably precursors to the
electronic means of data exchange now available. Like
face-to-face and paper-based interactions, the tele-
phone and fax are generally limited to two people.
Breaches of phone line security, while possible and
perhaps even frequent, are unlikely to affect thou-
sands of people at once.
In this paper, we examine the development of a new
set of EHR tools, Personal Health Records (PHRs).
PHRs may be variously defined (Table I) and have sev-
eral potential functional and payment models (Table
II), but the general aim of all PHRs is to increase
patients’ access to and sense of ownership over their
health care information. According to the Markle
Foundation, the advent of PHRs “represents a transi-
tion from a patient record that is physician-centered
to one that is patient-centered, prospective, interac-
Matthew Wynia, M.D., M.P.H., is the Director of the In-
stitute for Ethics at the American Medical Association and a
Clinical Assistant Professor at the University of Chicago. He
received his M.D. from the Oregon Health and Science Univer-
sity in Portland, Oregon and his M.P.H. from Harvard Uni-
versity School of Public Health in Boston, MA. Kyle Dunn,
M.H.S., was a Research Assistant at the Institute for Ethics
at the American Medical Association and is now a Ph.D. can-
didate in the Department of Health Policy and Management
at the Johns Hopkins Bloomberg School of Public Health. He
received a B.S. in Molecular, Cellular and Developmental Bi-
ology .
An electronic health record is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings.
This document summarizes research on the effects of computerized physician order entry (CPOE) systems on patient outcomes. While CPOE systems aim to reduce errors, some studies have found mixed or even negative results. Two potential issues are automation bias, where doctors over-rely on the system, and reduced situational awareness. The proposed study will examine whether CPOE implementation led to changes in adverse drug events, medication errors, and malpractice suits using medical records. It will also test whether automation bias and situational awareness, as measured in a simulation, affect performance when using CPOE. The study hypothesizes CPOE increased some errors due to new cognitive biases and that experience level may interact with system
Healthcare Communications Study Among Physicians: Medical Monitor 2013Joshua Spiegel
Where do physicians get their information? What’s the best way to reach these important healthcare stakeholders? Find out with our Physician Healthcare Communications report.
Note This assignment is for academic research pro only Thank y.docxgabriellabre8fr
Note: This assignment is for
academic research pro
only Thank you.
Due by 8 Jul @ 8 am
Please address a brief 1 page discussion citing the references below including references page in APA format.
Note: Please address it from a nursing view
Patient-Centered Care
When electronic health records (EHRs) first entered the market, their primary focus was to collect and analyze patient information within health care settings. As technological capabilities grew, so did the interest in making these records available to patients. In addition, many health care professionals saw benefits in allowing the patient to enter his or her own health data into EHR platforms. Though many patients are already utilizing personal health records (PHRs) to manage and track their own health, some believe that an integrated system would provide a better, more comprehensive picture of a patient’s health history.
As a result, many EHR platforms are now equipped with a PHR tool. This PHR tool allows patients to enter health information as they would in a stand-alone PHR system. In addition, web-based portals within the EHR allow patients to access information entered by their physicians and health care providers.
Like many emerging trends and technologies, there is much discussion about the potential benefits and challenges of this type of integrated system. While many health care professionals are excited about the empowerment provided to patients, others express significant concerns about access, security, ethics, and other implications.
In this Discussion, you explore how integrating PHRs into EHR platforms could impact you and your patients.
To prepare
:
·
Review the media
Patient-Centered Technologies
, and reflect upon Dr. Simpson’
s
statements about the ownership of patient data.
SEE ATTACHMENT
·
Review the article, “Dreams and Nightmares: Practice and Ethical Issues for Patients and Physicians Using Personal Health Records” found in this week’s Learning Resources. Consider how PHR capabilities can be integrated into EHR platforms.
·
Examine the “dreams” and the “nightmares” the authors associate with this type of integrated health record. Select one benefit or one challenge of integrating PHRs into EHR platforms. Then, consider its potential impact on health care providers and patients. Why is this considered to be a benefit or challenge for health care professionals and patients?
References
Crilly, J. F., Keefe, R. H., & Volpe, F. (2011). Use of electronic technologies to promote community and personal health for individuals unconnected to health care systems.
American Journal of Public Health
,
101
(7), 1163–1167.
The authors of this article describe technologies that have been used to increase access to health care for underserved populations. The authors present strategies, benefits, and challenges of addressing this issue, and they provide examples of successful programs.
Laureate Education, Inc. (Executive Producer). (2012f).
Electroni.
The document discusses computer-based patient records (CPRs). It defines CPRs and compares them to electronic medical records (EMRs). CPRs contain complete patient data across providers and are designed to support users. EMRs focus on a single provider and usually stay within a practice. The document also outlines characteristics of CPRs like accountability, flexibility, interoperability and comprehensiveness. Benefits include coordinated care, reduced errors and costs. Legal issues involve privacy and patients' rights to access their health records.
Robeznieks, A. (2013). What doctor shortage Modern Healthcare, 43.docxSUBHI7
While some experts warn of a physician shortage in the coming years, others argue that changes to healthcare delivery models can reduce the need for physicians. New models like patient-centered medical homes and accountable care organizations optimize the roles of different providers, allowing nurses, nurse practitioners, and physician assistants to take on tasks previously done by physicians. This reallocation of responsibilities and use of technology may eliminate the projected physician shortage. Several healthcare organizations have implemented these new models successfully.
This document summarizes the evolution and current state of emergency medicine clinical pharmacists internationally. It describes how their role has expanded from medication distribution to active clinical roles on multidisciplinary teams. Studies show emergency medicine pharmacists can reduce medication errors, mortality, readmissions, and improve time to appropriate treatments. While initially confined to North America, their benefits are now reported internationally. More evidence is still needed on reducing adverse drug events, but existing data shows emergency medicine pharmacists improve patient outcomes and reduce costs.
1. Pharmacists are well-positioned to help healthcare organizations transition to a patient-centered medical home model focused on quality, efficiency, and outcomes over fee-for-service.
2. CHI Franciscan Health implemented a polypharmacy initiative and patient-centered medical home model with pharmacists playing a key role in identifying high-risk patients, optimizing complex medication regimens, and building trust with providers.
3. Starting small by saying yes to all opportunities, prioritizing clinics with the most need and building trust, the pharmacists were able to expand their roles and impact more patients with limited resources.
Team Sol2 01 Health Care Informatics Power PointMessner Angie
The document discusses clinical information systems and their components. It provides an overview of electronic health records and describes key parts of a clinical information system including health information, order entry, decision support, and clinical documentation. It also discusses clinical decision making systems and their importance in reducing variation, costs, and improving diagnosis. Safety, education and costs related to clinical information systems are also evaluated.
The Mobile Personal Health Record_2010Bianca Chung
The document discusses the potential for mobile personal health records (mPHRs) to help manage healthcare costs by engaging consumers to better manage their health. mPHRs combine personal health records with mobile devices to allow consumers to monitor health data, receive reminders and alerts, and communicate with providers. While pilot programs show mPHRs can reduce utilization, there are barriers to widespread adoption like lack of health data integration and standards, low consumer demand and privacy concerns. The document outlines factors that could accelerate mPHR use, such as greater electronic health record adoption, data standards, and incentives for providers and consumers.
The document discusses the development and importance of Nursing Minimum Data Sets (NMDS) systems. It notes that the identification of NMDS in the 1980s spurred the development of similar nursing data sets around the world. The chapter provides a historical overview and synthesis of NMDS systems, and discusses how they can increase nursing data and information capacity to support knowledge building for the nursing discipline and profession. This data can help inform the development of electronic health record systems.
Write a 2 Paragraph response (with 2-3 sources) to this post offerin.docxlindorffgarrik
Write a 2 Paragraph response (with 2-3 sources) to this post offering additional/alternative ideas regarding opportunities and risks related to the observations shared.
Healthcare system presently is faced with challenges to improving quality of care and controlling costs and according to the Institute of Medicine, electronic health records (EHR) serve as a solution to these challenges (2001). The Health Information Technology for Economic and Clinical Health Act (HITECH) passed by President Barack Obama promotes the adaptation of EHR system by providing health organizations and providers with incentives through Medicare and Medicaid for meaningful utilization of EHR systems (McGonigle&Mastrian, 2017). Technology in nursing has evolved and transformed the way nurses work and continues to grow, along with the role’s nurses play in today’s health care environment (Melissa Wirkus, 2016).For many years the paper chat served as the patient’s primary medical records such as medical histories, medical diagnosis, medications, and other pertinent patient information. In the future, an expected healthcare technology trend in nursing practice will be a significant increase in the use of the Electronic health record (EHR) instead of the traditional paper charting As technology continues to grow so does additional information technology that helps caregivers, engage patients and improve efficiencies and better patient outcomes (Laureate Education, 2018). For example, patients can now have access to their medical health records at their own convenient through online portals and can effectively communicate with their health care provider. In addition, patients are also using social media platforms like Facebook and twitter to get/communicate with others with the same health-related diagnosis.
According to McGonigle & Mastrain “Public health information systems represent a partnership of federal, state, and local public health professionals” (2017). In the present-day majority of health care organizations are embracing the implementation of electronic health records. In the hospital I work, we are making use of the Meditech operating system. Patient medical histories, diagnosis, home medications, and current medications are updated and readily available. During patient’s hospital stay, all health care providers can log in with their personal access codes to document as well as view patients’ labs, patient notes, care plans and so on. More so, one intriguing benefit for the patients is during the patient’s hospital stay and at discharge, patients are educated about our patient portal where they can easily log in to look up their personal medical records.
Potential Risk/ Challenge Associated with data Safety.
A potential risk associated with data and or technology safety is the lack of patient confidentiality. For example, when a nurse who is from a different unit assesses patient medical records they took care of three days before, that is considered a.
Managed Care and IT Impact on Health Care DavidOsunde
Managed care aims to control healthcare costs by establishing relationships between managed care organizations (MCOs), providers, and patients. MCOs use various models like HMOs, PPOs, and IPAs. They employ cost control measures such as restricting provider choice, utilizing gatekeepers, and conducting utilization reviews. While MCOs focus on costs, physicians are concerned this limits care quality. Health information technology (HIT) and electronic health records (EHRs) aim to manage health data, but issues include implementation costs and ensuring privacy and data sharing complies with regulations. Telehealth expands access through technologies like telemedicine and online health information.
Per the text, computers are playing an increasingly important role i.docxodiliagilby
Per the text, computers are playing an increasingly important role in the practice of law. Successful paralegals must be comfortable with using electronic databases and research tools.
Write a two to three (2-3) page paper in which you:
Discuss a paralegal’s ethical obligation to conduct competent electronic research. Provide two (2) examples of the potential consequences of inept electronic research practices.
Determine whether or not traditional reference materials (e.g., State and Federal Reporters, West’s Encyclopedia, etc.) can be as current as electronic resources. Provide two (2) advantages and two (2) disadvantages to using traditional resource materials.
Use at least two (2) quality references.
Note:
Wikipedia and other Websites do not qualify as academic resources.
THIS IS PART 1.
.
Pennsylvania was the leader in sentencing and correctional reform .docxodiliagilby
Pennsylvania was the leader in sentencing and correctional reform in the early history of the United States. Discuss what groups were associated with this reform.
Why did they want the reform?
Examine whether it was successful and if the reform brought forth further changes.
What influences does the system have on the correctional system today?
What influences have changed? Why?
Use the Internet, library, and any other resources available to research your answer. Submit a 4 page paper (double-spaced) to your instructor. Support your reasoning with outside sources. Be sure to reference all sources using APA style.
The following will be the grading criteria for this assignment:
20%:
Discuss what groups were associated with this reform.
10%:
Why did they want the reform?
20%:
Examine whether it was successful and if the reform brought forth further changes.
25%:
What direct influences do you see the Pennsylvania system in the correctional systems used today?
25%:
What influences have changed? Why?
4 pages. APA format. No plagerism. 5 sources referenced throughout the paper. Reference Page and Abstract.
.
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Pharmaceutical companies have been slow to adopt digital technologies and engage directly with consumers, unlike other industries that have transformed to business-to-consumer models. However, the healthcare system is shifting towards value-based care and consumers are taking a more active role in their healthcare decisions by researching options online. To remain competitive in this new environment and understand consumer needs, pharmaceutical companies will need to leverage real-world data from multiple sources, including electronic health records, social media, claims data, and patient-reported data. Partnerships that allow for integrated analysis of these diverse data sources will help pharmaceutical companies develop effective segmenting and targeting strategies aimed at consumers.
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The document discusses key changes in quality management and patient safety in the healthcare industry. It outlines several major developments that have advanced this area, including a 1999 IOM report that found medical errors resulted in up to 98,000 deaths per year. This prompted increased focus on quality, errors, and transparency from hospitals and regulators. It also discusses ongoing challenges like the need for standardized quality measures and electronic medical records to further improve outcomes.
The document discusses personal health records (PHRs) and examines their types, benefits, and challenges through various case studies and examples. It summarizes a case study of HealthSpace, a PHR implemented in the UK, which had low adoption rates due to unsuitable design, flawed concepts, and impractical implementation. Different types of PHRs are described, including institution-centered, standalone, self-managed, and linked/tethered records, with linked PHRs seen as most beneficial when integrated with electronic health records. Potential benefits of PHRs include improved disease management, prevention, self-management, and patient-provider communication, though privacy and consent remain ethical considerations.
Computer Technology’S Effect On The Practice Of Nursing EssayJessica Deakin
Computer technology has significantly impacted the practice of nursing. At one hospital, nurses use electronic documentation to record patient information and chart vital signs, medications, and other care. Computerized systems integrate various functions like lab results, prescribing medications, and patient tracking. While this hospital currently uses paper charting, it plans to implement online computerized documentation and physician order entry within a year to further improve patient care.
This document provides a summary of recent literature on electronic health records (EHRs), personal health records (PHRs), and their role in health care reform. It discusses definitions of EHRs and PHRs, consumer acceptance and expectations of PHRs, strategies for implementing PHRs, accuracy of medical record documentation, and implications for using information therapy to address issues like data quality and patient engagement.
64 journal of law, medicine & ethicsDreams and Nightmare.docxevonnehoggarth79783
64 journal of law, medicine & ethics
Dreams and
Nightmares:
Practical and
Ethical Issues
for Patients and
Physicians Using
Personal Health
Records
Matthew Wynia and Kyle Dunn
Introduction and Definitions
The term “Electronic Health Records” (EHR) means
something different to each of the stakeholders in
health care, but it always seems to carry a degree of
emotional baggage. Increasingly, EHRs are advert-
ized as a nearly unmitigated good that will transform
medical care, improve safety and efficiency, allow
better patient engagement, and open the door to an
era of cheap, effective, timely, and patient-centered
care.1 Indeed, for some EHR proponents the ben-
efits of adopting them are so obvious that adoption
has become an end in itself.2 But for others — and
especially for a number of skeptical practitioners and
patients — EHR is a code word that portends the cor-
porate transformation of health care delivery, the loss
of patient privacy, the demand that patients bear more
responsibility in health care, and the unreflective take-
over of the health care system by people who do not
understand medical care or how health care relation-
ships unfold.3
For our purposes, we will consider EHRs impar-
tially, as a set of tools that can be used for a variety of
purposes. We define EHRs broadly as any electronic
means of storing and transferring health-related
information. We exclude from this definition the use
of the telephone and fax, arguably precursors to the
electronic means of data exchange now available. Like
face-to-face and paper-based interactions, the tele-
phone and fax are generally limited to two people.
Breaches of phone line security, while possible and
perhaps even frequent, are unlikely to affect thou-
sands of people at once.
In this paper, we examine the development of a new
set of EHR tools, Personal Health Records (PHRs).
PHRs may be variously defined (Table I) and have sev-
eral potential functional and payment models (Table
II), but the general aim of all PHRs is to increase
patients’ access to and sense of ownership over their
health care information. According to the Markle
Foundation, the advent of PHRs “represents a transi-
tion from a patient record that is physician-centered
to one that is patient-centered, prospective, interac-
Matthew Wynia, M.D., M.P.H., is the Director of the In-
stitute for Ethics at the American Medical Association and a
Clinical Assistant Professor at the University of Chicago. He
received his M.D. from the Oregon Health and Science Univer-
sity in Portland, Oregon and his M.P.H. from Harvard Uni-
versity School of Public Health in Boston, MA. Kyle Dunn,
M.H.S., was a Research Assistant at the Institute for Ethics
at the American Medical Association and is now a Ph.D. can-
didate in the Department of Health Policy and Management
at the Johns Hopkins Bloomberg School of Public Health. He
received a B.S. in Molecular, Cellular and Developmental Bi-
ology .
An electronic health record is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings.
This document summarizes research on the effects of computerized physician order entry (CPOE) systems on patient outcomes. While CPOE systems aim to reduce errors, some studies have found mixed or even negative results. Two potential issues are automation bias, where doctors over-rely on the system, and reduced situational awareness. The proposed study will examine whether CPOE implementation led to changes in adverse drug events, medication errors, and malpractice suits using medical records. It will also test whether automation bias and situational awareness, as measured in a simulation, affect performance when using CPOE. The study hypothesizes CPOE increased some errors due to new cognitive biases and that experience level may interact with system
Healthcare Communications Study Among Physicians: Medical Monitor 2013Joshua Spiegel
Where do physicians get their information? What’s the best way to reach these important healthcare stakeholders? Find out with our Physician Healthcare Communications report.
Note This assignment is for academic research pro only Thank y.docxgabriellabre8fr
Note: This assignment is for
academic research pro
only Thank you.
Due by 8 Jul @ 8 am
Please address a brief 1 page discussion citing the references below including references page in APA format.
Note: Please address it from a nursing view
Patient-Centered Care
When electronic health records (EHRs) first entered the market, their primary focus was to collect and analyze patient information within health care settings. As technological capabilities grew, so did the interest in making these records available to patients. In addition, many health care professionals saw benefits in allowing the patient to enter his or her own health data into EHR platforms. Though many patients are already utilizing personal health records (PHRs) to manage and track their own health, some believe that an integrated system would provide a better, more comprehensive picture of a patient’s health history.
As a result, many EHR platforms are now equipped with a PHR tool. This PHR tool allows patients to enter health information as they would in a stand-alone PHR system. In addition, web-based portals within the EHR allow patients to access information entered by their physicians and health care providers.
Like many emerging trends and technologies, there is much discussion about the potential benefits and challenges of this type of integrated system. While many health care professionals are excited about the empowerment provided to patients, others express significant concerns about access, security, ethics, and other implications.
In this Discussion, you explore how integrating PHRs into EHR platforms could impact you and your patients.
To prepare
:
·
Review the media
Patient-Centered Technologies
, and reflect upon Dr. Simpson’
s
statements about the ownership of patient data.
SEE ATTACHMENT
·
Review the article, “Dreams and Nightmares: Practice and Ethical Issues for Patients and Physicians Using Personal Health Records” found in this week’s Learning Resources. Consider how PHR capabilities can be integrated into EHR platforms.
·
Examine the “dreams” and the “nightmares” the authors associate with this type of integrated health record. Select one benefit or one challenge of integrating PHRs into EHR platforms. Then, consider its potential impact on health care providers and patients. Why is this considered to be a benefit or challenge for health care professionals and patients?
References
Crilly, J. F., Keefe, R. H., & Volpe, F. (2011). Use of electronic technologies to promote community and personal health for individuals unconnected to health care systems.
American Journal of Public Health
,
101
(7), 1163–1167.
The authors of this article describe technologies that have been used to increase access to health care for underserved populations. The authors present strategies, benefits, and challenges of addressing this issue, and they provide examples of successful programs.
Laureate Education, Inc. (Executive Producer). (2012f).
Electroni.
The document discusses computer-based patient records (CPRs). It defines CPRs and compares them to electronic medical records (EMRs). CPRs contain complete patient data across providers and are designed to support users. EMRs focus on a single provider and usually stay within a practice. The document also outlines characteristics of CPRs like accountability, flexibility, interoperability and comprehensiveness. Benefits include coordinated care, reduced errors and costs. Legal issues involve privacy and patients' rights to access their health records.
Robeznieks, A. (2013). What doctor shortage Modern Healthcare, 43.docxSUBHI7
While some experts warn of a physician shortage in the coming years, others argue that changes to healthcare delivery models can reduce the need for physicians. New models like patient-centered medical homes and accountable care organizations optimize the roles of different providers, allowing nurses, nurse practitioners, and physician assistants to take on tasks previously done by physicians. This reallocation of responsibilities and use of technology may eliminate the projected physician shortage. Several healthcare organizations have implemented these new models successfully.
This document summarizes the evolution and current state of emergency medicine clinical pharmacists internationally. It describes how their role has expanded from medication distribution to active clinical roles on multidisciplinary teams. Studies show emergency medicine pharmacists can reduce medication errors, mortality, readmissions, and improve time to appropriate treatments. While initially confined to North America, their benefits are now reported internationally. More evidence is still needed on reducing adverse drug events, but existing data shows emergency medicine pharmacists improve patient outcomes and reduce costs.
1. Pharmacists are well-positioned to help healthcare organizations transition to a patient-centered medical home model focused on quality, efficiency, and outcomes over fee-for-service.
2. CHI Franciscan Health implemented a polypharmacy initiative and patient-centered medical home model with pharmacists playing a key role in identifying high-risk patients, optimizing complex medication regimens, and building trust with providers.
3. Starting small by saying yes to all opportunities, prioritizing clinics with the most need and building trust, the pharmacists were able to expand their roles and impact more patients with limited resources.
Team Sol2 01 Health Care Informatics Power PointMessner Angie
The document discusses clinical information systems and their components. It provides an overview of electronic health records and describes key parts of a clinical information system including health information, order entry, decision support, and clinical documentation. It also discusses clinical decision making systems and their importance in reducing variation, costs, and improving diagnosis. Safety, education and costs related to clinical information systems are also evaluated.
The Mobile Personal Health Record_2010Bianca Chung
The document discusses the potential for mobile personal health records (mPHRs) to help manage healthcare costs by engaging consumers to better manage their health. mPHRs combine personal health records with mobile devices to allow consumers to monitor health data, receive reminders and alerts, and communicate with providers. While pilot programs show mPHRs can reduce utilization, there are barriers to widespread adoption like lack of health data integration and standards, low consumer demand and privacy concerns. The document outlines factors that could accelerate mPHR use, such as greater electronic health record adoption, data standards, and incentives for providers and consumers.
The document discusses the development and importance of Nursing Minimum Data Sets (NMDS) systems. It notes that the identification of NMDS in the 1980s spurred the development of similar nursing data sets around the world. The chapter provides a historical overview and synthesis of NMDS systems, and discusses how they can increase nursing data and information capacity to support knowledge building for the nursing discipline and profession. This data can help inform the development of electronic health record systems.
Write a 2 Paragraph response (with 2-3 sources) to this post offerin.docxlindorffgarrik
Write a 2 Paragraph response (with 2-3 sources) to this post offering additional/alternative ideas regarding opportunities and risks related to the observations shared.
Healthcare system presently is faced with challenges to improving quality of care and controlling costs and according to the Institute of Medicine, electronic health records (EHR) serve as a solution to these challenges (2001). The Health Information Technology for Economic and Clinical Health Act (HITECH) passed by President Barack Obama promotes the adaptation of EHR system by providing health organizations and providers with incentives through Medicare and Medicaid for meaningful utilization of EHR systems (McGonigle&Mastrian, 2017). Technology in nursing has evolved and transformed the way nurses work and continues to grow, along with the role’s nurses play in today’s health care environment (Melissa Wirkus, 2016).For many years the paper chat served as the patient’s primary medical records such as medical histories, medical diagnosis, medications, and other pertinent patient information. In the future, an expected healthcare technology trend in nursing practice will be a significant increase in the use of the Electronic health record (EHR) instead of the traditional paper charting As technology continues to grow so does additional information technology that helps caregivers, engage patients and improve efficiencies and better patient outcomes (Laureate Education, 2018). For example, patients can now have access to their medical health records at their own convenient through online portals and can effectively communicate with their health care provider. In addition, patients are also using social media platforms like Facebook and twitter to get/communicate with others with the same health-related diagnosis.
According to McGonigle & Mastrain “Public health information systems represent a partnership of federal, state, and local public health professionals” (2017). In the present-day majority of health care organizations are embracing the implementation of electronic health records. In the hospital I work, we are making use of the Meditech operating system. Patient medical histories, diagnosis, home medications, and current medications are updated and readily available. During patient’s hospital stay, all health care providers can log in with their personal access codes to document as well as view patients’ labs, patient notes, care plans and so on. More so, one intriguing benefit for the patients is during the patient’s hospital stay and at discharge, patients are educated about our patient portal where they can easily log in to look up their personal medical records.
Potential Risk/ Challenge Associated with data Safety.
A potential risk associated with data and or technology safety is the lack of patient confidentiality. For example, when a nurse who is from a different unit assesses patient medical records they took care of three days before, that is considered a.
Managed Care and IT Impact on Health Care DavidOsunde
Managed care aims to control healthcare costs by establishing relationships between managed care organizations (MCOs), providers, and patients. MCOs use various models like HMOs, PPOs, and IPAs. They employ cost control measures such as restricting provider choice, utilizing gatekeepers, and conducting utilization reviews. While MCOs focus on costs, physicians are concerned this limits care quality. Health information technology (HIT) and electronic health records (EHRs) aim to manage health data, but issues include implementation costs and ensuring privacy and data sharing complies with regulations. Telehealth expands access through technologies like telemedicine and online health information.
Similar to · My Bookshelf· TOCAnnotation menu· Downloads· Print· Sea.docx (20)
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Per the text, computers are playing an increasingly important role in the practice of law. Successful paralegals must be comfortable with using electronic databases and research tools.
Write a two to three (2-3) page paper in which you:
Discuss a paralegal’s ethical obligation to conduct competent electronic research. Provide two (2) examples of the potential consequences of inept electronic research practices.
Determine whether or not traditional reference materials (e.g., State and Federal Reporters, West’s Encyclopedia, etc.) can be as current as electronic resources. Provide two (2) advantages and two (2) disadvantages to using traditional resource materials.
Use at least two (2) quality references.
Note:
Wikipedia and other Websites do not qualify as academic resources.
THIS IS PART 1.
.
Pennsylvania was the leader in sentencing and correctional reform .docxodiliagilby
Pennsylvania was the leader in sentencing and correctional reform in the early history of the United States. Discuss what groups were associated with this reform.
Why did they want the reform?
Examine whether it was successful and if the reform brought forth further changes.
What influences does the system have on the correctional system today?
What influences have changed? Why?
Use the Internet, library, and any other resources available to research your answer. Submit a 4 page paper (double-spaced) to your instructor. Support your reasoning with outside sources. Be sure to reference all sources using APA style.
The following will be the grading criteria for this assignment:
20%:
Discuss what groups were associated with this reform.
10%:
Why did they want the reform?
20%:
Examine whether it was successful and if the reform brought forth further changes.
25%:
What direct influences do you see the Pennsylvania system in the correctional systems used today?
25%:
What influences have changed? Why?
4 pages. APA format. No plagerism. 5 sources referenced throughout the paper. Reference Page and Abstract.
.
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What is penetration testing
Testing Stages
Testing Methods
Testing, web applications and firewalls
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Be approximately four to six pages in length, not including the required cover page and reference page.
Follow APA7 guidelines. Your paper should include an introduction, a body with fully developed content, and a conclusion.
Support your answers with the readings from the course and at least two scholarly journal articles to support your positions, claims, and observations, in addition to your textbook. The UC Library is a great place to find resources.
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Droppa, D., & Luczak, R. (2004, January). Collaboration, technology,
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Behavioral Health Management
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Current Issues in the Behavioral Healthcare System
.
Your final paper is due for submission. The paper should adhere to the following guidelines:
The length of the paper should be eight to ten double-spaced pages (not including the title and reference pages).
The main sections should have a:
Title page
Introduction
Body of the paper (with subheadings)
Conclusion
Reference page(s)
The paper must use the APA format for citing sources and references.
Your final paper introduction (one page) should include the following points:
An overview of the research paper
The purpose or objective of the research paper
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Based on your previous assignments and review of the literature, what are some of the major issues faced by today’s behavioral healthcare system? How have the current and future trends that are evolving in the industry addressed some of those issues?
Do you think there is a difference between the changing trends taking place in the private sector and that of public behavioral healthcare inpatient facilities? Based on your understanding about behavioral health services and the populations being served by them, do you agree that both private and public organizations are able to provide the necessary clinical services? Provide a rationale in support of your response.
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Your conclusion (one to two pages) should include the following points:
What conclusions can you draw from your research that would demonstrate the role played by behavioral health in the healthcare industry?
What changes would you like to bring to today's behavioral healthcare system in order to resolve the current issues identified?
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2. Explain the thesis that author is putting forth.
3. Find two secondary sources, they need not be peer review which relate to the main article you are presenting. Do these sources compliment or contrast the thesis being put forth by the original author?
4. Leave some time & space at the end to present your perspective and opinion on the thesis as well.
5. 5-7 pages; typed doubled spaced standard borders & fonts. Please use citation; APA, MLA, Chicago are all acceptable.
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Upon arrival, the patient reports to the hospital registration or admitting area. The patient completes paperwork and provides an insurance identification card, if insured. Often, patients register before the date of hospital admission to facilitate the registration process. An identification bracelet including the patient’s name and doctor’s name is placed around the patient’s wrist. Before any procedure is performed or any form of medical care is provided, the patient is asked to sign a consent form. If the patient is not feeling well, a family member or caregiver can help the patient complete the admission process.
Include a minimum of three peer-reviewed references, not including the textbook.
Format your paper consistent with APA 6th guidelines.
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People. I need some help with this assignment that needs to be done in Excel
Problem 1:
Oregon Surplus Inc. qualifies to use the installment-sales method for tax purposes and sold an investment on an installment basis. The total gain of $75000 was reported for financial reporting purposes in the period of sale. The installment period is 3 years; one-third of the sale price is collected in 2014 and the rest in 2015 and 2016. The tax rate was 35% in 2014, 30% in 2015, and 30% in 2016. The enacted tax rates of 2015 and 2016 are not known until 2015.
The accounting and tax data are shown below.
Financial Accounting
Tax Return
2014 (35% tax rate)
Income before temporary difference
$
175,000
$
175,000
Temporary difference
$
75,000
$
25,000
Income
$
250,000
$
200,000
2015 (30% tax rate)
Income before temporary difference
$
200,000
$
200,000
Temporary difference
$
-
$
25,000
Income
$
200,000
$
225,000
2016 (30% tax rate)
Income before temporary difference
$
180,000
$
180,000
Temporary difference
$
-
$
25,000
Income
$
180,000
$
205,000
Required:
1)
Prepare the journal entries to record the income tax expense, deferred income taxes, and the income taxes payable for 2014, 2015, and 2016. No deferred income taxes existed at the beginning of 2012.
2)
Explain how the deferred taxes will appear on the balance sheet at the end of each year. (Assume Installment Accounts Receivable is classified as a current asset.)
3)
Show the income tax expense section of the income statement for each year, beginning with “Income before income taxes.”
Problem 2:
Philadelphia Co. incurred a net operating loss of $850,000 in 2014. Combined income of 2012 and 2013 was $650,000. The tax rate for all years is 30%. Trenton elects the carry back option.
Required:
a.
Prepare the journal entries to record the benefit of loss carry back and loss carry forward option.
b.
Assuming that it is more likely than not that the entire net operating loss carry forward will not be realized in future years, prepare all the journal entries necessary at the end of 2014.
.
Perceptions and Causes of Psychopathology PaperPrepare a 1,0.docxodiliagilby
Culture determines how psychopathology is expressed. Biopsychosocial or diathesis-stress models examine causes of psychopathology from biological, psychological, and social factors. Society's perceptions of psychopathology have changed over historical time periods.
People are attracted to occupations that complement their personalit.docxodiliagilby
This document requests a 500 word essay identifying and describing the six personality types by John Holland, providing an example vocational choice for each type. It also asks the essay to analyze how dualistic and relativistic thinking contribute to vocational choices and discuss the role of commitment within relativistic thinking.
Perception of Pleasure and Pain Presentation3 slides- An explanati.docxodiliagilby
This presentation discusses the role of the somatosensory cortex in perceiving pleasure and pain through 3 slides and how damage to the cutaneous system can impact quality of life in another 3 slides. It includes one peer-reviewed source and speaker notes in APA format, needing completion by 12pm Eastern on May 4th, 2015.
Pennsylvania v. MarkMark Davis has been charged with Driving W.docxodiliagilby
Pennsylvania v. Mark
Mark Davis has been
charged
with Driving While Intoxicated (DWI) for reckless driving, speeding, four counts of felony assault, and one count of involuntary manslaughter as the result of a crash that occurred on a night out with his friends. Mark has been out on bail and pleaded not guilty when he was arraigned. The Judge set a date for Mark's trial and his defense team has been working to collect information about the technology used by the Highway Patrol to reconstruct the crash.
District Attorney O'Malley offered Mark a plea bargain, but Mark chose to take his chances at trial. Mark's attorney, Mr. Chen Long, advised Mark that accepting the plea offer was completely up to Mark, although Mr. Long advised against accepting it because the defense planned to highlight mistakes made by law enforcement during the investigation that could create reasonable doubt in the minds of the jurors.
The trial begins and during the voir dire of potential jurors, several individuals are excused because they have previous knowledge of Mark's case from the media. Two individuals stated that they could not be impartial because they had loved ones
killed
in alcohol related crashes as well. Eventually, two men and ten women were seated in Mark's trial.
District Attorney O'Malley presented the State's case clearly and concisely depicting a night on the town full of heavy drinking, which ultimately resulted in Mark's actions causing the death of one individual and injuring four others. Highway Patrolman Green explained to the jury that he immediately suspected alcohol when he arrived on scene because Mark appeared to be intoxicated when they spoke. Following the Judge ruling that it was admissible and not prejudicial, Sergeant Rodney Monroe, from the Highway Patrol Reconstruction Team presented their reconstruction complete with a high-tech computer animated reenactment of the crash. During the cross examination, Defense Attorney Long challenged the reconstruction because the Defense Crash Reconstruction Expert had discovered errors in the mathematical calculations for vehicle speed. The jury appeared to have liked the reconstruction very much regardless of the errors highlighted by the defense.
Mark was convicted of DWI, four counts of felony assault, and one count of involuntary manslaughter; however, he was acquitted of reckless driving and speeding. The Jury said they could not convict Mark of those offenses because of the mistakes made by law enforcement officers during the investigation.
Because Mark pleads not guilty, but was convicted during trial and had two prior DWI offenses, he was sentenced to ten years in the State Prison. Defense Attorney Long immediately notified the court of an impending appeal that would be filed by the defendant. In a report, using external sources to support your claims, answer the following:
Compare and contrast the roles of the Judge, Jury, District Attorney (Prosecutor), and Defense Attorney. What ar.
PBAD201-1501A-02 Public AdministrationTask NamePhase 3 Individu.docxodiliagilby
PBAD201-1501A-02 Public Administration
Task Name:
Phase 3 Individual Project
Deliverable Length:
750–1,000 words; Tabular budget
Details:
Weekly tasks or assignments (Individual or Group Projects) will be due
by
Monday and late submissions will be assigned a late penalty in accordance with the late penalty policy found in the syllabus. NOTE: All submission posting times are based on midnight Central Time.
Concern among the public sector is the demand for public organizations to be transparent about their budgets and spending habits. You have been scheduled to conduct a presentation for the State Budgeting Committee about the type of budget that the organization operates under. Identify the type of public organization for which you work, as well as what types of services, goods, or activities the organization provides to the public. Identify the size and scope of the organization.
Construct a budget using Excel that will provide a breakdown of the various budget items. Copy and paste the Excel spreadsheet of your budget into a Word document. Finally, explain how the budget is made available to the public for review. For example, is the budget made available at public meetings, on a special request, published in a newsletter, on the organization’s premises during regular business hours, via the organization’s Web site, or by some other means? If the budget is not available for the public to review, explain why. Furthermore, are there any provisions in place regarding the budget being made available for public view? Explain in detail.
Assignment Guidelines
Address the following in 750–1,000 words:
Identify the type of public organization for which you work, as well as what types of services, goods, or activities the organization provides to the public. Identify the size and scope of the organization.
Construct a budget using Excel that will provide a breakdown of the various organizational budget items.
Copy and paste the Excel spreadsheet of your budget into a Word document.
Is the budget made available to the public for review?
If yes, explain how in detail.
If no, explain in detail why it is not.
Are there any types of provisions in place regarding the budget being made available for public view? Identify and explain.
Be sure to reference all sources using APA style.
.
Part1 Q1. Classify each of the following as- (i)qual.docxodiliagilby
Part1
Q1. Classify each of the following as:-
(i)
qualitative or quantitative
(ii)
nominal, ordinal, interval or ratio scale.
a.
Times for swimmers to complete a 50meters race.
b.
Months of the year: Meskerem, Tikimit, Hidat, ---.
c.
Region numbers of Riyadh: 1, 2, 3, 4, ---.
d.
Pollen counts provided as numbers between 1 and 10 where 1 means there is almost no pollen and 10 means that it is rampant, but for which the values do not represent an actual count of grains of pollen.
e.
Packages in the city of Cleveland telephone book.
f.
Rankings of tennis players.
g.
Weights of air conditioners.
h.
Personal ID numbers
i.
Telephone numbers
j.
Temperatures inside 10 refrigerators.
k.
Salaries of the top five CEOs in the United States.
l.
Ratings of eight local plays ( poor, fair, good, excellent)
m.
Times required for mechanics to do a tune up.
n.
Ages of students in a classroom.
o.
Marital Status of patients in a physician’s office.
p.
Horsepower of tractor engines.
q.
Colors of baseball caps in a store.
r.
Classification of kids at a day care (infant, toddler, pre-school)
Q2. The following are the grades which 40 students obtained in a certain course in 1997E.C. here in Mekelle University of the Arid Campus.
75 89 66 52 90 68 83 94 77 60 38 47 87 65 97 49 65 72 73 81 63 77 31 88 74 37 85 76 74 63 69 72 91 87 76 58 63 70 72 65
a. Construct an absolute frequency distribution.
b. Convert the distribution obtained in (a) into a Relative & Percentage distribution.
c. Convert the distribution in (a) into a “Less than” &
a “More than” cumulative distribution
d. Construct a histogram, frequency polygon and ogive curve
Q3. The following distribution shows that the result obtained by 100 accounting students in the final examination of statistics in
Saudi Electronic University.
Mark of students.
0-10
10-20
20-30
30-40
40-50
No. of students
14
f1
28
f2
15
If the median mark of students is 22.5, compute:-
i.
The missing frequencies, f1 and f2.
ii.
the mode, and
iii.
the arithmetic mean
iv.
variance
Part 2
Q1.
a. (Smoking and Coffee Drinking)
Coffee
No Coffee
Total
Smoker
60
40
100
Non-Smoker
115
85
200
Total
175
125
300
What is the probability that a randomly selected person from the sample either smokes or drinks coffee.
Q1. b. What is the probability that I flip a coin and get a Head, Roll a die and get a 4 or a 6, and then pull the king of Spades and a diamond from a deck of cards.
Q2: The random variable X has the following probability distribution:
X
0
1
2
3
Total
P(x)
0.22
0.38
0.1
0.3
1
Find the expected value (E(x)) & the Variance.
Q3: A radar unit is used to measure speeds of cars on a highway. The speeds are
normally
distributed with a mean of 90 km/hr and a standard deviation of 10 km/hr. What is the probability that a car picked at random is travelling at:
a-
More than 100 km/hr?
b-
Less than 85 Km/hr?
c-
Between them?
Part 3
Q-1..
Paul’s Letter to the EphesiansThe First Letter of PeterThe Fir.docxodiliagilby
Paul’s Letter to the Ephesians
The First Letter of Peter
The First Letter to Timothy
For each document above; Identify specific content, features, or themes which permit classifying each text early Catholic in character.
At least one credible source
one and half pages
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Past and FuturePlease respond to the followingImagine back .docxodiliagilby
"Past and Future"
Please respond to the following:
Imagine back in time to pre-Internet days. Describe how you would have established communications for international trade in these time periods: 1935 and 1977.
Imagine it is now 2050. Predict the ease and speed of international trade communications and how it will occur.
2-
"Backtracking from Globalization"
Please respond to the following:
From the e-Activity, illustrate with two examples how the U.S. has restrained trade over the past 60 years and state why you think that happened.
Some believe these restraints have been deleterious to national economic prosperity. In your estimation, speculate as to how these restraints have affected national economic prosperity.
.
Partisan considerations have increasingly influenced the selection.docxodiliagilby
Partisan considerations have increasingly influenced the selection of federal judges. Interest groups on the right and the left have insisted on the appointment of judges who hold compatible views. Presidents and members of Congress have also increasingly sought appointees who will decide issues in ways they prefer. What is your view? Should politics play such a large role in judicial appointments? Or should merit be given greater weight?
Does a merit based system favor ONLY those with money and the connections? needs to be at least 200 words APA
.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
How to Build a Module in Odoo 17 Using the Scaffold Method
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Chapter 18 Partners HealthCare System
Previous section
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18 Partners HealthCare System
Thomas H. Davenport
Partners HealthCare System (Partners) is the single largest prov
ider of healthcare in the Boston area. It consists of 12 hospitals,
with morethan 7,000 affiliated physicians. It has 4 million outp
atient visits and 160,000 inpatient admissions a year. Partners is
a nonprofitorganization with almost $8 billion in revenues, and
it spends more than $1 billion per year on biomedical research.
It is a major teachingaffiliate of Harvard Medical School.
Partners is known as a “system,” but it maintains substantial aut
onomy at each of its member hospitals. While some information
systems(the electronic medical record, for example) are standar
dized across Partners, other systems and data, such as patient sc
heduling, arespecific to particular hospitals. Analytical activitie
s also take place both at the centralized Partners level and at ind
ividual hospitals such asMassachusetts General Hospital (MGH)
and Brigham and Women’s Hospital (usually described as “the
Brigham”). In this chapter, bothcentralized and hospital-
specific analytical resources are described. The focus for hospit
al-
specific analytics is the two major teachinghospitals of Partners
—MGH and the Brigham—
although other Partners hospitals also have their own analytical
capabilities and systems.
2. Centralized Data and Systems at Partners
The basis of any hospital’s clinical information systems is the cl
inical data repository, which contains information on all patient
s, theirconditions, and the treatments they have received. The in
patient clinical data repository for Partners was initially implem
ented at theBrigham during the 1980s. Richard Nesson, the Brig
ham and Women’s CEO, and John Glaser, the hospital’s chief in
formation officer,initiated an outpatient electronic medical reco
rd (EMR) at the Brigham in 1989.1 This EMR contributed outpa
tient data to the clinical datarepository. The hospital was one of
the first to embark on an EMR, though MGH had begun to deve
lop one of the first full-function EMRs asearly as 1976.
A clinical data repository provides the basic data about patients.
Glaser and Nesson came to agree that in addition to a repositor
y and anoutpatient EMR, the Brigham—
and Partners after 1994, when Glaser became its first CIO—
needed facilities for doctors to input onlineorders for drugs, test
s, and other treatments. Online ordering (called CPOE, or Comp
uterized Provider Order Entry) would not only solvethe time-
honored problem of interpreting poor physician handwriting, but
could also, if endowed with a bit of intelligence, check whether
aparticular order made sense or not for a particular patient. Did
a prescribed drug comply with best-
known medical practice, and did thepatient have any adverse rea
ctions in the past to it? Had the same test been prescribed six ti
mes before with no apparent benefit? Was thespecialist to whom
a patient was being referred covered by his or her health plan?
With this type of medical and administrative knowledgebuilt int
o the system, dangerous and time-
consuming errors could be prevented. The Brigham embarked on
its CPOE system in 1989.
Nesson and Glaser knew that there were other approaches to red
ucing medical error than CPOE. Some provider institutions, suc
h asIntermountain Healthcare in Utah, were focused on close ad
herence by physicians to well-
established medical protocols. Others, like KaiserPermanente in
3. California and the Cleveland Clinic, combined insurance and m
edical practices in ways that incented all providers to workjointl
y on behalf of patients. Nesson and Glaser admired those approa
ches, but felt that their impact would be less in an academic me
dicalcenter such as Partners, where physicians were somewhat a
utonomous, and individual departments prided themselves on th
eir separatereputations for research and practice innovations. Co
mmon, intelligent systems seemed like the best way to improve
patient care atPartners.
In 1994, when the Brigham and Mass General combined as Partn
ers HealthCare System, there was still considerable autonomy fo
rindividual hospitals in the combined organization. However, fr
om the onset of the merger, the two hospitals agreed to use a co
mmonoutpatient EMR called the longitudinal medical record (L
MR) and a CPOE system, both of which were developed at the B
righam. This waspowerful testimony in favor of the LMR and C
POE systems, since there was considerable rivalry between the t
wo hospitals, and MassGeneral had its own EMR.
Perhaps the greatest challenge was in getting the extended netw
ork of Partners-
affiliated physicians up on the LMR and CPOE. Thephysician n
etwork of more than 6,000 practicing generalist and specialist p
hysician groups was scattered around the Boston metropolitanar
ea, and often operated out of their own private offices. Many lac
ked the IT or telecom infrastructures to implement the systems
on theirown, and implementation of an outpatient EMR cost abo
ut $25,000 per physician. Yet full use of the system across Partn
ers-
affiliatedproviders was critical to a seamless patient experience
across the organization.
Glaser and the Partners information systems (IS) organization w
orked diligently to spread the LMR and CPOE to the growing nu
mber ofPartners hospitals and to Partners-
affiliated physicians and medical practices. To assist in bringin
g physicians outside the hospitals onboard, Partners negotiated
payment schedules with insurance companies that rewarded phy
4. sicians for supplying the kind of informationavailable from the
LMR and CPOE. By 2007, 90% of Partners-
affiliated physicians were using the systems, and by 2009, 100%
were. By2009, more than 1,000 orders per hour were being ente
red through the CPOE system across Partners.
The combination of the LMR and the CPOE proved to be a powe
rful one in helping to avoid medical error. Adverse drug events,
or the useof the wrong drug for the condition or one that caused
an allergic reaction in the patient, typically were encountered b
y about 14 of every1,000 inpatients. At the Brigham before LM
R and CPOE, the number was about 11. After the widespread im
plementation of these systems atBrigham and Women’s, there w
ere just above five adverse drug events per 1,000 inpatients—
a 55% reduction.
Managing Clinical Informatics and Knowledge at Partners
The Clinical Informatics Research & Development (CIRD) grou
p, headed by Blackford Middleton, is one of the key centralized
resources forhealthcare analytics at Partners. Many of CIRD’s st
aff, like Middleton, have multiple advanced degrees; Middleton
has an MD, a Master ofPublic Health degree, and a Master of Sc
ience in Health Services Research.
The mission of CIRD is
to improve the quality and efficiency of care for patients at Part
ners HealthCare System by assuring that the most advancedcurr
ent knowledge about medical informatics (clinical computing) is
incorporated into clinical information systems at PartnersHealt
hCare.2
CIRD is part of the Partners IS organization. It was CIRD’s role
to help create the strategy for how Partners used information sy
stems inpatient care, and to develop both production systems ca
pabilities and pilot projects that employ informatics and analyti
cs. CIRD’s work hadplayed a substantial role in making Partner
s a worldwide leader in the use of data, analysis, and computeri
zed knowledge to improvepatient care. CIRD also has had sever
al projects funded by U.S. government health agencies to adapt
some of the same tools andapproaches it developed for Partners
5. to the broader healthcare system.
One key function of CIRD was to manage clinical knowledge, a
nd translate healthcare research findings into daily medical prac
tice atPartners. In addition to facilitating adoption of the LMR a
nd CPOE, Partners faced a major challenge in getting control of
the clinicalknowledge that was made available to care provider
s through these and other systems. The “intelligent CPOE” strat
egy demanded thatknowledge be online, accessible, and easily u
pdated so that it could be referenced by and presented to care pr
oviders in real-
timeinteractions with patients. There were, of course, a variety
of other online knowledge tools, such as medical literature searc
hing, available toPartners personnel; in total they were referred
to as the “Partners Handbook.” At one point after use of the CP
OE had become widespreadat Brigham and Women’s, a compari
son was made between online usage of the Handbook and usage
of the knowledge base from orderentry. There were more than 1
3,000 daily accesses through the CPOE system at the Brigham a
lone, and only 3,000 daily accesses of theHandbook by all Partn
ers personnel at all hospitals. Therefore, there was an ongoing e
ffort to ensure that as much high-
quality knowledgeas possible made it into the CPOE.
The problem with knowledge at Partners was not that there wasn
’t enough of it; indeed, the various hospitals, labs, departments,
andindividuals were overflowing with knowledge. The problem
was how to manage it. At one point, Tonya Hongsermeier, a phy
sician with anMBA degree who was charged with managing kno
wledge at Partners, counted the number of places around Partner
s where there wassome form of rule-
based knowledge about clinical practice that was not centrally
managed. She found about 23,000 of them. The knowledgewas c
ontained in a variety of formats: paper documents, computer “sc
reen shots,” process flow diagrams, references, and data or repo
rtson clinical outcomes—
all in a variety of locations, and only rarely shared.
Hongsermeier set out to create a “knowledge engineering and m
6. anagement” factory that would capture the knowledge at Partner
s, put it ina common format and central repository, and make it
available for CPOE and other online systems. This required not
only a new computersystem for holding the thousands of rules t
hat constituted the knowledge, but an extensive human system f
or gathering, certifying, andmaintaining the knowledge. It consi
sted of the following roles and organizations:
• A set of committees of senior physicians who oversaw clinical
practice in various areas, such as the Partners Drug TherapyCo
mmittee, which reviewed and sanctioned the knowledge as corre
ct or best known practice
• A group of subject matter experts who, using online collaborat
ion systems, debated and refined knowledge such as the best dru
g fortreating high cholesterol under various conditions, or the b
est treatment protocol for diabetes patients
• A cadre of “knowledge editors” who took the approved knowle
dge from these groups and put it into a rule-
based form that wouldbe accepted by the online knowledge repo
sitory
High Performance Medicine at Partners
Glaser and Partners IS had always had the support of senior Part
ners executives, but for the most part their involvement in the a
ctivitiesdesigned to build Partners’ informatics and analytics ca
pabilities was limited to some of the hospitals and those physici
an practices thatwanted to be on the leading edge. Then Jim Mo
ngan moved from being president of MGH (a role he had occupi
ed since 1996, shortly afterthe creation of Partners) to being CE
O of Partners overall in January 2003. Not since Dick Nesson ha
d Glaser had such a strong partner inthe executive suite.
Mongan had come to appreciate the value of the LMR and CPO
E, and other clinical systems, while he headed Mass General. B
ut when hecame into the Partners CEO role, with responsibility
over a variety of diverse and autonomous institutions, he began
to view it differently.Mongan said:
So when I was preparing to make the move to Partners, I began t
o think about what makes a health system. One of the keys that
7. would unite us was the electronic record. I saw it as the connect
ive tissue, the thing we had in common, that could help us get a
handle on utilization, quality, and other issues.
Together Mongan and Glaser agreed that while Partners already
had strong clinical systems and knowledge management compar
ed toother institutions, a number of weaknesses still needed to b
e addressed (most importantly that the systems were not univers
ally usedacross Partners care settings), and steps needed to be ta
ken to get to the next level of capability. Working with other cli
nical leaders atPartners, they began to flesh out the vision for w
hat came to be known as the High Performance Medicine (HPM)
initiative, which took placebetween 2003 and 2009.
Glaser commented on the process the team followed to specify t
he details of the HPM initiative:
Shortly after he took the reins at Partners, however, Jim had a cl
ear idea on where he wanted this to go. To help refine that visio
n,several of us went on a road trip, to learn from other highly in
tegrated health systems such as Kaiser, Intermountain Healthcar
e,and the Veterans Administration about ways we might bring th
e components of our system closer together.
Mongan concluded:
We also were working with a core team of 15-
20 clinical leaders and eventually came up with a list of seven o
r eight initiatives,which then needed to be prioritized. We did a
“Survivor”-
style voting process, to determine which initiatives to “kick off
the island.”That narrowed down the list to five Signature Initiati
ves.
The five initiatives consisted of the following specific programs
, each of which was addressed by its own team:
• Creating an IT infrastructure—
Much of the initial work of this program had already been done;
it consisted of the LMR and theCPOE, which was extended to t
he other hospitals and physician practices in the Partners networ
k and maintained. This project alsoaddressed patient data qualit
y reporting, further enhancement of knowledge management pro
8. cesses, and a patient data portal togive patients access to their o
wn health information.
• Enhancing patient safety—
The team addressing patient safety issues focused on four specif
ic projects: 1) providing decisionsupport about what medication
s to administer in several key areas, including renal and geriatri
c dosing; 2) communicating “clinicallysignificant test results,”
particularly to physicians after their patients have left the hospit
al; 3) ensuring effective flow of informationduring patient care t
ransitions and handoffs in hospitals and after discharge; 4) prov
iding better decision support, patient education,and best practic
es and metrics for anticoagulation management.
• Uniform high quality—
This team addressed quality improvement in the specific domain
s of hospital-
based cardiac care,pneumonia, diabetes care, and smoking cessa
tion; it employed both registries and decision support tools to d
o so.
• Chronic disease management—
The team addressing disease management focused on prevention
of hospital admission byidentifying Partners patients who were
at highest risk for hospitalization, and then developed health co
aching programs to addresspatients with high levels of need, for
example, heart failure patients; the team also pulled together a
new database of informationabout patient wishes about end-of-
life decisions.
• Clinical resource management—
At Jim Mongan’s suggestion, this team focused on how to lower
the usage of high-cost drugs andhigh-
cost imaging services; it employed both “low-
tech” methods (e.g., chart reviews) and “high-
tech” approaches (e.g., a datawarehouse making transparent phy
sicians’ imaging behaviors relative to peers) to begin to make u
se of scarce resources moreefficiently.
Overall, Partners spent about $100 million on HPM and related
clinical systems initiatives, most of which were ultimately paid
9. for by thePartners hospitals and physician practices that used th
em. To track progress, a Partners-
wide report, called the HPM Close, was developedthat shows cu
rrent and trend performance on the achievement of quality, effic
iency, and structural goals. The report was publishedquarterly t
o ensure timely feedback for measuring performance and suppor
ting accountability across Partners.
New Analytical Challenges for Partners
Partners had made substantial progress on many of the basic app
roaches to clinical analytics, but there were many other areas at
theintersection of health and analytics that it could still address.
One was the area of personalized genetic medicine—
the idea that patientswould someday receive specific therapies b
ased on their genomic, proteomic, and metabolic information. P
artners had created the i2b2(Informatics for Integrating Biology
and the Bedside), a National Center for Biomedical Computing
that was funded by the NationalInstitutes of Health. John Glaser
was co-
director of i2b2 and developed the IT infrastructure for the Part
ners Center for PersonalizedGenetic Medicine. One of the many
issues these efforts addressed in personalized genetic medicine
was how relevant genetic informationwould be included in the L
MR.
Partners was also attempting to use clinical information for post
market surveillance—
the identification of problems with drugs and medicaldevices in
patients after they have been released to the market. Some Partn
ers researchers had identified dangerous side effects fromcertain
drugs through analysis of LMR data. Specifically, research scie
ntist John Brownstein’s analyses suggested that the level of pati
entswith heart attack admissions to Mass General and the Brigh
am had increased 18% beginning in 2001 and returned to its bas
eline level in2004, which coincided with the timeframe for the b
eginning and end of Vioxx prescriptions. Thus far the identifica
tion of problems hadtaken place only after researchers from oth
er institutions had identified them, but Partners executives belie
10. ved it had the ability to identifythem at an earlier stage. The ins
titution was collaborating with the Food and Drug Administratio
n and the Department of Defense toaccelerate the surveillance p
rocess. John Glaser noted:
I don’t know that we’ll get as much specificity as might be need
ed to really challenge whether a drug ought to be in a market, b
ut Ialso think it’s fairly clear that you can be much faster and in
volve much fewer funds, frankly, to do what we would call the “
canaryin the mine” approach.3
Partners was also focused on the use of communications technol
ogies to improve patient care. Its Center for Connected Health,
headed byDr. Joe Kvedar, developed one of the first physician-
to-
physician online consultation services in an academic medical s
etting. The Center wasalso exploring combinations of remote m
onitoring technologies, sensors (for example, pill boxes that kno
w whether today’s dosage hasbeen taken), and online communic
ations and intelligence to improve patient adherence to medicati
on regimes, engagement in personalhealth, and clinical outcome
s.
In the clinical knowledge management area, Partners had done a
n impressive job of organizing and maintaining the many rules a
ndknowledge bases that informed its “intelligent” CPOE system.
However, it was apparent to Glaser, Blackford Middleton, and
TonyaHongsermeier—
and her successor as head of knowledge management, Roberto R
ocha—
that it made little sense for each medicalinstitution to develop it
s own knowledge base. Therefore, Partners was actively engage
d in helping other institutions with the managementof clinical k
nowledge. Middleton (the principal investigator), Hongsermeier,
Rocha, and at least 13 other Partners employees were involvedi
n a major Clinical Decision Support Consortium project funded
by the U.S. Agency for Healthcare Research and Quality. The c
onsortiuminvolved a variety of other research institutions and h
ealthcare companies, and was primarily focused on finding ways
11. to make clinicalknowledge widely available to healthcare provi
ders through EMR and CPOE systems furnished by leading vend
ors.
Despite all these advances, not all Partners executives and physi
cians had fully bought into the vision of using smart informatio
n systems toimprove patient care. Some found, for example, the
LMR and CPOE to be invasive in the relationship of doctor and
patient. A seniorcardiologist at Brigham and Women’s, for exa
mple, argued in an interview [with the author] that:
I have a problem with the algorithmic approach to medicine. Pe
ople end up making rote decisions that don’t fit the patient, and
itcan also be medically quite wasteful. I don’t have any choice h
ere if I want to write prescriptions—
virtually all of them are doneonline. But I must say that I am ge
tting alert fatigue. Every time I write a prescription for nitrogly
cerine, I am given an alert thatasks me to ensure that my patient
isn’t on Viagra. Don’t you think I know that at this point? As f
or online treatment guidelines, Ibelieve in them up to a point. B
ut once something is in computerized guidelines it’s sacrosanct,
whether or not the data arelegitimate. Recommendations should
be given with notification of how certain we are about them....
Maybe these things are moreuseful to some doctors than others.
If you’re in a subspecialty like cardiology you know it very well
. But if you are an internist, youmay have shallow knowledge, b
ecause you have to cover a wide variety of medical issues.
Many of the people involved in developing computer systems fo
r patient care at Partners regarded these as valid concerns. “Aler
t fatigue,”for example, had been recognized as a problem within
Blackford Middleton’s group for several years. They had tried t
o eliminate the moreobvious alerts, and to make changes in the
system to allow physicians to modify the types of alerts they rec
eived. There was a difficult lineto draw, however, between savi
ng physician attention and saving lives.
Centralized Business Analytics at Partners
While much of the centralized analytical activity at Partners has
been on the clinical side, the organization is also making progr
12. ess onbusiness analytics. The primary focus of these efforts is o
n financial reporting and analysis.
For several years, for example, Partners has employed an extern
al “software as a service” tool to provide reporting on the organ
ization’srevenue cycle. It has also developed several customized
analytics applications in the areas of cash management, underp
ayments, bad debtreserves, and charge capture. These activities
primarily took place in the Partners Revenue Finance function.
The Partners Information Systems organization is also increasin
g its focus on administrative and financial analytics. It is puttin
g in placeCompass, a common billing and administrative system
, at all Partners hospitals. At the same time, Partners has created
a set of standardprocesses for collecting, defining, and modifyi
ng financial and administrative data. Further, as one article put i
t:
At Partners, John Stone, corporate director for financial and ad
ministrative systems, is developing a corporate center of busine
ssanalytics and business intelligence. Some 12 to 14 financial e
xecutives will oversee the center, define Partners’ strategy for d
atamanagement, and determine data-
related budget priorities. “Our analysts spend the majority of th
eir time gathering, cleaning, andscrubbing administrative data a
nd less time providing value-
added analytics and insight into what the data is saying,” says S
tone.“We want to flip that equation so our analysts are spending
more time producing a story that goes along with the data.”4
Hospital-Specific Analytical Activities—
Massachusetts General Hospital
MGH, because it was a highly research-
driven institution, had long focused primarily on clinical resear
ch and the resulting clinicalinformatics and analytics. In additio
n to the LMR and CPOE systems used by Partners overall, MGH
researchers and staff have developed anumber of IT tools to an
alyze and search clinical data, one of which was a tool that sear
ched across multiple enterprise clinical systems,including the L
MR.
13. While historically, the research, clinical, information systems, a
nd the analytically focused business arms of MGH tended to ope
rate in stovepipes, the challenges of an evolving healthcare land
scape have forced a change in that paradigm. For instance, a str
ong current focus withinMGH is on how to achieve federal “mea
ningful use” reimbursement for the organization’s expenditures
on EMR. Because achievingmeaningful use objectives is predica
ted on a high level of coordination among information systems,
the physicians, and businessintelligence, people like David Y. T
ing, the associate medical director for Information Systems for
MGH and Massachusetts GeneralPhysicians Organization, and C
hris Hutchins, the director of Finance Systems and deputy CIO,
are beginning to collaborate extensively.
The HITECH/ARRA criteria for Stage 1 EMR meaningful use pr
escribe 25 specific objectives to incentivize providers to adopt a
nd useelectronic health records.5
To raise the level of EMR use by all its providers, as well as to
provide resources for the work needed to achieve that level, MG
H has arrivedat a novel funds distribution model. They determin
ed that the physicians organization will reserve a portion of the
pool of $44,000 perphysician toward IT and analytics infrastruct
ure, then distribute the remaining incentive payment across all p
roviders, proportional to theamount of data a particular physicia
n is charged with entering. An internal quality incentive progra
m would serve as the distributionmechanism. So, for example, if
you recorded demographics, vital signs, and smoking status for
the requisite number of patients, you wouldreceive 30% of the p
er-
physician payment from the pool. If you fulfilled all ten quality
measures, you would receive 100% of the paymentfrom the pool
. This encourages all physicians to contribute to the meaningful
use program, but it also means that no physicians will receiveth
e full amount of $44,000. The incentive from the federal govern
ment is up to $44,000 for each eligible provider who fulfills the
meaningful use criteria. MGH has examined the objectives and
broken them down into ten major pieces of patient data that phy
14. sicians needto record in the EMR. However, many are not releva
nt for all of its physicians. For example, a primary care physicia
n would logically entersuch data as demographics, vital signs, a
nd smoking status, but these would be less relevant for certain s
pecialists to enter.
Clearly, such a complex quality incentive model requires an unp
recedented level of analytics. Currently, Ting, Hutchins, and oth
ers at MGHare working to map the myriad clinical and finance d
ata sources that are scattered among individual departments, exi
st at a hospital sitelevel, or exist at the Partners enterprise level.
Simultaneously, they must negotiate data governance agreemen
ts even among other Partnersentities, to ensure that the requisite
data feeds from sources within Partners and pertaining to MGH
, but stored outside MGH’s physical datawarehouses, are availa
ble for MGH analytics purposes.
MGH has some experience with reimbursement metrics based on
physician behaviors, having used them in Partners Community
HealthCare, Inc. (PCHI), its physician network in the Boston ar
ea. Physician incentives have been provided through PCHI on th
e basis ofadmission rates, cost-
effective use of pharmacy and imaging services, and screening f
or particular diseases and conditions, such as diabetes. This was
also the mechanism used to encourage the adoption of the LMR
and CPOE systems by physicians. But MGH, like otherprovider
s, struggles with developing clear and transparent metrics across
the institution that can help to drive awareness and newbehavio
rs. If MGH could create broadly accessible metrics on individua
l physicians’ frequency of prescribing generic drugs, for exampl
e, itwould undoubtedly drive MGH’s competitive physicians to
excel in the rankings.
On the business side, MGH is trying to develop a broad set of c
apabilities in business intelligence and analytics. A BusinessInt
elligence/Performance Management group has recently been cre
ated under the direction of Chris Hutchins, deputy CIO and dire
ctor offinance systems for the Mass General Physicians Organiz
ation (MGPO). The group is generating reports on such financia
15. l and administrativetopics as
• Billing efficiency, claims adjudication, rejection rates, and tim
es to resolve billing accounts, both at MGH overall and across p
ractices
• Improving patient access, average wait times to see a physicia
n, and cancellation and no show rates
• Employer attrition as an MGH customer
MGH is also working with CMS on the Physician Quality Repor
ting Initiative. To combine all these measures in a meaningful f
ashion, MGPO isalso working on a balanced scorecard.6
While the current analytical activity is largely around reporting,
Hutchins plans to develop more capabilities around alerts, exce
ptionreporting, and predictive models. The MGH Physicians Or
ganization is implementing capabilities for statistical and predic
tive analytics thatwould be applied to several topics. For examp
le, one key area in which better prediction would be useful invo
lves patient volume. They arealso pursuing more general models
that would predict shifts in business over time. At the moment,
however, Hutchins feels that thescorecard is still early in its dev
elopment and current efforts are focused on identifying leading
indicators.
Hospital-Specific Analytical Activities—
Brigham and Women’s Hospital
Like MGH, the Brigham’s analytical activities in the past have
been largely focused on clinical research. Today it is also addre
ssing much ofthe same business, operational, and meaningful us
e issues that MGH is. Many of the analytical activities at the Br
igham are pursued by theCenter for Clinical Excellence (CCE),
which was founded by Dr. Michael Gustafson in 2001. The cent
er has five functionally interrelatedsections, including
• Quality programs
• Patient safety
• Performance improvement
• Decision support systems (including all internal and external d
ata management and reporting activities)
• Analysis and planning (which oversees business plan develop
16. ment, ROI assessments for major investments, cost benchmarkin
g,asset utilization reporting, and support for strategic planning)
The CCE has close working relationships with the Brigham’s C
FO and finance organizations, the Brigham’s information syste
msorganization, the Partners Business Development and Plannin
g function, and other centers and medical departments at the Bri
gham.
One major difference between the Brigham and MGH (and most
other hospitals, for that matter) is that the Brigham established
a balancedscorecard beginning in 2000. It was based on a well-
established cultural orientation to operational and quality metric
s throughout thehospital. Richard Nesson, the Brigham CEO wh
o had partnered with CIO John Glaser to introduce the LMR and
CPOE systems, was also astrong advocate of information-
driven decision making on both the clinical and business sides o
f the hospital. The original systems thatNesson and Glaser had e
stablished also incorporated a reporting tool called EX, and a da
ta warehouse called CHASE (ComputerizedHospital Analysis Sy
stem for Efficiency). The analyses and data from these systems
formed the core of the Brigham’s balanced scorecard.
Before an effective scorecard could be developed, the Brigham
had to undertake considerable work on data definitions and man
agement.One analysis discovered, for example, that there were f
ive different definitions of the length of a patient stay circulatin
g in 11 differentreports. The chief medical officer at the time, D
r. Andy Whittemore, and the CCE’s Dr. Gustafson, a surgeon w
ho had just taken on qualitymeasurement issues at the Brigham,
addressed these data issues with a senior executive steering com
mittee and decided to present thedata in an easy-to-
digest scorecard.
Under the ongoing management of the CCE, the scorecard conta
ins a variety of financial, operational, and clinical metrics from
across thehospital. The choice of metrics is driven by a “strateg
y map”7 specifying the relationships among key variables that d
rive the performance ofthe hospital (see Figure 18.1). Unlike m
ost corporate strategy maps, financial performance variables are
17. at the bottom of the map ratherthan the top. In the scorecard its
elf, there are more than 50 specific measures in the hospital-
wide scorecard, and more detailed scorecardsfor particular depa
rtments, such as Nursing and Surgery. The scorecard has also be
en extended to Faulkner Hospital, a Partners institutionthat is m
anaged jointly with the Brigham.
Figure 18.1 Strategy map for Brigham & Women’s balanced sco
recard
Dr. Gary Gottlieb, the Brigham president from 1992 to 2009, wa
s the most aggressive user of the scorecard. He noted:
I review the balanced scorecard on a regular basis, because ther
e is specific data that is of interest to me. There are key metrics
Iexamine for trends and if they develop, then I analyze the data
to better understand what is going right or wrong. It is one view
,but an important one of our hospital. I can look at the balanced
scorecard and get information in another way, from a differentp
erspective than I can when I’m making rounds on a hospital unit
, or sitting in the meeting with chiefs.8
Gottlieb left the Brigham CEO role to become the CEO of Partn
ers overall in 2010. One of the primary initiatives in his new Pa
rtners role isto expand the degree of common systems throughou
t Partners, so that there can be common data and analytics throu
ghout theorganization. Perhaps one day all of Partners HealthCa
re System will be managed through one scorecard.
Notes
1. This and other details of the Partners LMR/CPOE systems are
derived from Richard Kesner, “Partners Healthcare System:Tra
nsforming Healthcare Services Delivery Through Information M
anagement,” Ivey School of Business Case Study (2009).
2. “CIRD, Clinical Informatics Research & Development,” http:
//www.partners.org/cird/.
3. PricewaterhouseCoopers, “Partners HealthCare: Using EHR
Data for Post-
market Surveillance of Drugs” (2009). http://pwchealth.com/cgi
-local/hregister.cgi/reg/partners_healthcare_case_study.pdf.
18. 4. Healthcare Financial Management Association, “Developing
a Meaningful EHR,” http://www.hfma.org/Publications/Leaders
hip-Publication/Archives/Special-Reports/Spring-
2010/Developing-a-Meaningful-
EHR/, Part 3 of “Leadership Spring-
Summer 2010Report: Collaborating for Results.”
5. The 25 meaningful use criteria are described in “Eligible Pro
vider: ‘Meaningful Use’ Criteria,” by Jack Beaudoin, Healthcar
e IT News,December 30, 2009, http://www.healthcareitnews.co
m/news/eligible-provider-meaningful-use-criteria.
6. Robert S. Kaplan and David P. Norton, “The Balanced Scorec
ard: Measures that Drive Performance,” Harvard Business Revie
w (January– February 1992).
7. Robert S. Kaplan and David P. Norton, “Having Trouble With
Your Strategy? Then Map It,” Harvard Business Review (Septe
mber –October, 2000).
8. Ibid.
· Notebook
Davenport, T., & McNeill, D. (2014). Analytics in healthcare
and the life sciences: Strategies,implementation, methods, and
best practices. Retrieved from https://content.ashford.edu
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