Real-World Decisions
HRM/350 Version 2
1
University of Phoenix Material
Real-World Decisions
Read the following scenarios, which represent real-world decisions, and respond to each in 150 to 200 words.
Scenario One
You are the director of production at a multinational company. Your position is in Tokyo, Japan. Recently, this division experienced production quota problems. You determine that you must identify a team leader who will lead the work team to tackle the problem. You identify several possible team leaders, including Joan, a manager who is an expatriate US citizen and has recently arrived in your company’s Japanese office. You are also aware of Bob, a European national who has worked at the facility for about a year. His experience includes reengineering production processes at one of the company’s production facilities in Europe. The final candidate is Noriko, a Japanese national who has been at the facility for several years.
Questions
The team you assemble is composed of American expatriates and Japanese nationals. Compare the three candidates for the position. Based on cultural norms and traditions, what cultural factors and management styles may benefit or present obstacles for others on the team? Explain.
Response
Scenario Two
You have been assigned to an overseas position with your company. The local government of the host country offers gifts periodically to senior management as a way of thanking them for opening a facility and employing locals. These gifts include cash or merchandise into the thousands of dollars. Typically, to refuse a gift is considered an insult. Your country’s policy is to prohibit employees from accepting anything from clients and customers of more than $50. Your employer values its relationship with the host country and government officials, and it intends to continue operating in the venue.
Questions
How would you address a situation where you are presented with a gift of more than $50? Explain your rationale. How could your actions affect your company? How could your decision affect your working relationship with your company’s and the host country’s officials?
Response
Scenario Three
Christine, the leading expert in information technology (IT) organizational design, works for a large consulting firm and has been asked to work on a temporary assignment in Saudi Arabia. One of her firm’s biggest revenue-generating customers is embarking on an initiative to redesign the IT structure to improve efficiency and effectiveness, and to align the business unit’s output with the organization’s strategic objectives. The customer has read research reports and articles Christine has published, and the chief executive officer has asked Christine to handle this project. She is excited about the professional challenge of the assignment, but she is unsure of adopting customs and practices in a Muslim country.
Questions
Discuss the ethical considerations for Christine and her company. What implications m ...
1 day ago
Benjamin Proffitt
Discussion 7
COLLAPSE
Top of Form
Job Oppurtunities
Indirect care settings are defined as services that are related to patient care but do not require interactions between the healthcare provider and the patient. There is a vast amount of jobs and professions related to Indirect care that make this an extremely explosive market for those seeking to join the medical field. Indirect care organizations are organizations such as pharmaceutical companies, insurance carriers, health information technologists and many more. Job oppurtunities for those seeking a degree and employment in the field of health care administration could seek out jobs in these fields to include the Director of Quality control, the chief executive officer, the chief financial officer etc. These positions are extremely impactful on the product and services these organizations provide and allow them to better support direct care facilities in providing safe, quality patient care with the latest and most up to date services and technologies. While ultimately, all companies are seeking to make profits in order to enhance their company and pay their employees it is important to look at how indirect care supports direct care oganizations.
Correleation
Although not directly involved in the intracicies of patient care, there is a direct correleation to the work done in indirect care facilities with direct care facilities. One of the most major sector of indirect care, and likely the fastest growing is the field of Healthcare Information Technology. Healthcare information technology or HIT is defined as “the application of information processing involving both computer hardware and software that deals with the storage, retrieval and use of healthcare information, data, and knowledge for communication and decision making.” (Alotaibi & Frederico., 2017). One way that healthcare technology influences direct care organizations is through the use of automated reminders and alerts in computers that support clinicians and support staff with safety nets in the clinical decision making process. For example, hard stops in Electronic health records, which are stops implemented that cause a user to address the issue at hand before continuing with care have been shown to decrease prescription errors by 22% (Feldman et al., 2018).
Another major implementation that Healthcare information technology has implemented is the development of the Electronic Health Record. The electronic health record has been a major introduction in the world of healthcare that has improved the quality of care, patient outcomes, safety and reduced medication errors, redundant testing, and improved overall communication between providers. With their creation, medical organizations that participate in direct care have been able to significantly increase their productivity, abandon old outdated and dangerous paper charting and have been provi ...
1 day agoBenjamin Proffitt Discussion 7COLLAPSETop of FoAbbyWhyte974
1 day ago
Benjamin Proffitt
Discussion 7
COLLAPSE
Top of Form
Job Oppurtunities
Indirect care settings are defined as services that are related to patient care but do not require interactions between the healthcare provider and the patient. There is a vast amount of jobs and professions related to Indirect care that make this an extremely explosive market for those seeking to join the medical field. Indirect care organizations are organizations such as pharmaceutical companies, insurance carriers, health information technologists and many more. Job oppurtunities for those seeking a degree and employment in the field of health care administration could seek out jobs in these fields to include the Director of Quality control, the chief executive officer, the chief financial officer etc. These positions are extremely impactful on the product and services these organizations provide and allow them to better support direct care facilities in providing safe, quality patient care with the latest and most up to date services and technologies. While ultimately, all companies are seeking to make profits in order to enhance their company and pay their employees it is important to look at how indirect care supports direct care oganizations.
Correleation
Although not directly involved in the intracicies of patient care, there is a direct correleation to the work done in indirect care facilities with direct care facilities. One of the most major sector of indirect care, and likely the fastest growing is the field of Healthcare Information Technology. Healthcare information technology or HIT is defined as “the application of information processing involving both computer hardware and software that deals with the storage, retrieval and use of healthcare information, data, and knowledge for communication and decision making.” (Alotaibi & Frederico., 2017). One way that healthcare technology influences direct care organizations is through the use of automated reminders and alerts in computers that support clinicians and support staff with safety nets in the clinical decision making process. For example, hard stops in Electronic health records, which are stops implemented that cause a user to address the issue at hand before continuing with care have been shown to decrease prescription errors by 22% (Feldman et al., 2018).
Another major implementation that Healthcare information technology has implemented is the development of the Electronic Health Record. The electronic health record has been a major introduction in the world of healthcare that has improved the quality of care, patient outcomes, safety and reduced medication errors, redundant testing, and improved overall communication between providers. With their creation, medical organizations that participate in direct care have been able to significantly increase their productivity, abandon old outdated and dangerous paper charting and have been provi ...
HIM 500 Milestone One Guidelines and Rubric Overview I.docxpooleavelina
HIM 500 Milestone One Guidelines and Rubric
Overview: Imagine you have been contracted to consult on the recent developments at the Featherfall Medical Center. Featherfall has been struggling of late; it
has had a series of problems that have prompted your hiring. It has faced the following issues:
1. Featherfall has recently violated several government regulations regarding the current state of its technology and how it is being used. The technology
system is vastly out of date, and staff are not always using the technology that is in place or they are using the technology inappropriately. These
problems have lost the institution lots of money for not meeting government regulations and have caused operational and ethical problems from
inefficient and ineffective use of technology.
2. The staff at Featherfall are not well-trained on the use of technology and do not communicate appropriately about technology use. The roles that
pertinent to your consult are the health information management team, the clinical staff (doctors, nurses, etc.), and administrative staff. The health
information management team uses proper coding practices, and the current technology system serves them well, despite its age. However, other roles
in the hospital have had issues with the system. Clinical staff, for instance, have had record-keeping issues both due to lack of training on the system and
the system itself being out of date. Administrative staff within the organization have taken issue with the lack of communication about the technology
and its use between the various roles. When the current technology system was chosen many years ago, the needs of these various roles were not
considered.
In this milestone, you will submit a discussion of the history of healthcare information management/informatics and the current landscape in terms of
technology. This milestone will set the stage for your project.
Specifically the following critical elements must be addressed:
I. Preparation for Consult: In this section of your final project, you will prepare for your consultation on the organization’s technology choice. To prepare,
you will analyze the field of health information management for determining standard technologies and guidelines related to technology use in order to
inform your technology selection.
A. Analyze key historical events in the field of health informatics for how technology has been used that could inform the management of health
information. Be sure to support your response with appropriate examples.
B. Determine guidelines for technology use in the field of health information management that Featherfall could implement. Be sure to support
your response with research.
C. Determine the standard technologies currently used in the field of health information management. Be sure to support your response with
research. For example, what record-keeping technologies are typically used in the field?
D. Dev ...
Assignment 1 Legal Aspects of U.S. Health Care System Administrat.docxbraycarissa250
Assignment 1: Legal Aspects of U.S. Health Care System Administration
Due Week 3 and worth 200 points
Prevailing wisdom reinforces the fact that working in U.S. health care administration in the 21st Century requires knowledge of the various aspects of health laws as they apply to dealing with medical professionals. Further, because U.S. health care administrators must potentially interact with many levels of professionals beyond the medical profession, it is prudent that they be aware of any federal, state, and local laws that may be applicable to their organizations. Thus, their conduct is also subject to the letter of the law. They must evaluate the quality of their professional interactions and be mindful of the implications and ramifications of their decisions.
Nearly 65 million surgical operations were performed in 2015 in the U.S. resulting in an estimated 200,000 deaths from complications or other post-operative issues (Ghaferi, Myers, Sutcliffe, & Pronovost, 2016). Ongoing innovation in healthcare can improve patient outcomes. According to the Harvard Business Review article, The Next Wave of Hospital Innovation to Make Patients Safer, over the past several decades, there have been three distinct waves of surgical improvement: technical advancements, standardizing procedures, and high reliability organizing.
Assume the role of a top health administrator at We Care Hospital. You are interested in propelling the hospital to the next level by applying for the Malcolm Baldrige National Quality Award. However, you want to ensure surgical outcomes for patient morbidity and mortality rates. You begin by researching the Surgical Care Improvement Project (SCIP) aimed to improve adherence to quality protocols. You need to ensure the hospital policy is consistent with the law and that the hospital is correctly reporting Sentinel Events to the Joint Commission, a hospital regulatory agency.
Note: You may create and / or make all necessary assumptions needed for the completion of this assignment.
Write a three to four (3-4) page paper in which you:
1. Analyze how standardizing procedures and documenting steps can improve outcomes when performing a complex procedure. Review the peer-reviewed journal article, The Next Wave of Hospital Innovation to Make Patients Safer. Articulate your position as the top administrator concerned about the importance of professional conduct and negligence in SCIP quality guidelines.
2. High Reliability Organizing emphasizes the varying actions that can affect patient safety given that standardized systems ignore the fact that each patient is different. Ascertain the major ramifications when the health care team “fails to rescue” the patient. Identify what hospital policies should be in place and identify previous case laws.
3. Analyze the four (4) elements required of a plaintiff to prove medical negligence.
4. Discuss the overarching duties of the health care governing board in mitigating the effects of medical non- ...
Exercises in Measurement and validity For this assignment, you.docxSANSKAR20
Exercises in Measurement and validity
For this assignment, you will be working through questions regarding measurement and validity.. Your answers should be written in complete sentences. Some of the answers may require you to show your work.
1. You have just started a new diet program. To mark your progress, you start weighing yourself three times a day. You also notice that each time you weigh yourself in a given day, the number of pounds is different. Based on the rules regarding the scales of measurement, why is it wrong to weigh yourself more than once a day?
2. Your hospital administration has received several phone complaints from patients about rude behavior from registration staff and long wait times to register in both the Dermatology and Audiology Outpatient Clinics. A decision is made to send a patient satisfaction survey to all Outpatient Clinic patients to determine overall patient satisfaction in the hospital’s Clinic setting. The survey developed uses this type of scoring: 1 = strongly disagree and 5 = strongly agree. What type of scale of measurement is this?
3. Your hospital wants to study patients readmitted within 30-days. What measures (e.g. Medicare patients only) would you recommend be included in the study (identify at least 3)? Where would you locate the data elements (e.g. admission records)?
4. Your hospital’s Pharmacy and Therapeutics Committee undertook a quality review of Medication forms from discharges in the first quarter of the year and identified the errors by 5 general categories and then calculated the percentage of the total errors by category. The results were: Dosage Form 6%, Name confusion 13%, Communication 19%, Labeling 20%, and Human Factors 42%. As the HIM Director you are a member of the P&T Committee, the Chair asks you to prepare a graphic display of the error results for Medical Staff review. What is the best choice of a graphic display to present this data to the Medical Staff? And why
a. Line Graph
b. Bar Graph
c. Pie chart
d. Data Table
5. Provide a definition and example for the following terms:
a. Content validity
b. Construct validity
c. Criterion validity
Running head: BUSINESS AND USER REQUIREMENTS DOCUMENT DRAFT 1
BUSINESS AND USER REQUIREMENTS DOCUMENT DRAFT 6
Business and User Requirements Document Draft
thanks for your Draft report on the EHR project and requirements. There are 3 main parts to cover: Sources of information, departments affected: Provide more information about the clinical departments. HIM is not the "most important" department for this system. Clean up some of the writing possible errors or misunderstandings, too. 5 /7 Methods to gather information: Glad you mentioned interviews, focus groups, and questionnaires and explained all three. 7 /7
Requirements statements:3 /6 You are not quite understanding what Requirements are yet. They are what the system must do. We will get later on in the class, onto project implementation tasks such ...
1 day ago
Benjamin Proffitt
Discussion 7
COLLAPSE
Top of Form
Job Oppurtunities
Indirect care settings are defined as services that are related to patient care but do not require interactions between the healthcare provider and the patient. There is a vast amount of jobs and professions related to Indirect care that make this an extremely explosive market for those seeking to join the medical field. Indirect care organizations are organizations such as pharmaceutical companies, insurance carriers, health information technologists and many more. Job oppurtunities for those seeking a degree and employment in the field of health care administration could seek out jobs in these fields to include the Director of Quality control, the chief executive officer, the chief financial officer etc. These positions are extremely impactful on the product and services these organizations provide and allow them to better support direct care facilities in providing safe, quality patient care with the latest and most up to date services and technologies. While ultimately, all companies are seeking to make profits in order to enhance their company and pay their employees it is important to look at how indirect care supports direct care oganizations.
Correleation
Although not directly involved in the intracicies of patient care, there is a direct correleation to the work done in indirect care facilities with direct care facilities. One of the most major sector of indirect care, and likely the fastest growing is the field of Healthcare Information Technology. Healthcare information technology or HIT is defined as “the application of information processing involving both computer hardware and software that deals with the storage, retrieval and use of healthcare information, data, and knowledge for communication and decision making.” (Alotaibi & Frederico., 2017). One way that healthcare technology influences direct care organizations is through the use of automated reminders and alerts in computers that support clinicians and support staff with safety nets in the clinical decision making process. For example, hard stops in Electronic health records, which are stops implemented that cause a user to address the issue at hand before continuing with care have been shown to decrease prescription errors by 22% (Feldman et al., 2018).
Another major implementation that Healthcare information technology has implemented is the development of the Electronic Health Record. The electronic health record has been a major introduction in the world of healthcare that has improved the quality of care, patient outcomes, safety and reduced medication errors, redundant testing, and improved overall communication between providers. With their creation, medical organizations that participate in direct care have been able to significantly increase their productivity, abandon old outdated and dangerous paper charting and have been provi ...
1 day agoBenjamin Proffitt Discussion 7COLLAPSETop of FoAbbyWhyte974
1 day ago
Benjamin Proffitt
Discussion 7
COLLAPSE
Top of Form
Job Oppurtunities
Indirect care settings are defined as services that are related to patient care but do not require interactions between the healthcare provider and the patient. There is a vast amount of jobs and professions related to Indirect care that make this an extremely explosive market for those seeking to join the medical field. Indirect care organizations are organizations such as pharmaceutical companies, insurance carriers, health information technologists and many more. Job oppurtunities for those seeking a degree and employment in the field of health care administration could seek out jobs in these fields to include the Director of Quality control, the chief executive officer, the chief financial officer etc. These positions are extremely impactful on the product and services these organizations provide and allow them to better support direct care facilities in providing safe, quality patient care with the latest and most up to date services and technologies. While ultimately, all companies are seeking to make profits in order to enhance their company and pay their employees it is important to look at how indirect care supports direct care oganizations.
Correleation
Although not directly involved in the intracicies of patient care, there is a direct correleation to the work done in indirect care facilities with direct care facilities. One of the most major sector of indirect care, and likely the fastest growing is the field of Healthcare Information Technology. Healthcare information technology or HIT is defined as “the application of information processing involving both computer hardware and software that deals with the storage, retrieval and use of healthcare information, data, and knowledge for communication and decision making.” (Alotaibi & Frederico., 2017). One way that healthcare technology influences direct care organizations is through the use of automated reminders and alerts in computers that support clinicians and support staff with safety nets in the clinical decision making process. For example, hard stops in Electronic health records, which are stops implemented that cause a user to address the issue at hand before continuing with care have been shown to decrease prescription errors by 22% (Feldman et al., 2018).
Another major implementation that Healthcare information technology has implemented is the development of the Electronic Health Record. The electronic health record has been a major introduction in the world of healthcare that has improved the quality of care, patient outcomes, safety and reduced medication errors, redundant testing, and improved overall communication between providers. With their creation, medical organizations that participate in direct care have been able to significantly increase their productivity, abandon old outdated and dangerous paper charting and have been provi ...
HIM 500 Milestone One Guidelines and Rubric Overview I.docxpooleavelina
HIM 500 Milestone One Guidelines and Rubric
Overview: Imagine you have been contracted to consult on the recent developments at the Featherfall Medical Center. Featherfall has been struggling of late; it
has had a series of problems that have prompted your hiring. It has faced the following issues:
1. Featherfall has recently violated several government regulations regarding the current state of its technology and how it is being used. The technology
system is vastly out of date, and staff are not always using the technology that is in place or they are using the technology inappropriately. These
problems have lost the institution lots of money for not meeting government regulations and have caused operational and ethical problems from
inefficient and ineffective use of technology.
2. The staff at Featherfall are not well-trained on the use of technology and do not communicate appropriately about technology use. The roles that
pertinent to your consult are the health information management team, the clinical staff (doctors, nurses, etc.), and administrative staff. The health
information management team uses proper coding practices, and the current technology system serves them well, despite its age. However, other roles
in the hospital have had issues with the system. Clinical staff, for instance, have had record-keeping issues both due to lack of training on the system and
the system itself being out of date. Administrative staff within the organization have taken issue with the lack of communication about the technology
and its use between the various roles. When the current technology system was chosen many years ago, the needs of these various roles were not
considered.
In this milestone, you will submit a discussion of the history of healthcare information management/informatics and the current landscape in terms of
technology. This milestone will set the stage for your project.
Specifically the following critical elements must be addressed:
I. Preparation for Consult: In this section of your final project, you will prepare for your consultation on the organization’s technology choice. To prepare,
you will analyze the field of health information management for determining standard technologies and guidelines related to technology use in order to
inform your technology selection.
A. Analyze key historical events in the field of health informatics for how technology has been used that could inform the management of health
information. Be sure to support your response with appropriate examples.
B. Determine guidelines for technology use in the field of health information management that Featherfall could implement. Be sure to support
your response with research.
C. Determine the standard technologies currently used in the field of health information management. Be sure to support your response with
research. For example, what record-keeping technologies are typically used in the field?
D. Dev ...
Assignment 1 Legal Aspects of U.S. Health Care System Administrat.docxbraycarissa250
Assignment 1: Legal Aspects of U.S. Health Care System Administration
Due Week 3 and worth 200 points
Prevailing wisdom reinforces the fact that working in U.S. health care administration in the 21st Century requires knowledge of the various aspects of health laws as they apply to dealing with medical professionals. Further, because U.S. health care administrators must potentially interact with many levels of professionals beyond the medical profession, it is prudent that they be aware of any federal, state, and local laws that may be applicable to their organizations. Thus, their conduct is also subject to the letter of the law. They must evaluate the quality of their professional interactions and be mindful of the implications and ramifications of their decisions.
Nearly 65 million surgical operations were performed in 2015 in the U.S. resulting in an estimated 200,000 deaths from complications or other post-operative issues (Ghaferi, Myers, Sutcliffe, & Pronovost, 2016). Ongoing innovation in healthcare can improve patient outcomes. According to the Harvard Business Review article, The Next Wave of Hospital Innovation to Make Patients Safer, over the past several decades, there have been three distinct waves of surgical improvement: technical advancements, standardizing procedures, and high reliability organizing.
Assume the role of a top health administrator at We Care Hospital. You are interested in propelling the hospital to the next level by applying for the Malcolm Baldrige National Quality Award. However, you want to ensure surgical outcomes for patient morbidity and mortality rates. You begin by researching the Surgical Care Improvement Project (SCIP) aimed to improve adherence to quality protocols. You need to ensure the hospital policy is consistent with the law and that the hospital is correctly reporting Sentinel Events to the Joint Commission, a hospital regulatory agency.
Note: You may create and / or make all necessary assumptions needed for the completion of this assignment.
Write a three to four (3-4) page paper in which you:
1. Analyze how standardizing procedures and documenting steps can improve outcomes when performing a complex procedure. Review the peer-reviewed journal article, The Next Wave of Hospital Innovation to Make Patients Safer. Articulate your position as the top administrator concerned about the importance of professional conduct and negligence in SCIP quality guidelines.
2. High Reliability Organizing emphasizes the varying actions that can affect patient safety given that standardized systems ignore the fact that each patient is different. Ascertain the major ramifications when the health care team “fails to rescue” the patient. Identify what hospital policies should be in place and identify previous case laws.
3. Analyze the four (4) elements required of a plaintiff to prove medical negligence.
4. Discuss the overarching duties of the health care governing board in mitigating the effects of medical non- ...
Exercises in Measurement and validity For this assignment, you.docxSANSKAR20
Exercises in Measurement and validity
For this assignment, you will be working through questions regarding measurement and validity.. Your answers should be written in complete sentences. Some of the answers may require you to show your work.
1. You have just started a new diet program. To mark your progress, you start weighing yourself three times a day. You also notice that each time you weigh yourself in a given day, the number of pounds is different. Based on the rules regarding the scales of measurement, why is it wrong to weigh yourself more than once a day?
2. Your hospital administration has received several phone complaints from patients about rude behavior from registration staff and long wait times to register in both the Dermatology and Audiology Outpatient Clinics. A decision is made to send a patient satisfaction survey to all Outpatient Clinic patients to determine overall patient satisfaction in the hospital’s Clinic setting. The survey developed uses this type of scoring: 1 = strongly disagree and 5 = strongly agree. What type of scale of measurement is this?
3. Your hospital wants to study patients readmitted within 30-days. What measures (e.g. Medicare patients only) would you recommend be included in the study (identify at least 3)? Where would you locate the data elements (e.g. admission records)?
4. Your hospital’s Pharmacy and Therapeutics Committee undertook a quality review of Medication forms from discharges in the first quarter of the year and identified the errors by 5 general categories and then calculated the percentage of the total errors by category. The results were: Dosage Form 6%, Name confusion 13%, Communication 19%, Labeling 20%, and Human Factors 42%. As the HIM Director you are a member of the P&T Committee, the Chair asks you to prepare a graphic display of the error results for Medical Staff review. What is the best choice of a graphic display to present this data to the Medical Staff? And why
a. Line Graph
b. Bar Graph
c. Pie chart
d. Data Table
5. Provide a definition and example for the following terms:
a. Content validity
b. Construct validity
c. Criterion validity
Running head: BUSINESS AND USER REQUIREMENTS DOCUMENT DRAFT 1
BUSINESS AND USER REQUIREMENTS DOCUMENT DRAFT 6
Business and User Requirements Document Draft
thanks for your Draft report on the EHR project and requirements. There are 3 main parts to cover: Sources of information, departments affected: Provide more information about the clinical departments. HIM is not the "most important" department for this system. Clean up some of the writing possible errors or misunderstandings, too. 5 /7 Methods to gather information: Glad you mentioned interviews, focus groups, and questionnaires and explained all three. 7 /7
Requirements statements:3 /6 You are not quite understanding what Requirements are yet. They are what the system must do. We will get later on in the class, onto project implementation tasks such ...
Workflow RedesignAfter conducting a thorough gap analysis, the.docxvelmakostizy
Workflow Redesign
After conducting a thorough gap analysis, the next step in the systems development life cycle (SDLC) is to target potential solutions to the gaps. There may be many potential solutions that can help to address workflow issues and inefficiencies, or there may be one seemingly obvious solution that could address almost all of the gaps in the current-state workflow. The challenge lies in selecting the most appropriate course of action from potential solutions that also works within organizational constraints.
In this Discussion, you revisit the scenarios from the Week 3 Discussion. You determine the possible avenues for workflow redesign and consider the constraints and factors that might impact your decision.
Scenario 1:
Stephanie is a nurse practitioner at Central Care Hospital who is often involved in administering prescribed medications for patients in the general care ward. When a physician sees a patient, he or she uses the hospital’s electronic health record (EHR) to document findings and recommendations for treatment but submits medication and drug orders by faxing prescriptions to the hospital’s pharmacy. Before Stephanie administers the medications from the pharmacy, she must cross-check the medication and dosage with the physician’s notes and patient information in the EHR. In doing so, Stephanie often identifies problems with the medication the physician prescribed; patients are sometimes prescribed a medication to which they have a known allergy or one that conflicts with another medication they are currently taking. In addition, the pharmacy sometimes sends the wrong medication or the wrong dosage. Furthermore, for patients who have been transferred from other parts of the hospital, such as the intensive care unit or the maternity ward, Stephanie often encounters duplicate drug orders or incorrect medications sent from the pharmacy.
Scenario 2:
General Health Hospital is implementing new outreach programs and preventative care support groups for patients with certain conditions or health risks, such as diabetes, smoking, and obesity. Philip, a nurse leader, is the manager of a team of nurses to organize these programs and groups and to identify patients who would be eligible and interested in being involved in these opportunities. However, Philip and his team have run into a variety of challenges and problems as they attempt to complete these tasks. In identifying patients to contact about the outreach programs and support groups, Philip’s team has had to browse the hospital’s entire electronic health record (EHR). The team has also run across significant holes in the EHR as they try to contact patients; many patients’ contact information is inaccurate or out of date. Furthermore, Philip’s team has partnered with the hospital’s Appointments Desk personnel in sending reminders about meeting dates and times to patients who express interest. However, the Appointments Desk often either neglects to send out these.
Nutrition CounselingDiscussion TopicTop of FormBottom of FormTatianaMajor22
Nutrition Counseling
Discussion Topic
Top of FormBottom of Form
Discussion Prompt
Healthy People 2030 identifies objectives related to nutrition and its role in promoting health and reducing chronic disease risk. Choose one preventable chronic condition from the list. As a nurse practitioner, how will you educate your patient about nutrition to help prevent your chosen chronic condition? Support your answer with evidence-based research.
Expectations
Initial Post:
APA format with intext citations
Word count minimum of 250, not including references.
References: 2 high-level scholarly references within the last 5 years in APA format.
Plagiarism free.
Turnitin receipt.
Module 06 Content
Top of Form
Collect the knowledge you gathered in this course and prepare a 10+ slide PowerPoint presentation as if you were presenting to your workgroup. Make sure you touch on a topic from each week and describe what things you would like to immediately implement. Your presentation should be APA formatted if outside research is cited and free from grammatical errors.
Gather your research from at least 2 sources, other than your textbook. Cite your sources using APA guidelines. All submitted work should be free of grammatical errors.
Bottom of Form
Explain how the globalization of healthcare can impact the improvement and outcome of healthcare results and subsequently improve healthcare costs.
The globalization of healthcare has provided opportunities for many organizations to rapidly develop their products and to expand their network of customers. But with this globalization, we also need to realize there are also a number of important economic and public health concerns.
Healthcare organizations have an obligation to understand the interdependencies inherent in their supply chains, and to examine their supply chain practices through a strategic lens focused on the public's health. We are seeing changes in where and how many healthcare products are produced and this is not always in the best interest of U.S. hospitals or our patients.
4
Company Analysis
Marion Allen
Rasmussen College
Healthcare Operations Management
Deborah Ryan
July 9th, 2022
Company Analysis
The role of managers and technology
As technology is becoming a big part of the health care systems, the role of health information managers is becoming more significant. There is a large amount of information related to the patients in a single hospital; the managers must analyze and organize this information by storing it in electronic health records. This helps keep the information about the patient's medical condition and any other medical history on a cloud that the internet can access. The manager should have enough knowledge related to technology to help him monitor technological aspects (Alolayyan, 2020). The managers must also ensure that the staff members have the required training and information related to the technology used in the healthcare facility.
Ways to improve heal ...
The Nurse Leader as Knowledge WorkerHenry Ehizokhale.docxarnoldmeredith47041
The Nurse Leader as Knowledge Worker
Henry Ehizokhale
Walden University
Transforming Nursing And Health Through Technology
NURS 6051
Nov 27, 2019
1
The Nurse Leader as Knowledge Worker
2
Purpose
Explain the concept of a knowledge worker.
Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.
The concept of a knowledge worker
The term “knowledge worker” was first coined by Peter Drucker. Ducker defined knowledge workers as high-level workers who apply theoretical and analytical knowledge, acquired through formal training, to develop products and services (CFI, 2019). He emphasized that due to the high level of productivity and creativity of knowledge worker, that they would be the most valuable assets in the 21st century organization. Professionals that can be referred to as knowledge worker includes engineers, pharmacists, architects, financial analysts, public accountants, physicians, scientists, design thinkers, and lawyers. Furthermore, knowledge workers have a high degree of expertise, experience, education and the primary purpose of their jobs involve the distribution, creation and application of knowledge.
3
Definition of a knowledge worker by Peter Drucker
Professional that are referred to as knowledge worker
Nursing Informatics
Nursing Informatics is a subset of informatics, specific to the nursing field and the role of the nurse in the healthcare setting. There has been several interpretation of nursing informatics. The American Nurses Association (ANA), identified nursing informatics as a specialty that integrates nursing, science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice (ANA, 2001, pg.17).
4
Nurse leader as a knowledge worker.
A nurse leader is one who inspire others to work together to achieve a common goal, for instance enhanced patient care or satisfaction. All nurses are called to nurse leadership, however there are different levels of nurse leadership. Nurse leaders are expected to help the organization to fulfill the organization’s mission, vision, values, and strategies to achieve long-range plans. Nurse leaders part take in policy setting, overseeing quality measures are carried out, accountability for overall quality of patient care delivery, staff satisfaction and organizational outcomes. For a nurse leader as a knowledge worker to be productive in an organization, the nurse leader must understand that knowledge work requires continuous learning on the part of the knowledge worker, but equally continuous teaching on the part of the knowledge worker. Having said that, a knowledge worker nurse leader will depend hugely on evidenced based practice to be productive in a healthcare organization. The use of EBP by knowledge worker nurse leader will require learning and teaching. Most healthcare organizations or hospitals rely on evidenced based.
Preparing physicians for a future will likely look very different than things look today. Increasing costs, value-based payment models (e.g., PDGM), and personalized care (in the home) are all coming together to disrupt traditional health care ecosystems.
This presentation addresses:
- What's driving physician changes
- Physician burnout
- Evolving care model
- Technology advances
- Physician's changing roles
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, DioneWang844
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, AND PROJECT INSTRUCTIONS
Page | 1
Quality
Nearly fifteen years ago, the Institute of Medicine published the “To Err Is Human” report, which exposed the substantial impact of medical errors in the US healthcare system and called for a dramatic system change, including an improved understanding of those errors (McCarthy, Tuiskula, Driscoll, & Davis, 2017). Medical errors are considered to be failure to achieve the original goal or plan of action, and these errors may range from a patient falls to a mistake in the operating room. Not only do medical errors cause harm to the patient and jeopardize the patient’s trust, but they also cause a financial strain for the health system (“To Err is Human,” 1999). One of the contributing factors to medical errors is the lack of effective communication between doctors who are treating the same patient. This results in healthcare providers overprescribing medications for patients as well as increases the possibility of a patient having unnecessary tests or procedures performed. The report’s four-tiered approach includes:
· Focusing on creating a stronger foundation of education on patient safety
· Mandating a nationwide reporting system to encourage timely reporting of errors
· Increasing the standards of performance for healthcare providers
· Taking advantage of the security that safety systems offer (“To Err is Human,” 1999)
Creating a strong educational foundation for patient safety is most important. Healthcare personnel are much more likely to actively participate in reporting systems, encourage one another to perform at a higher level, and take advantage of safety systems when they are well educated on patient safety and the implications of medical errors. The reporting system seems to provide the least amount of impact on patient safety as they can result in losing patient trust in certain healthcare systems. The healthcare system as a whole has made progress in establishing a safe environment for patients when they are in need of care.
Challenges for Patient Safety and Steps for Improvement
Despite continuing evidence of problems in patient safety and gaps between the care that patients receive and the evidence about what they should receive, efforts to improve quality in healthcare show mostly inconsistent and patchy results.
Tap each image to know more.
Data Collection and Monitoring Systems
This always takes much more time and energy than anyone anticipates. It is worth investing heavily in data from the outset. Assess local systems, train people, and have quality assurance.
Tribalism and Lack of Staff Engagement
Overcoming a perceived lack of ownership and professional or disciplinary boundaries can be very difficult. Clarify who owns the problem and solution, agree roles and responsibilities at the outset, work to common goals, and use shared language.
Convince People That There's a Problem
Use hard data to secure emotional e ...
COMPETIVENESS AND PERFORMANCE COMPETIVENESS AN.docxdonnajames55
COMPETIVENESS AND PERFORMANCE
COMPETIVENESS AND PERFORMANCE
Competiveness and Performance Effectiveness for Health Care IT Systems
Teresa Pride
Strayer University
February 25, 2018
Dr. Renita Ellis
HSA 315 Health Information Systems
Information technology (IT) has undergone significant improvements thereby requiring organizations to integrate these technologies to remain competitive. Considerably, health institutions are striving to improve primary care delivery, a facet that can be attained by incorporating the use of IT in service delivery. Information technology systems enable these institutions to streamline their processes based on its ability to improve the communication aspect of the system. Enhanced communication between employees and management simplify the organization’s operations as information can be shared in real time. Notably, healthcare institutions have priorities that must be addressed adequately to ensure that both the patients and stakeholders are satisfied with the organization’s service delivery system. Based on this, the institutions ought to retain IT management personnel to sustain its processes. This paper discusses the responsibilities and characteristics of the Chief Information and Chief Technology Officers. Additionally, the paper outlines how technologies can be used to improve healthcare processes, approaches to prevent misuse of information by upholding data privacy, strategies for organizations to train providers in using IT, and best practices for efficient IT alignment with strategic planning initiatives.
Characteristics and Roles of a CTO and a CIO
Often people confuse the two important senior leadership roles within the health care organization, the Chief Information Officer and Chief Technology Officer (Wager, Lee and Glaser 2013). Despite this, they have distinct tasks that must be performed to ensure the smooth running of the healthcare organization. Primarily, the CTO ensures that the institution’s services are tailored to meet the needs of the consumers. Notably, technological innovations are continually evolving thereby the organizations should retain an individual who is conversant with the new changes whenever they occur. In this regard, the CTO has the responsibility of advising top-level executives on strategic decisions regarding technology (Stephens, Ledbetter, Mitra & Ford, 2011). Additionally, the CTO identifies, evaluates and examines high return and high-risk IT systems with the potential of its application within the organization. As a result, the CTO must assess and monitor technologies for use in better service delivery in the future. The CTO’s focus is the client whereby he/she uses technology to foster collaboration amid suppliers and management to promote the organization’s services (Stephens, Ledbetter, Mitra & Ford, 2011). As the CTO works in the external environment, he/she can comprehend what is working in other institutions and apply it within the organization.
1-Racism Consider the two films shown in class Night and Fog,.docxcatheryncouper
1-Racism:
Consider the two films shown in class "Night and Fog", and "Mr. Tanimoto's Journey". What do you think are the salient similarities, if any? What are the crucial differences? Why?
2- Slavery New & Old
Bales notes that New Slavery is very different from Old Slavery. What are some of the differences he describes? What are the links between New Slavery and the Globalized Economy?
Bales also notes that there are things we each can do to end slavery, but that this requires taking a "very dispassionate look at slaves as a commodity" (Bales 250). Why?
Finally, he suggests that activism without a broad-based explanatory framework is worse than none at all. Why does he think so? Do you agree? Why or why not?
3- Human- The Film
How, if at all, does the film "Human" resonate with or reflect themes explored in What Matters? Which of the characters was most compelling to you, and why?
4- Culture and Power Create Scarcity
Recognize that power and culture are inseparable, one does not exist without the other, and currently the dominant form of culture is based upon industrial production requiring essentially infinite energy supplies – which do not in fact exist. So we collectively face a terrible problem. And yet the greatest burden of this problem is being borne by those least able to do anything about it, while at the same time those who benefit most from the economic inequalities imposed by the culture of industrial production and imposed scarcity are unwilling or unable to recognize that things cannot continue as they are. This is our dilemma; one we must solve now or ignore and risk facing unimaginable chaos later.
Concerned about the ultimate implications of his theories about space, time and energy, Einstein pointed out that 20th century problems would never be solved by 19th century thinking. Indeed, by the same token, 21st century problems will not be solved with 20th century thinking either. The same can be said for oversimplified false dichotomies between 'conservatives' and 'liberals' and particularly 'capitalism' and 'communism'. The latter pair of binary opposites are 19th century ideas while the former are legacies of the 20th century.
We are well beyond the political and economic circumstances that informed such artificially limited conceptualizations of the human condition in many, many ways. And yet, these same tired inaccurate philosophical cages are still supposed to encompass the almost infinite variety and subtleties of contemporary global and local political economies? This is essentially the problem Einstein was concerned with when he noted the conceptual poverty of such willed ignorance. Our technological capacity has outstripped our cultural mechanisms of maintaining social control (consider greed: how much is enough?) and exacerbated our ability to impose physically violent solutions to complex and entirely negotiable problems. Our challenge now is to reassert the primacy of compassion and respect for differenc.
1-http://fluoridealert.org/researchers/states/kentucky/
2-
3-School fluoridation studies in Elk Lake, Pennsylvania, and Pike County, Kentucky--results after eight years.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1229128/?page=1
4-American Association for Dental Research Policy Statement on Community Water Fluoridation
http://journals.sagepub.com/doi/abs/10.1177/0022034518797274
5- Ground-Water Quality in Kentucky: Fluoride - University of Kentucky
http://www.uky.edu/KGS/pdf/ic12_01.pdf
6-Kentucky Oral Health Program Brochure - Cabinet for Health.
https://chfs.ky.gov/agencies/dph/dmch/cfhib/Oral%20Health%20Program/beigebrochureoralhealth80107.pdf
7-
8-
9-
PIIS00028177146263
98.pdf
746 JADA, Vol. 131, June 2000
Enamel fluorosis is a hypomineralization of the
enamel caused by the ingestion of an amount of
fluoride that is above optimal levels during
enamel formation.1,2 Clinically, the appearance of
enamel fluorosis can vary. In its mildest form, it
appears as faint white lines or streaks visible
only to trained examiners under controlled exam-
ination conditions. In its pronounced form, fluo-
rosis manifests as white mottling of the teeth in
which noticeable white lines or streaks often
have coalesced into larger opaque areas.2,3 Brown
staining or pitting of the enamel also may be
present.2,3 In its most severe form, actual break-
down of the enamel may occur.2,3
In recent years, there has been an increase in
the prevalence of children seen with enamel fluo-
A B S T R A C T
Background. Few studies have evaluated the
impact of specific fluoride sources on the prevalence of
enamel fluorosis in the population. The author con-
ducted research to determine attributable risk percent
estimates for mild-to-moderate enamel fluorosis in two
populations of middle-school–aged children.
Methods. The author recruited two groups of
children 10 to 14 years of age. One group of 429 had
grown up in nonfluoridated communities; the other
group of 234 had grown up in optimally fluoridated
communities. Trained examiners measured enamel
fluorosis using the Fluorosis Risk Index and meas-
ured early childhood fluoride exposure using a ques-
tionnaire completed by the parent. The author then
calculated attributable risk percent estimates, or the
proportion of cases of mild-to-moderate enamel fluo-
rosis associated with exposure to specific early fluo-
ride sources, based on logistic regression models.
Results. In the nonfluoridated study sample,
sixty-five percent of the enamel fluorosis cases were
attributed to fluoride supplementation under the pre-
1994 protocol. An additional 34 percent were
explained by the children having brushed more than
once per day during the first two years of life. In the
optimally fluoridated study sample, 68 percent of the
enamel fluorosis cases were explained by the children
using more than a pea-sized amount of toothpaste
during the first year of life, 13 percent by having
been inappropriately given a fluoride supple.
1. Consider our political system today, in 2019. Which groups of peo.docxcatheryncouper
1. Consider our political system today, in 2019. Which groups of people are
excluded from participating in the political process?
Please identify at least two groups of people who are excluded and engage with at least one of your colleagues and explain why you either agree or disagree with the group of people that they identified. As always, use your critical thinking skills to answer this.
2.
What speech is protected under the
first amendment
and what speech is
excluded
from first amendment protection? And why?
.
1-Ageism is a concept introduced decades ago and is defined as .docxcatheryncouper
1-Ageism is a concept introduced decades ago and is defined as “the prejudices and stereotypes that are applied to older people sheerly on the basis of their age…” (Butler, Lewis, & Sutherland, 1991).
DQ: What are some common misconceptions you have heard or believed about older adults? What can you do to dispel these myths?
2-Please use textbook as, at least, one reference.
3-Please abide by APA 7th edition format in your writing.
4-Answers should be 2-3 Paragraphs made up of 3-4 sentences each
UNIT 1 CHAPTER 4 LIFE TRANSITIONS AND HISTORY (ATTACHED)
.
1. Create a PowerPoint PowerPoint must include a minimum of.docxcatheryncouper
1.
Create a PowerPoint:
PowerPoint must include a minimum of 12 slides (including Title Slide and Reference slide). Ensure that information is cited in-text throughout the presentation. Use inspirational quotes, graphics, visual aids, and video clips to enhance your presentation. Ensure that information included on your slides is properly paraphrased and cited; the use of direct quotes is prohibited. A minimum of three sources should be included (your textbook counts); ensure sources are credible.
Once you have chosen your format, choose a type of stress (schoolwork, family, job, a relationship, etc) and answer all of the following questions:
1. Give examples that causes the stress.
2. Describe healthy coping mechanisms you can use to help with stress.
3. Discuss of the warning signs of stress is in your life.
4. Describe the short-term effects stress can have on an individual.
5. Describe the long-term effects stress can have on an individual.
.
1. Compare vulnerable populations. Describe an example of one of the.docxcatheryncouper
1. Compare vulnerable populations. Describe an example of one of these groups in the United States or from another country. Explain why the population is designated as "vulnerable." Include the number of individuals belonging to this group and the specific challenges or issues involved. Discuss why these populations are unable to advocate for themselves, the ethical issues that must be considered when working with these groups, and how nursing advocacy would be beneficial.
2.
How does the community health nurse recognize bias, stereotypes, and implicit bias within the community? How should the nurse address these concepts to ensure health promotion activities are culturally competent? Propose strategies that you can employ to reduce cultural dissonance and bias to deliver culturally competent care. Include an evidence-based article that address the cultural issue. Cite and reference the article in APA format.
.
1. Complete the Budget Challenge activity at httpswww.federa.docxcatheryncouper
1. Complete the Budget Challenge activity at: https://www.federalbudgetchallenge.org/challenges/20/pages/overview
a. Keep a record of your selections and why you decided to select them and not the other options. ( keep a record of your selections in piece of paper so you can go back and reflect on your choices in your write-up. For instance, the first choice is about investments. So, on a piece of paper write down whether you selected any of the investment choices and a quick note about why you chose (for example) to spend $30B to establish a National Infrastructure Bank but didn't select to invest in the other options.) your selections as those reflect your own personal, subjective, choices. I will grade the assignment based on whether you have provided a thoughtful written response that answers the questions posted on the instructions.
b. When you’ve finished, save your results summary page.
2. Write a 2.5+ page summary overview of your experience, discussing your budget selections and analyzing your responses. Use the following questions to guide your response, but don't be limited by them:
a. What was challenging?
b. What was easy?
c. What do your selections say about your policy priorities and political ideologies?
** source: (Author Last Name, Year, pg.)
June 2003: WAY IN THE MIDDLE OF THE AIR
“Did you hear about it?”
“About what?”
“The niggers, the niggers!”
“What about ’em?”
“Them leaving, pulling out, going away; did you hear?”
“What you mean, pulling out? How can they do that?”
“They can, they will, they are.”
“Just a couple?”
“Every single one here in the South!”
“No.”
“Yes!”
“I got to see that. I don’t believe it. Where they going — Africa?”
A silence.
“Mars.”
“You mean the planet Mars?”
“That’s right.”
The men stood up in the hot shade of the hardware porch. Someone quit lighting a pipe. Somebody else spat out into the hot dust of noon.
“They can’t leave, they can’t do that.”
“They’re doing it, anyways.”
“Where’d you hear this?”
“It’s everywhere, on the radio a minute ago, just come through.”
Like a series of dusty statues, the men came to life.
Samuel Teece, the hardware proprietor, laughed uneasily. “I wondered what happened to Silly. I sent him on my bike an hour ago. He ain’t come back from Mrs. Bordman’s yet. You think that black fool just pedaled off to Mars?”
The men snorted.
“All I say is, he better bring back my bike. I don’t take stealing from no one, by God.”
“Listen!”
The men collided irritably with each other, turning.
Far up the street the levee seemed to have broken. The black warm waters descended and engulfed the town. Between the blazing white banks of the town stores, among the tree silences, a black tide flowed. Like a kind of summer molasses, it poured turgidly forth upon the cinnamon-dusty road. It surged slow, slow, and it was men and women and horses and barking dogs, and it was little boys and girls. And from the mouths of the people partaking of this tide came the sound of a river. A summer-.
1. Connections between organizations, information systems and busi.docxcatheryncouper
1. Connections between organizations, information systems and business processes.
2. There are a number of benefits associated with cutting edge business analytics.
3. Three conditions that contribute to data redundancy and inconsistency are:
4. Network neutrality
5. Simple Object Access Protocol (SOAP).
6. Outsourcing IT-advantages and disadvantages
7. The security challenges faced by wireless networks
.
1-Experiences with a Hybrid Class Tips And PitfallsCollege .docxcatheryncouper
1-Experiences with a Hybrid Class: Tips And Pitfalls
College Teaching Methods & Styles Journal, 2006, Vol.2(2), p.9-12
Notes
This paper will discuss the author's experiences with converting a traditional classroom-based course to a hybrid class, using a mix of traditional class time and web-support. The course which was converted is a lower-level human relations class, which has been offered in both the traditional classroom-based setting and as an asynchronous online course. After approximately five years of offering the two formats independently, the author decided to experiment with improving the traditional course by adopting more of the web-based support and incorporating more research and written assignments in "out of class" time. The course has evolved into approximately 60% traditional classroom meetings and 40% assignments and other assessments out of class. The instructor's assessment of the hybrid nature of the class is that students are more challenged by the mix of research and writing assignments with traditional assessments, and the assignments are structured in such a way as to make them more "customizable" for each student. Each student can find some topics that they are interested in to pursue in greater depth as research assignments. However, the hybrid nature of the class has resulted in an increased workload for the instructor. The course has been well received by the students, who have indicated that they find the hybrid format appealing.
2-Undergraduate Research Methods: Does Size Matter? A Look at the Attitudes and Outcomes of Students in a Hybrid Class Format versus a Traditional Class Format.
Author
Gordon, Jill A.
Barnes, Christina M.
Martin, Kasey J.
Publisher
Taylor & Francis Ltd
Is Part Of
Journal of Criminal Justice Education, 2009, Vol.20 (3), p.227-249
Notes
The goal of this study is to understand if there are any variations regarding student engagement and course outcomes based on the course format. A new course format was introduced in fall of 2006 that involves a hybrid approach (large lecture with small recitations) with a higher level of student enrollment than traditional research methods courses. During the same time frame, the discipline maintained its traditional research methods courses as well. A survey was administered to all students enrolled in research methods regardless of course format in fall 2006 and spring 2007. Student responses are discussed, including information concerning the preparation, design, cost and benefits of offering a hybrid research methods course format.
3- Distance Education: Linking Traditional Classroom Rehabilitation Counseling Students with their Colleagues Using Hybrid Learning Models.
Author
Main, Doug
Dziekan, Kathryn
Publisher
Springer Publishing Company, Inc.
Is Part Of
Rehabilitation Research, Policy & Education, 2012, Vol.26 (4), p.315-321
Notes
Current distance learning technological advances allow real and virtual classrooms to unite. In this .
RefereanceSpectra.jpg
ReactionInformation.jpg
WittigReactionOfTransCinnamaldehye.docx
Wittig Reaction of trans-Cinnamaldehyde
GOAL: Identify the major isomer of the Wittig reaction
E,E-1,4-diphenyl-1,3-butadiene OR E,Z-1,4-diphenyl-1,3-butadiene
Attached are the:
1. Drawing of the overall reaction
2. Drawing of the structure of the two possible isomers
3. Reference NMR spectra of what is labeled trans, trans-1,4-diphenyl-1,3-butadiene
4. IR spectra
5. UV vis spectra
6. 1H NMR not-detailed
7. 1H NMR detailed
8. BASED ON # 4, 5 and 7 Identify the major isomer of the Wittig reaction, can the integration values of the NMR be used to give approximate percent of each isomer
IR.jpg
UV-visSpectra.jpg
NMR.jpg
NMR-DeterminePredominantIsomer.jpg
...
Reconciling the Complexity of Human DevelopmentWith the Real.docxcatheryncouper
Reconciling the Complexity of Human Development
With the Reality of Legal Policy
Reply to Fischer, Stein, and Heikkinen (2009)
Laurence Steinberg Temple University
Elizabeth Cauffman University of California, Irvine
Jennifer Woolard Georgetown University
Sandra Graham University of California, Los Angeles
Marie Banich University of Colorado
The authors respond to both the general and specific con-
cerns raised in Fischer, Stein, and Heikkinen’s (2009)
commentary on their article (Steinberg, Cauffman, Wool-
ard, Graham, & Banich, 2009), in which they drew on
studies of adolescent development to justify the American
Psychological Association’s positions in two Supreme
Court cases involving the construction of legal age bound-
aries. In response to Fischer et al.’s general concern that
the construction of bright-line age boundaries is inconsis-
tent with the fact that development is multifaceted, variable
across individuals, and contextually conditioned, the au-
thors argue that the only logical alternative suggested by
that perspective is impractical and unhelpful in a legal
context. In response to Fischer et al.’s specific concerns
that their conclusion about the differential timetables of
cognitive and psychosocial maturity is merely an artifact of
the variables, measures, and methods they used, the au-
thors argue that, unlike the alternatives suggested by Fi-
scher et al., their choices are aligned with the specific
capacities under consideration in the two cases. The au-
thors reaffirm their position that there is considerable
empirical evidence that adolescents demonstrate adult lev-
els of cognitive capability several years before they evince
adult levels of psychosocial maturity.
Keywords: policy, science, adolescent development, chro-
nological age
In our article (Steinberg, Cauffman, Woolard, Graham,& Banich, 2009, this issue), we asked whether therewas scientific justification for the different positions
taken by the American Psychological Association (APA) in
two related Supreme Court cases—Hodgson v. Minnesota
(1990; a case concerning minors’ competence to make
independent decisions about abortion, in which APA ar-
gued that adolescents were just as mature as adults) and
Roper v. Simmons (2005; a case about the constitutionality
of the juvenile death penalty, in which APA argued that
adolescents were not as mature as adults). On the basis of
our reading of the extant literature in developmental psy-
chology, as well as findings from a recent study of our own,
we concluded that the capabilities relevant to judging in-
dividuals’ competence to make autonomous decisions
about abortion reach adult levels of maturity earlier than do
capabilities relevant to assessments of criminal culpability,
and that it was therefore reasonable to draw different age
boundaries between adolescents and adults in each in-
stance.
In their commentary on our article, Fischer, Stein, and
Heikkinen (2009, this issue) raised both general and spe-
cif ...
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Workflow Redesign
After conducting a thorough gap analysis, the next step in the systems development life cycle (SDLC) is to target potential solutions to the gaps. There may be many potential solutions that can help to address workflow issues and inefficiencies, or there may be one seemingly obvious solution that could address almost all of the gaps in the current-state workflow. The challenge lies in selecting the most appropriate course of action from potential solutions that also works within organizational constraints.
In this Discussion, you revisit the scenarios from the Week 3 Discussion. You determine the possible avenues for workflow redesign and consider the constraints and factors that might impact your decision.
Scenario 1:
Stephanie is a nurse practitioner at Central Care Hospital who is often involved in administering prescribed medications for patients in the general care ward. When a physician sees a patient, he or she uses the hospital’s electronic health record (EHR) to document findings and recommendations for treatment but submits medication and drug orders by faxing prescriptions to the hospital’s pharmacy. Before Stephanie administers the medications from the pharmacy, she must cross-check the medication and dosage with the physician’s notes and patient information in the EHR. In doing so, Stephanie often identifies problems with the medication the physician prescribed; patients are sometimes prescribed a medication to which they have a known allergy or one that conflicts with another medication they are currently taking. In addition, the pharmacy sometimes sends the wrong medication or the wrong dosage. Furthermore, for patients who have been transferred from other parts of the hospital, such as the intensive care unit or the maternity ward, Stephanie often encounters duplicate drug orders or incorrect medications sent from the pharmacy.
Scenario 2:
General Health Hospital is implementing new outreach programs and preventative care support groups for patients with certain conditions or health risks, such as diabetes, smoking, and obesity. Philip, a nurse leader, is the manager of a team of nurses to organize these programs and groups and to identify patients who would be eligible and interested in being involved in these opportunities. However, Philip and his team have run into a variety of challenges and problems as they attempt to complete these tasks. In identifying patients to contact about the outreach programs and support groups, Philip’s team has had to browse the hospital’s entire electronic health record (EHR). The team has also run across significant holes in the EHR as they try to contact patients; many patients’ contact information is inaccurate or out of date. Furthermore, Philip’s team has partnered with the hospital’s Appointments Desk personnel in sending reminders about meeting dates and times to patients who express interest. However, the Appointments Desk often either neglects to send out these.
Nutrition CounselingDiscussion TopicTop of FormBottom of FormTatianaMajor22
Nutrition Counseling
Discussion Topic
Top of FormBottom of Form
Discussion Prompt
Healthy People 2030 identifies objectives related to nutrition and its role in promoting health and reducing chronic disease risk. Choose one preventable chronic condition from the list. As a nurse practitioner, how will you educate your patient about nutrition to help prevent your chosen chronic condition? Support your answer with evidence-based research.
Expectations
Initial Post:
APA format with intext citations
Word count minimum of 250, not including references.
References: 2 high-level scholarly references within the last 5 years in APA format.
Plagiarism free.
Turnitin receipt.
Module 06 Content
Top of Form
Collect the knowledge you gathered in this course and prepare a 10+ slide PowerPoint presentation as if you were presenting to your workgroup. Make sure you touch on a topic from each week and describe what things you would like to immediately implement. Your presentation should be APA formatted if outside research is cited and free from grammatical errors.
Gather your research from at least 2 sources, other than your textbook. Cite your sources using APA guidelines. All submitted work should be free of grammatical errors.
Bottom of Form
Explain how the globalization of healthcare can impact the improvement and outcome of healthcare results and subsequently improve healthcare costs.
The globalization of healthcare has provided opportunities for many organizations to rapidly develop their products and to expand their network of customers. But with this globalization, we also need to realize there are also a number of important economic and public health concerns.
Healthcare organizations have an obligation to understand the interdependencies inherent in their supply chains, and to examine their supply chain practices through a strategic lens focused on the public's health. We are seeing changes in where and how many healthcare products are produced and this is not always in the best interest of U.S. hospitals or our patients.
4
Company Analysis
Marion Allen
Rasmussen College
Healthcare Operations Management
Deborah Ryan
July 9th, 2022
Company Analysis
The role of managers and technology
As technology is becoming a big part of the health care systems, the role of health information managers is becoming more significant. There is a large amount of information related to the patients in a single hospital; the managers must analyze and organize this information by storing it in electronic health records. This helps keep the information about the patient's medical condition and any other medical history on a cloud that the internet can access. The manager should have enough knowledge related to technology to help him monitor technological aspects (Alolayyan, 2020). The managers must also ensure that the staff members have the required training and information related to the technology used in the healthcare facility.
Ways to improve heal ...
The Nurse Leader as Knowledge WorkerHenry Ehizokhale.docxarnoldmeredith47041
The Nurse Leader as Knowledge Worker
Henry Ehizokhale
Walden University
Transforming Nursing And Health Through Technology
NURS 6051
Nov 27, 2019
1
The Nurse Leader as Knowledge Worker
2
Purpose
Explain the concept of a knowledge worker.
Define and explain nursing informatics and highlight the role of a nurse leader as a knowledge worker.
The concept of a knowledge worker
The term “knowledge worker” was first coined by Peter Drucker. Ducker defined knowledge workers as high-level workers who apply theoretical and analytical knowledge, acquired through formal training, to develop products and services (CFI, 2019). He emphasized that due to the high level of productivity and creativity of knowledge worker, that they would be the most valuable assets in the 21st century organization. Professionals that can be referred to as knowledge worker includes engineers, pharmacists, architects, financial analysts, public accountants, physicians, scientists, design thinkers, and lawyers. Furthermore, knowledge workers have a high degree of expertise, experience, education and the primary purpose of their jobs involve the distribution, creation and application of knowledge.
3
Definition of a knowledge worker by Peter Drucker
Professional that are referred to as knowledge worker
Nursing Informatics
Nursing Informatics is a subset of informatics, specific to the nursing field and the role of the nurse in the healthcare setting. There has been several interpretation of nursing informatics. The American Nurses Association (ANA), identified nursing informatics as a specialty that integrates nursing, science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice (ANA, 2001, pg.17).
4
Nurse leader as a knowledge worker.
A nurse leader is one who inspire others to work together to achieve a common goal, for instance enhanced patient care or satisfaction. All nurses are called to nurse leadership, however there are different levels of nurse leadership. Nurse leaders are expected to help the organization to fulfill the organization’s mission, vision, values, and strategies to achieve long-range plans. Nurse leaders part take in policy setting, overseeing quality measures are carried out, accountability for overall quality of patient care delivery, staff satisfaction and organizational outcomes. For a nurse leader as a knowledge worker to be productive in an organization, the nurse leader must understand that knowledge work requires continuous learning on the part of the knowledge worker, but equally continuous teaching on the part of the knowledge worker. Having said that, a knowledge worker nurse leader will depend hugely on evidenced based practice to be productive in a healthcare organization. The use of EBP by knowledge worker nurse leader will require learning and teaching. Most healthcare organizations or hospitals rely on evidenced based.
Preparing physicians for a future will likely look very different than things look today. Increasing costs, value-based payment models (e.g., PDGM), and personalized care (in the home) are all coming together to disrupt traditional health care ecosystems.
This presentation addresses:
- What's driving physician changes
- Physician burnout
- Evolving care model
- Technology advances
- Physician's changing roles
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, DioneWang844
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, AND PROJECT INSTRUCTIONS
Page | 1
Quality
Nearly fifteen years ago, the Institute of Medicine published the “To Err Is Human” report, which exposed the substantial impact of medical errors in the US healthcare system and called for a dramatic system change, including an improved understanding of those errors (McCarthy, Tuiskula, Driscoll, & Davis, 2017). Medical errors are considered to be failure to achieve the original goal or plan of action, and these errors may range from a patient falls to a mistake in the operating room. Not only do medical errors cause harm to the patient and jeopardize the patient’s trust, but they also cause a financial strain for the health system (“To Err is Human,” 1999). One of the contributing factors to medical errors is the lack of effective communication between doctors who are treating the same patient. This results in healthcare providers overprescribing medications for patients as well as increases the possibility of a patient having unnecessary tests or procedures performed. The report’s four-tiered approach includes:
· Focusing on creating a stronger foundation of education on patient safety
· Mandating a nationwide reporting system to encourage timely reporting of errors
· Increasing the standards of performance for healthcare providers
· Taking advantage of the security that safety systems offer (“To Err is Human,” 1999)
Creating a strong educational foundation for patient safety is most important. Healthcare personnel are much more likely to actively participate in reporting systems, encourage one another to perform at a higher level, and take advantage of safety systems when they are well educated on patient safety and the implications of medical errors. The reporting system seems to provide the least amount of impact on patient safety as they can result in losing patient trust in certain healthcare systems. The healthcare system as a whole has made progress in establishing a safe environment for patients when they are in need of care.
Challenges for Patient Safety and Steps for Improvement
Despite continuing evidence of problems in patient safety and gaps between the care that patients receive and the evidence about what they should receive, efforts to improve quality in healthcare show mostly inconsistent and patchy results.
Tap each image to know more.
Data Collection and Monitoring Systems
This always takes much more time and energy than anyone anticipates. It is worth investing heavily in data from the outset. Assess local systems, train people, and have quality assurance.
Tribalism and Lack of Staff Engagement
Overcoming a perceived lack of ownership and professional or disciplinary boundaries can be very difficult. Clarify who owns the problem and solution, agree roles and responsibilities at the outset, work to common goals, and use shared language.
Convince People That There's a Problem
Use hard data to secure emotional e ...
COMPETIVENESS AND PERFORMANCE COMPETIVENESS AN.docxdonnajames55
COMPETIVENESS AND PERFORMANCE
COMPETIVENESS AND PERFORMANCE
Competiveness and Performance Effectiveness for Health Care IT Systems
Teresa Pride
Strayer University
February 25, 2018
Dr. Renita Ellis
HSA 315 Health Information Systems
Information technology (IT) has undergone significant improvements thereby requiring organizations to integrate these technologies to remain competitive. Considerably, health institutions are striving to improve primary care delivery, a facet that can be attained by incorporating the use of IT in service delivery. Information technology systems enable these institutions to streamline their processes based on its ability to improve the communication aspect of the system. Enhanced communication between employees and management simplify the organization’s operations as information can be shared in real time. Notably, healthcare institutions have priorities that must be addressed adequately to ensure that both the patients and stakeholders are satisfied with the organization’s service delivery system. Based on this, the institutions ought to retain IT management personnel to sustain its processes. This paper discusses the responsibilities and characteristics of the Chief Information and Chief Technology Officers. Additionally, the paper outlines how technologies can be used to improve healthcare processes, approaches to prevent misuse of information by upholding data privacy, strategies for organizations to train providers in using IT, and best practices for efficient IT alignment with strategic planning initiatives.
Characteristics and Roles of a CTO and a CIO
Often people confuse the two important senior leadership roles within the health care organization, the Chief Information Officer and Chief Technology Officer (Wager, Lee and Glaser 2013). Despite this, they have distinct tasks that must be performed to ensure the smooth running of the healthcare organization. Primarily, the CTO ensures that the institution’s services are tailored to meet the needs of the consumers. Notably, technological innovations are continually evolving thereby the organizations should retain an individual who is conversant with the new changes whenever they occur. In this regard, the CTO has the responsibility of advising top-level executives on strategic decisions regarding technology (Stephens, Ledbetter, Mitra & Ford, 2011). Additionally, the CTO identifies, evaluates and examines high return and high-risk IT systems with the potential of its application within the organization. As a result, the CTO must assess and monitor technologies for use in better service delivery in the future. The CTO’s focus is the client whereby he/she uses technology to foster collaboration amid suppliers and management to promote the organization’s services (Stephens, Ledbetter, Mitra & Ford, 2011). As the CTO works in the external environment, he/she can comprehend what is working in other institutions and apply it within the organization.
1-Racism Consider the two films shown in class Night and Fog,.docxcatheryncouper
1-Racism:
Consider the two films shown in class "Night and Fog", and "Mr. Tanimoto's Journey". What do you think are the salient similarities, if any? What are the crucial differences? Why?
2- Slavery New & Old
Bales notes that New Slavery is very different from Old Slavery. What are some of the differences he describes? What are the links between New Slavery and the Globalized Economy?
Bales also notes that there are things we each can do to end slavery, but that this requires taking a "very dispassionate look at slaves as a commodity" (Bales 250). Why?
Finally, he suggests that activism without a broad-based explanatory framework is worse than none at all. Why does he think so? Do you agree? Why or why not?
3- Human- The Film
How, if at all, does the film "Human" resonate with or reflect themes explored in What Matters? Which of the characters was most compelling to you, and why?
4- Culture and Power Create Scarcity
Recognize that power and culture are inseparable, one does not exist without the other, and currently the dominant form of culture is based upon industrial production requiring essentially infinite energy supplies – which do not in fact exist. So we collectively face a terrible problem. And yet the greatest burden of this problem is being borne by those least able to do anything about it, while at the same time those who benefit most from the economic inequalities imposed by the culture of industrial production and imposed scarcity are unwilling or unable to recognize that things cannot continue as they are. This is our dilemma; one we must solve now or ignore and risk facing unimaginable chaos later.
Concerned about the ultimate implications of his theories about space, time and energy, Einstein pointed out that 20th century problems would never be solved by 19th century thinking. Indeed, by the same token, 21st century problems will not be solved with 20th century thinking either. The same can be said for oversimplified false dichotomies between 'conservatives' and 'liberals' and particularly 'capitalism' and 'communism'. The latter pair of binary opposites are 19th century ideas while the former are legacies of the 20th century.
We are well beyond the political and economic circumstances that informed such artificially limited conceptualizations of the human condition in many, many ways. And yet, these same tired inaccurate philosophical cages are still supposed to encompass the almost infinite variety and subtleties of contemporary global and local political economies? This is essentially the problem Einstein was concerned with when he noted the conceptual poverty of such willed ignorance. Our technological capacity has outstripped our cultural mechanisms of maintaining social control (consider greed: how much is enough?) and exacerbated our ability to impose physically violent solutions to complex and entirely negotiable problems. Our challenge now is to reassert the primacy of compassion and respect for differenc.
1-http://fluoridealert.org/researchers/states/kentucky/
2-
3-School fluoridation studies in Elk Lake, Pennsylvania, and Pike County, Kentucky--results after eight years.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1229128/?page=1
4-American Association for Dental Research Policy Statement on Community Water Fluoridation
http://journals.sagepub.com/doi/abs/10.1177/0022034518797274
5- Ground-Water Quality in Kentucky: Fluoride - University of Kentucky
http://www.uky.edu/KGS/pdf/ic12_01.pdf
6-Kentucky Oral Health Program Brochure - Cabinet for Health.
https://chfs.ky.gov/agencies/dph/dmch/cfhib/Oral%20Health%20Program/beigebrochureoralhealth80107.pdf
7-
8-
9-
PIIS00028177146263
98.pdf
746 JADA, Vol. 131, June 2000
Enamel fluorosis is a hypomineralization of the
enamel caused by the ingestion of an amount of
fluoride that is above optimal levels during
enamel formation.1,2 Clinically, the appearance of
enamel fluorosis can vary. In its mildest form, it
appears as faint white lines or streaks visible
only to trained examiners under controlled exam-
ination conditions. In its pronounced form, fluo-
rosis manifests as white mottling of the teeth in
which noticeable white lines or streaks often
have coalesced into larger opaque areas.2,3 Brown
staining or pitting of the enamel also may be
present.2,3 In its most severe form, actual break-
down of the enamel may occur.2,3
In recent years, there has been an increase in
the prevalence of children seen with enamel fluo-
A B S T R A C T
Background. Few studies have evaluated the
impact of specific fluoride sources on the prevalence of
enamel fluorosis in the population. The author con-
ducted research to determine attributable risk percent
estimates for mild-to-moderate enamel fluorosis in two
populations of middle-school–aged children.
Methods. The author recruited two groups of
children 10 to 14 years of age. One group of 429 had
grown up in nonfluoridated communities; the other
group of 234 had grown up in optimally fluoridated
communities. Trained examiners measured enamel
fluorosis using the Fluorosis Risk Index and meas-
ured early childhood fluoride exposure using a ques-
tionnaire completed by the parent. The author then
calculated attributable risk percent estimates, or the
proportion of cases of mild-to-moderate enamel fluo-
rosis associated with exposure to specific early fluo-
ride sources, based on logistic regression models.
Results. In the nonfluoridated study sample,
sixty-five percent of the enamel fluorosis cases were
attributed to fluoride supplementation under the pre-
1994 protocol. An additional 34 percent were
explained by the children having brushed more than
once per day during the first two years of life. In the
optimally fluoridated study sample, 68 percent of the
enamel fluorosis cases were explained by the children
using more than a pea-sized amount of toothpaste
during the first year of life, 13 percent by having
been inappropriately given a fluoride supple.
1. Consider our political system today, in 2019. Which groups of peo.docxcatheryncouper
1. Consider our political system today, in 2019. Which groups of people are
excluded from participating in the political process?
Please identify at least two groups of people who are excluded and engage with at least one of your colleagues and explain why you either agree or disagree with the group of people that they identified. As always, use your critical thinking skills to answer this.
2.
What speech is protected under the
first amendment
and what speech is
excluded
from first amendment protection? And why?
.
1-Ageism is a concept introduced decades ago and is defined as .docxcatheryncouper
1-Ageism is a concept introduced decades ago and is defined as “the prejudices and stereotypes that are applied to older people sheerly on the basis of their age…” (Butler, Lewis, & Sutherland, 1991).
DQ: What are some common misconceptions you have heard or believed about older adults? What can you do to dispel these myths?
2-Please use textbook as, at least, one reference.
3-Please abide by APA 7th edition format in your writing.
4-Answers should be 2-3 Paragraphs made up of 3-4 sentences each
UNIT 1 CHAPTER 4 LIFE TRANSITIONS AND HISTORY (ATTACHED)
.
1. Create a PowerPoint PowerPoint must include a minimum of.docxcatheryncouper
1.
Create a PowerPoint:
PowerPoint must include a minimum of 12 slides (including Title Slide and Reference slide). Ensure that information is cited in-text throughout the presentation. Use inspirational quotes, graphics, visual aids, and video clips to enhance your presentation. Ensure that information included on your slides is properly paraphrased and cited; the use of direct quotes is prohibited. A minimum of three sources should be included (your textbook counts); ensure sources are credible.
Once you have chosen your format, choose a type of stress (schoolwork, family, job, a relationship, etc) and answer all of the following questions:
1. Give examples that causes the stress.
2. Describe healthy coping mechanisms you can use to help with stress.
3. Discuss of the warning signs of stress is in your life.
4. Describe the short-term effects stress can have on an individual.
5. Describe the long-term effects stress can have on an individual.
.
1. Compare vulnerable populations. Describe an example of one of the.docxcatheryncouper
1. Compare vulnerable populations. Describe an example of one of these groups in the United States or from another country. Explain why the population is designated as "vulnerable." Include the number of individuals belonging to this group and the specific challenges or issues involved. Discuss why these populations are unable to advocate for themselves, the ethical issues that must be considered when working with these groups, and how nursing advocacy would be beneficial.
2.
How does the community health nurse recognize bias, stereotypes, and implicit bias within the community? How should the nurse address these concepts to ensure health promotion activities are culturally competent? Propose strategies that you can employ to reduce cultural dissonance and bias to deliver culturally competent care. Include an evidence-based article that address the cultural issue. Cite and reference the article in APA format.
.
1. Complete the Budget Challenge activity at httpswww.federa.docxcatheryncouper
1. Complete the Budget Challenge activity at: https://www.federalbudgetchallenge.org/challenges/20/pages/overview
a. Keep a record of your selections and why you decided to select them and not the other options. ( keep a record of your selections in piece of paper so you can go back and reflect on your choices in your write-up. For instance, the first choice is about investments. So, on a piece of paper write down whether you selected any of the investment choices and a quick note about why you chose (for example) to spend $30B to establish a National Infrastructure Bank but didn't select to invest in the other options.) your selections as those reflect your own personal, subjective, choices. I will grade the assignment based on whether you have provided a thoughtful written response that answers the questions posted on the instructions.
b. When you’ve finished, save your results summary page.
2. Write a 2.5+ page summary overview of your experience, discussing your budget selections and analyzing your responses. Use the following questions to guide your response, but don't be limited by them:
a. What was challenging?
b. What was easy?
c. What do your selections say about your policy priorities and political ideologies?
** source: (Author Last Name, Year, pg.)
June 2003: WAY IN THE MIDDLE OF THE AIR
“Did you hear about it?”
“About what?”
“The niggers, the niggers!”
“What about ’em?”
“Them leaving, pulling out, going away; did you hear?”
“What you mean, pulling out? How can they do that?”
“They can, they will, they are.”
“Just a couple?”
“Every single one here in the South!”
“No.”
“Yes!”
“I got to see that. I don’t believe it. Where they going — Africa?”
A silence.
“Mars.”
“You mean the planet Mars?”
“That’s right.”
The men stood up in the hot shade of the hardware porch. Someone quit lighting a pipe. Somebody else spat out into the hot dust of noon.
“They can’t leave, they can’t do that.”
“They’re doing it, anyways.”
“Where’d you hear this?”
“It’s everywhere, on the radio a minute ago, just come through.”
Like a series of dusty statues, the men came to life.
Samuel Teece, the hardware proprietor, laughed uneasily. “I wondered what happened to Silly. I sent him on my bike an hour ago. He ain’t come back from Mrs. Bordman’s yet. You think that black fool just pedaled off to Mars?”
The men snorted.
“All I say is, he better bring back my bike. I don’t take stealing from no one, by God.”
“Listen!”
The men collided irritably with each other, turning.
Far up the street the levee seemed to have broken. The black warm waters descended and engulfed the town. Between the blazing white banks of the town stores, among the tree silences, a black tide flowed. Like a kind of summer molasses, it poured turgidly forth upon the cinnamon-dusty road. It surged slow, slow, and it was men and women and horses and barking dogs, and it was little boys and girls. And from the mouths of the people partaking of this tide came the sound of a river. A summer-.
1. Connections between organizations, information systems and busi.docxcatheryncouper
1. Connections between organizations, information systems and business processes.
2. There are a number of benefits associated with cutting edge business analytics.
3. Three conditions that contribute to data redundancy and inconsistency are:
4. Network neutrality
5. Simple Object Access Protocol (SOAP).
6. Outsourcing IT-advantages and disadvantages
7. The security challenges faced by wireless networks
.
1-Experiences with a Hybrid Class Tips And PitfallsCollege .docxcatheryncouper
1-Experiences with a Hybrid Class: Tips And Pitfalls
College Teaching Methods & Styles Journal, 2006, Vol.2(2), p.9-12
Notes
This paper will discuss the author's experiences with converting a traditional classroom-based course to a hybrid class, using a mix of traditional class time and web-support. The course which was converted is a lower-level human relations class, which has been offered in both the traditional classroom-based setting and as an asynchronous online course. After approximately five years of offering the two formats independently, the author decided to experiment with improving the traditional course by adopting more of the web-based support and incorporating more research and written assignments in "out of class" time. The course has evolved into approximately 60% traditional classroom meetings and 40% assignments and other assessments out of class. The instructor's assessment of the hybrid nature of the class is that students are more challenged by the mix of research and writing assignments with traditional assessments, and the assignments are structured in such a way as to make them more "customizable" for each student. Each student can find some topics that they are interested in to pursue in greater depth as research assignments. However, the hybrid nature of the class has resulted in an increased workload for the instructor. The course has been well received by the students, who have indicated that they find the hybrid format appealing.
2-Undergraduate Research Methods: Does Size Matter? A Look at the Attitudes and Outcomes of Students in a Hybrid Class Format versus a Traditional Class Format.
Author
Gordon, Jill A.
Barnes, Christina M.
Martin, Kasey J.
Publisher
Taylor & Francis Ltd
Is Part Of
Journal of Criminal Justice Education, 2009, Vol.20 (3), p.227-249
Notes
The goal of this study is to understand if there are any variations regarding student engagement and course outcomes based on the course format. A new course format was introduced in fall of 2006 that involves a hybrid approach (large lecture with small recitations) with a higher level of student enrollment than traditional research methods courses. During the same time frame, the discipline maintained its traditional research methods courses as well. A survey was administered to all students enrolled in research methods regardless of course format in fall 2006 and spring 2007. Student responses are discussed, including information concerning the preparation, design, cost and benefits of offering a hybrid research methods course format.
3- Distance Education: Linking Traditional Classroom Rehabilitation Counseling Students with their Colleagues Using Hybrid Learning Models.
Author
Main, Doug
Dziekan, Kathryn
Publisher
Springer Publishing Company, Inc.
Is Part Of
Rehabilitation Research, Policy & Education, 2012, Vol.26 (4), p.315-321
Notes
Current distance learning technological advances allow real and virtual classrooms to unite. In this .
RefereanceSpectra.jpg
ReactionInformation.jpg
WittigReactionOfTransCinnamaldehye.docx
Wittig Reaction of trans-Cinnamaldehyde
GOAL: Identify the major isomer of the Wittig reaction
E,E-1,4-diphenyl-1,3-butadiene OR E,Z-1,4-diphenyl-1,3-butadiene
Attached are the:
1. Drawing of the overall reaction
2. Drawing of the structure of the two possible isomers
3. Reference NMR spectra of what is labeled trans, trans-1,4-diphenyl-1,3-butadiene
4. IR spectra
5. UV vis spectra
6. 1H NMR not-detailed
7. 1H NMR detailed
8. BASED ON # 4, 5 and 7 Identify the major isomer of the Wittig reaction, can the integration values of the NMR be used to give approximate percent of each isomer
IR.jpg
UV-visSpectra.jpg
NMR.jpg
NMR-DeterminePredominantIsomer.jpg
...
Reconciling the Complexity of Human DevelopmentWith the Real.docxcatheryncouper
Reconciling the Complexity of Human Development
With the Reality of Legal Policy
Reply to Fischer, Stein, and Heikkinen (2009)
Laurence Steinberg Temple University
Elizabeth Cauffman University of California, Irvine
Jennifer Woolard Georgetown University
Sandra Graham University of California, Los Angeles
Marie Banich University of Colorado
The authors respond to both the general and specific con-
cerns raised in Fischer, Stein, and Heikkinen’s (2009)
commentary on their article (Steinberg, Cauffman, Wool-
ard, Graham, & Banich, 2009), in which they drew on
studies of adolescent development to justify the American
Psychological Association’s positions in two Supreme
Court cases involving the construction of legal age bound-
aries. In response to Fischer et al.’s general concern that
the construction of bright-line age boundaries is inconsis-
tent with the fact that development is multifaceted, variable
across individuals, and contextually conditioned, the au-
thors argue that the only logical alternative suggested by
that perspective is impractical and unhelpful in a legal
context. In response to Fischer et al.’s specific concerns
that their conclusion about the differential timetables of
cognitive and psychosocial maturity is merely an artifact of
the variables, measures, and methods they used, the au-
thors argue that, unlike the alternatives suggested by Fi-
scher et al., their choices are aligned with the specific
capacities under consideration in the two cases. The au-
thors reaffirm their position that there is considerable
empirical evidence that adolescents demonstrate adult lev-
els of cognitive capability several years before they evince
adult levels of psychosocial maturity.
Keywords: policy, science, adolescent development, chro-
nological age
In our article (Steinberg, Cauffman, Woolard, Graham,& Banich, 2009, this issue), we asked whether therewas scientific justification for the different positions
taken by the American Psychological Association (APA) in
two related Supreme Court cases—Hodgson v. Minnesota
(1990; a case concerning minors’ competence to make
independent decisions about abortion, in which APA ar-
gued that adolescents were just as mature as adults) and
Roper v. Simmons (2005; a case about the constitutionality
of the juvenile death penalty, in which APA argued that
adolescents were not as mature as adults). On the basis of
our reading of the extant literature in developmental psy-
chology, as well as findings from a recent study of our own,
we concluded that the capabilities relevant to judging in-
dividuals’ competence to make autonomous decisions
about abortion reach adult levels of maturity earlier than do
capabilities relevant to assessments of criminal culpability,
and that it was therefore reasonable to draw different age
boundaries between adolescents and adults in each in-
stance.
In their commentary on our article, Fischer, Stein, and
Heikkinen (2009, this issue) raised both general and spe-
cif ...
Reexamine the three topics you picked last week and summarized. No.docxcatheryncouper
Reexamine the three topics you picked last week and summarized. Now, break out each case into a list of ethical and legal considerations that might help to analyze each case—summarize the considerations in two paragraphs for each case.
For each case, also ask one legal and one ethical question that might present. Consider the principles of ethics from Week 1 and the laws addressed this week. You should also use outside references to dig deeper into each case for your list.
3 topics identified in paper below from last week
· The Principal of Justice
· Autonomy
· Non-maleficence
Health Care Ethics
Health care ethics is a set of beliefs, moral principles and values that guide health care centers and related institutions to make choices with regard to medical care. Some health ethics include: respect for autonomy, justice and non-maleficence (Percival, 1849).
The principle of justice in health care ensures that there is respect for people’s rights, fair distribution of health resources and respect for laws that are morally acceptable. There are mainly two elements in this principle; equity and equality. Equity ensure that are all cases have equal access to treatment regardless of the patients’ status in ethnic background, age, sexuality, legal capacity, disability, insurance cover or any other discriminating factors.
It is important to study this ethical issue of justice since there have been an increasing report of doctors and medical staff failing to administer certain treatment services to certain kind of patients. Consequently, there have been debates in countries such as the UK over the refusal to give expensive treatment to patients who are likely to benefit from the treatment but cannot afford it. One ethical in the principle of justice is as to whether the health care center is creating an environment for sensible and fair use of health care resources and no particular type of patients are shun away or stigmatized. The legal question is whether the health care center is breaking the law against inequality and discrimination particularly racism, tribalism, gender insensitivity and other discrimination noted and prohibited in the country’s constitution.
The second area of health care ethics is respect for autonomy. Autonomy means self-determination or self-rule. Hence, this principle stipulates that one should be allowed to direct their health life according to their personal rationale. The patients have a right to determine their own destiny freely and independently as well as having their decision respected (Pollard, 1993).
This principle is important for study because not many people would not want to be treated as those with dementia; a disease involving loss of mental power. Many people are afraid of the prospect of not being able to decide their own fate and exercise self-determination. An ethical question in this principle of respect for autonomy is whether the health care center ensures that the patient is provided with ...
Reconstruction
Dates:
The Civil War?_________
Reconstruction? ________
9-9-12
*
*
9/7/2010
Foner Chapter 15
"What Is Freedom?": Reconstruction, 1865–1877
*
After the Civil War, freed slaves and white allies in the North and South attempted to redefine the meaning and boundaries of American freedom. Freedom, once for whites only, now incorporated black Americans. By rewriting laws, African-Americans, for the first time, would be recognized as citizens with equal rights and the right to vote, even in the South. Blacks created their own schools, churches, and other institutions. Though many of Reconstruction’s achievements were short-lived and defeated by violence and opposition, Reconstruction laid the basis for future freedom struggles.
Introduction: Sherman Land
From the Plantation to the Senate
*
After the Civil War, freed slaves and white allies in the North and South attempted to redefine the meaning and boundaries of American freedom. Freedom, once for whites only, now incorporated black Americans. By rewriting laws, African Americans, for the first time, would be recognized as citizens with equal rights and the right to vote, even in the South. Blacks created their own schools, churches, and other institutions. Though many of Reconstruction’s achievements were short-lived and defeated by violence and opposition, Reconstruction laid the basis for future freedom struggles.
Click image to launch video
Q: Chapter 15 includes a new comparative discussion on the aftermath of slavery in various Western Hemisphere societies. You see important commonalities in the struggle over land and labor in post-Emancipation societies. How do you situate the experiences of former slaves in the United States in this borrowed content.
A: Well, just as slavery was a hemispheric institution, so was emancipation. It’s useful for us in thinking about the aftermath of slavery in the United States, the Reconstruction era and after to see what happened to other slaves in places where slavery was abolished. What you see is a similar set of issues and conquests taking place everywhere slaves desire land of their own—this is the No. 1 thing, they want autonomy, they want independence from white control. All of these regions are agricultural, everywhere former slaves demand land. In some places they get land fairly effectively, like in Jamaica, West Indies, where there’s a lot of unoccupied land they can take. In some places they don’t, but that battle to who’s going to have access to land and economic resources is a commonality in the aftermath of slavery. So too is the effort of local plantation owners trying to get the plantation going again and to force slaves to work back on the plantations, or if not, to bring labor from somewhere else—in the West Indies they bring workers from China, from India, from southeast Asia to replace slaves who were moving off on land of their own. They can’t quite do that in the United States—they tried to bring ...
Record, Jeffrey. The Mystery Of Pearl Harbor. Military History 2.docxcatheryncouper
Record, Jeffrey. "The Mystery Of Pearl Harbor." Military History 28.5 (2012): 28-39.Academic Search Complete. Web. 10 Dec. 2013.
According to the article "The Mystery of Pearl Harbor," it briefly examines the reason why Japan starts a war with the United States. On December 7th, 1941, Japan with about 182 aircrafts from the first assault invade U.S. Pacific fleet of Pearl Harbor. Japan's ultimate goal was to overthrow East Asia. The main point of this article is mainly for Japan's goal for economic security and determined to achieve their goal to conquer East Asia. Moreover, they wouldn't let U.S. stop them. Japan was humiliated to be dependent on the United States, including American imported oil. Ultimately, they fought a war that could not won since U.S. was more superior. United States outproduce Japan in every category of ammunition and armaments. If someone were to ask me what this article was about, I would say that this article is an inevitable defeat from Japan.
I believe this source was definitely helpful. This article made me realize how important Pearl Harbor is. If anything, we could have lost to the Japanese and everything would change. Personally, I believe our army played a significant role during the war between Japan and United States. I believe that this source is reliable. This source can be slightly biased because in the article, it says “If the Pacific War was inevitable, was not Japan's crushing defeat as well? If so, then why did Japan start a war that, as British strategist Colin Gray has argued, it "was always going to lose?”
This article can clearly be used for a American history classes. Several of the first paragraphs include a clear understanding and a great topic for students to discuss. This would benefit students who does not know anything about Pearl Harbor. This would be appropriate for students to realize what America has been through during the 1940’s. I admit I now have a better understanding of Pearl Harbor, this article enhanced my perspective and changed the way I view it.
Hanyok, Robert J. "The Pearl Harbor Warning That Never Was." Naval History 23.2 (2009): 50-53. Academic Search Complete. Web. 11 Dec. 2013.
This article particularly argues that Americans believe that the surprising attack from Japan Navy planes could not have happened without some sort of conspiracy or warning. Without a doubt, Americans thought that U.S. political and military leaders kept this serious warning from Pearl Harbor’s commanders. Furthermore, the National Security Agency Documentary, “West Wind Clear seemed to be not found. Robert Hanyok’s attempted to clear up the issue and as a result, the warning for the chief Navy doe- breaker was just a figment of his imagination.
I believe that this article offers reliable sources. Hanyok provides source documents for historical scholars and researchers. This article was extremely helpful due to the controversy with the “West Wind Clear. The goal of this article was basically des ...
Reasons for Not EvaluatingReasons from McCain, D. V. (2005). Eva.docxcatheryncouper
Reasons for Not Evaluating
Reasons from McCain, D. V. (2005). Evaluation basics. Arlington, VA: ASTD Press, pp. 14-16.
Below are reasons to not evaluate, but there are things you can do to overcome these reasons!
· Click Edit (upper right on the tool bar) to get into edit mode.
· Add at least 2 ideas to the page to overcome one or more of these reasons for not evaluating. Please explain in enough detail that someone reading this wiki will be able to understand it!
· Add your name in parenthesis after your idea so we know who contributed which idea!
· Click Save (upper right on tool bar) to save your changes.
1. Evaluation requires a particular skill set.
· Doing evaluation requires no particular skill. It only requires a desire to look into it a course or program and ask the right questions that would answer the whether or not the course was effective. There are many tools that would help in doing an evaluation. (D. Clark)
· Skills can be learned. Learning to evaluate is simply another avenue of training. If the skills to evaluate do not exist in your organization then the training may need to start at the Trainer level before moving on to more organizational specific training, (D Casper)
2. Evaluation is not a priority.
· In order to make progress in any learning environment, it is necessary to initiate check points and measurements producing an evaluation of knowledge (Valle)
· Evaluation is never a priority until things are going bad and the reason is not clear, Evaluation helps us understand where the issues are. (Jim K)
3. Evaluation is not required.
· Currently, as students we are being evaluated to check in our progress ion order to measure our understanding of the tasks given. We get a grade, it is required for this course.(Valle)
· Why are you only providing what is required? Why not go a little further and make the training better? (J. Sprague)
4. Evaluation can result in criticism.
· In order to grow as a person or a company we all need criticism, of course this needs presented in a positive light and in a way that people can learn and grow. (Jim K)
· In today's culture where everybody gets a trophy or everybody gets an "A" no matter how they perform it is not "PC" to criticize someone and hurt their feelings! Criticism is what motivated me to succeed and go beyond just what is normal! We need to stop equating "Criticism" with "Fault Finding" and realize we do more harm than good by not pointing out shortcomings and errors. (D Casper)
5. You can't measure training.
· In my place of work in the industry, we had to measure training. Time was spent in educating employees into new ways to create a product, cost effectiveness, supply management chain and distribution. Measuring effectiveness of the training was in direct correlation with the success of the given product into market.(Valle)
· You can always measure whether or not the training was successful. The key is to look for the right types of measurements. It may be measured ...
Recognize Strengths and Appreciate DifferencesPersonality Dimens.docxcatheryncouper
Recognize Strengths and Appreciate Differences
Personality Dimensions® is the latest evolution in presenting Personality Temperament Theory. It builds on research conducted in Canada over a period or two decades, and the foundations established by the work of Carl Jung, David Keirsey, Linda Berens, as well as a history of Temperament that spans 25 centuries.
The Personality Dimensions® system utilizes a convenient card sort and short questionnaire to reveal personality preferences. In addition to being the first Temperament assessment to incorporate the Introversion/Extraversion dichotomy, Personality Dimensions® also uses four colours along with short descriptors and symbols to represent the Temperament preferences: Inquiring Green, Organized Gold, Authentic Blue, Resourceful Orange. These combined aspects create a common language of understanding with a high level of retention.Know your Personality Dimensions to...
·
· Express yourself appropriately
· Appreciate yourself & others
· Negotiate more effectively
· Narrow gaps and differences
· Identify potential problems early
· Elevate morale and enthusiasm
· Optimize team performance
· Support and encourage others
· Organize efficient teams
· Yield higher productivity
· Influence others positively
Analyzing Personality Demensions:
Introverts:
· Tend to get their energy by spending some time alone.
· Prefer to think things through in their head before sharing their ideas with the larger group. They will often listen to other ideas, conversations and reactions, taking it all in, digesting it and then share their thoughts and ideas with the larger group. By the time they share an idea it has been given a lot of consideration -- they are not just thinking out loud.
· Learn best when they have the time for quiet reflection and are able to work on their own.
· May actually find that the standard brainstorming process shuts down their creative juices as it does not allow them the time they need to internally process information before building on it or reacting to it.
· Often prefer to keep their thoughts and feelings to themselves until they are totally comfortable with the people they will be sharing them with.
· Have a tendency to think through the consequences of a situation before acting.
· Preferred mode of problem solving is to have some quiet time alone to think, reflect on the situation and formulate a solution. They often become energized by this process.
· Project a sense of quiet and calmness. Their body language and tone of voice tends to be softer.
· Tend to have a small circle of people who they call true friends. These are people with whom they are comfortable and are willing to share their thoughts and feelings with.
What causes an Introvert stress at work
Introverts tend to like things to be quieter than Extraverts. A noisy work environment can cause real stress for an Introvert.
They can find it exhausting to work with Extraverts. If an Introvert has to work in situations ...
Real Clear PoliticsThe American Dream Not Dead –YetBy Ca.docxcatheryncouper
Real Clear Politics
“The American Dream: Not Dead –Yet
By Carl M. Cannon and Tom Bevan
March 6, 2019
Solid pluralities of Americans think their country is heading in the wrong direction, have lost faith in its prominent public institutions, and believe both major political parties are an impediment to realizing the American Dream. Nonetheless, that dream persists – threatened, yes, but not nearly dead.
These are the findings in the latest poll from RealClear Opinion Research, focusing on how Americans view their future possibilities and how much economic guidance and oversight should be provided by government. The answers provide a road map for the 2020 election season.
Nearly four times as many respondents say the American Dream is “alive and well” for them personally (27 percent) as those who say it’s “dead” (7 percent). The overwhelming majority express a more nuanced outlook. Two-thirds of those surveyed believe the American Dream is under moderate to severe duress: 37 percent say it is “alive and under threat” while another 28 percent say it is “under serious threat, but there is still hope.”
“In this poll, most people are telling us that the American Dream isn’t working as they believe it should be,” said John Della Volpe, polling director of RealClear Opinion Research. “The overwhelming number of people are not seeing the fruits of working hard, whether it’s through a professional (finances) or a personal (happiness) lens.”
The panel of 2,224 registered voters was probed for its views on other foundational aspects of 21st century American civic life, including their views of capitalism and socialism, and how they see the future unfolding for the younger generation of Americans.
Asked, for example, whether the American Dream is alive for those under 18 years of age, the attitudes were decidedly pessimistic -- especially among Baby Boomers and the so-called Silent Generation (Americans born between the mid-1920 and mid-1940s), those who have been in control of our public and private institutions for decades. While 23 percent of Baby Boomers and Silent Generation voters say the American Dream is alive for them (already the lowest percentage among all age groups) only 15 percent say they believe it will be there for the next generation.
Measuring attitudes about the American Dream means different things to different people. For this survey, RealClear Opinion Research defined it for the poll respondents by using Merriam-Webster’s dictionary, which describes the American Dream as “a happy way of living that can be achieved by anyone in the U.S. especially by working hard and becoming successful.”
As one would expect, perceptions of the health of this idea differ by party, age, education and class. Among the most striking findings in the survey were the variances by ethnicity. Asian-Americans are the most likely to say the American Dream is working for them (41 percent) – twice the percentage as Hispanics. Despite such differences, ...
Recommended Reading for both Papers.· Kolter-Keller, Chapter17 D.docxcatheryncouper
Recommended Reading for both Papers.
· Kolter-Keller, Chapter17 Designing & Managing Integrated Marketing Communications
· Kolter-Keller, Chapter18 Managing Mass Communications: Advertising, Sales Promotions, Events & Experiences and Public Relations
· Kolter-Keller, Chapter19 Managing Personal Communications: Direct and Interactive Marketing, Word of Mouth and Personal Selling
· PDF link to Kolter_keller 14th edition :
· http://socioline.ru/files/5/283/kotler_keller_-_marketing_management_14th_edition.pdf
· Keller,K.L.(2001).Mastering the Marketing Communications Mix: Micro and Macro Perspectives on Integrated Marketing Communication Programs. Journal of Marketing Management, Sep2001, Vol. 17 (7/8), 819-84.
· Luo, Xueming and Donthu, Naveen; Marketing's Credibility: A Longitudinal Investigation of Marketing Communication Productivity and Shareholder Value; The Journal of Marketing. Oct., 2006, Vol. 70, Issue 4, p70-91.
· Wright, E., Khanfar, N.M., Harrington, C., & Kizer,L.E. (2010). The Lasting Effects Of Social Media Trends On Advertising.Journal of Business & Economics Research, Vol. 8 (11), 73-80
Grading Rubric for both papers
· Identifies all or most of the key issues presented by the case.
· Discussion of issues reflects strong critical thinking and analytical skill.
· Discussion/analysis makes all or most of the recommendations called for by the case issues.
· Recommendations are supported by data from all or most of the relevant case facts and exhibits data.
· Data are creatively manipulated and applied. Discussion and recommendations are presented clearly, logically, and succinctly with no or few grammatical or other errors.
· Discussion/analysis reflects strong understanding of principles presented in course readings/materials.
· Where relevant, discussion/analysis employs proper APA style. Length limitations and other form/format requirements (if any) are followed.
1.The Changing Communications Environment 2 pages
Emerging media technologies have vastly empowered customers to decide whether or how they want to receive commercial content. Consumers are no longer passive recipients of marketing communications and the real challenge for a marketer is how to regain the customers’ attention through the clutter.
1 Web-based technologies can be combined with traditional media to build a successful marketing communication campaign. Cite two specific examples of companies/brands using this combination approach and discuss what made these campaigns successful. Did the two use similar techniques?
With the help of relevant examples, can you describe how modern technologies can be used to promote interactivity between the product and the customers? In this context discuss the use of social media to generate excitement around a brand. Can you cite any recently launched new products that have managed to achieve this?
2.Personal Application Paper, one and a half pages
Provide a detailed overview of Procter and Gamb ...
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Overview on Edible Vaccine: Pros & Cons with Mechanism
Real-World DecisionsHRM350 Version 21University of Phoe.docx
1. Real-World Decisions
HRM/350 Version 2
1
University of Phoenix Material
Real-World Decisions
Read the following scenarios, which represent real-world
decisions, and respond to each in 150 to 200 words.
Scenario One
You are the director of production at a multinational company.
Your position is in Tokyo, Japan. Recently, this division
experienced production quota problems. You determine that you
must identify a team leader who will lead the work team to
tackle the problem. You identify several possible team leaders,
including Joan, a manager who is an expatriate US citizen and
has recently arrived in your company’s Japanese office. You are
also aware of Bob, a European national who has worked at the
facility for about a year. His experience includes reengineering
production processes at one of the company’s production
facilities in Europe. The final candidate is Noriko, a Japanese
national who has been at the facility for several years.
Questions
The team you assemble is composed of American expatriates
and Japanese nationals. Compare the three candidates for the
position. Based on cultural norms and traditions, what cultural
factors and management styles may benefit or present obstacles
for others on the team? Explain.
2. Response
Scenario Two
You have been assigned to an overseas position with your
company. The local government of the host country offers gifts
periodically to senior management as a way of thanking them
for opening a facility and employing locals. These gifts include
cash or merchandise into the thousands of dollars. Typically, to
refuse a gift is considered an insult. Your country’s policy is to
prohibit employees from accepting anything from clients and
customers of more than $50. Your employer values its
relationship with the host country and government officials, and
it intends to continue operating in the venue.
Questions
How would you address a situation where you are presented
with a gift of more than $50? Explain your rationale. How could
your actions affect your company? How could your decision
affect your working relationship with your company’s and the
host country’s officials?
Response
Scenario Three
Christine, the leading expert in information technology (IT)
organizational design, works for a large consulting firm and has
been asked to work on a temporary assignment in Saudi Arabia.
One of her firm’s biggest revenue-generating customers is
embarking on an initiative to redesign the IT structure to
improve efficiency and effectiveness, and to align the business
unit’s output with the organization’s strategic objectives. The
customer has read research reports and articles Christine has
published, and the chief executive officer has asked Christine to
handle this project. She is excited about the professional
challenge of the assignment, but she is unsure of adopting
3. customs and practices in a Muslim country.
Questions
Discuss the ethical considerations for Christine and her
company. What implications must Christine consider when
making her decision? Why? How might Christine’s role as a
female expatriate affect her employer’s response if she passes
on the assignment?
Response
4. Insights to a Changing World (Volume 2014 Issue 1)
Franklin Publishing Company www.franklinpublishing.net
Does CPOE Increase Patient Safety By Reducing Medical
Errors?
Krista Charles
Lewis College of Business
Marshall University Graduate College
100 Angus E. Peyton Drive
South Charleston, WV 25303
Kent Willis
Lewis College of Business
Marshall University Graduate College
100 Angus E. Peyton Drive
South Charleston, WV 25303
Alberto Coustasse, DrPH, MD, MBA
Associate Professor
5. Lewis College of Business
Marshall University Graduate College
100 Angus E. Peyton Drive
South Charleston, WV 25303
(304) 746-1968
(304) 746-2063 FAX
[email protected]
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DOES CPOE INCREASE PATIENT SAFETY BY REDUCING
MEDICAL ERRORS?
ABSTRACT
Computerized Physician Order Entry (CPOE) is a system that
allows physicians to electronically
order patient services. The services that can be ordered, but are
not limited to include:
6. prescriptions, labs, x-rays, and referrals. Adopting CPOE will
eliminate the use of paper orders
with illegible hand writing. The purpose of this research project
was to examine the cause of
medical errors and to determine if adopting a CPOE system
would be an effective solution to this
problem. The findings of this study suggest that CPOE can
reduce medical errors and adverse
drug events significantly. The Adoption and implementation of
CPOE has been growing in
recent years pushed by financial incentives and potential
penalties of the HITECH Act of 2009.
Some major barriers of adoption and implementation of a CPOE
system has been the high cost
associated with it and older physicians being trapped in old
ways of practicing medicine.
Key words: CPOE, Meaningful Use, HITECH act, Medical
errors, Adverse Drug Events, quality,
patient safety
INTRODUCTION
The Health Information and Technology for Economic and
7. Clinical Health (HITECH) provision
of the American Recovery and Reinvestment Act of 2009 was
put into place hoping health
information technology would improve patient care, decrease
medical errors, decrease costs, and
advance the health of the population (Bloomrosen et. al., 2011).
Medicare and Medicaid
providers could be eligible to receive incentives once the
standards have been met using a
certified Electronic Health Record (EHR) for Meaningful Use
(MU), (Blumenthal, 2010). The
earlier the adoption the more incentives a medical clinic could
make using an EHR. Medicare
will pay $44,000 and Medicaid will pay $63,750 for the
adoption and implementation of an EHR
after demonstrating Meaningful Use (CMS, 2013). To make sure
a facility is going to receive
incentives 14 core objectives and 5 menu objectives needed to
be met to demonstrate Meaningful
Use (Jha, DesRoches, Kralovec, & Joshi, 2010). If medical
clinics take advantage of the
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incentives and demonstrate MU the money that is received can
help cover a huge amount of the
cost.
Meaningful Use has been divided into three stages.
Computerized Physician Order Entry
(CPOE) use is involved in the all three stages. In the first stage
CPOE needs to be used with at
least 30% of patients who are eligible. This means that
providers need to use CPOE to order
medication for at least 30% of the patients. The next two stages
would increase that percentage
close to 80% of patients. CPOE use is stressed in stage one as
the thought of preventable medical
errors starts at the moment a provider hand writes a prescription
(Jones, Heaton, Freidberg, &
Schneider, 2011). With the mandate that medical facilities
operate using a CPOE is underway,
by the end of 2011 57% of physicians/doctors have already
reported having an EHR system
9. (Hsiao, Decker, Hing & Sisk, 2011).
In the United States (U.S) every year approximately 200,000
people die due to
preventable medical errors (Andel, Davidow, Hollander, &
Moreno, 2012). The physician when
ordering services and prescriptions for patients initially starts
most medical errors. Physicians
that write out prescriptions using a paper pad often do not have
legible handwriting and are not
able to be read by a number of important individuals who
process the prescription and prepare it
for the patient. Adverse Drug Events (ADEs) are another cause
of 770,000 patient injuries and or
deaths a year (AHRQ, 2013). If a patient is given a drug that
was not prescribed by the
pharmacist who was not able to read the physicians hand
writing, those patients are at risk for
ADEs. The results from ADEs are patients experiencing
negative reactions to drugs which can
result in extended hospital stays, increased medical costs,
permanent disability, and possibly
death (Du, Goldsmith, Aikin, Encinosa, and Nardinelli, 2012).
A solution to fix the increasing
10. number of medical errors and ADEs is for hospitals to adopt a
CPOE system. According to
Jones, Heaton, Freidberg, & Schneider (2011), using a CPOE
system will enhance patient safety
and decrease preventable medical errors.
CPOE is a software system that can be utilized in hospitals and
can remove physician
hand written order legibility, remove abbreviations, and
increase order speed by having
physicians electronically order services and prescriptions
(Cucina, 2013). CPOE systems coexist
with Clinical Decision Support Systems (CDSSs) which offer
additional functions for a
providers use. Some functions of CDSSs include drug
interaction checks, drug allergy checks,
and prompts for the provider about when to order a service for a
patient (Kaushal & Bates,
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11. 2013). Some CDSS’s have been enabled with many different
alerts for the physician to check on
a patient’s health. When there are so many different alerts
popping up physicians can ignore
them, which can be a problem especially if the alert was about a
life-threatening drug that was
prescribed, this is known as alert fatigue. Providing a tailored
system to an individual facility for
the type of patients the facility provides care for or a certain
age group could help minimize the
excess alerts and limit the number of alerts the physicians may
receive (Kesselheim, Cresswell,
Phansalkar, Bates, & Sheikh, 2011).
With the adoption of a CPOE system, the increased number of
preventable medical errors
can decrease considerably. Unfortunately, less than 10% of
hospitals have adopted a CPOE
system (Altuwaijri, Bahanshal, & Almehaid, 2011). Some
barriers for implementing CPOE have
been the significant cost to hospitals and small practices that
cannot afford an EHR system and
the concerns that CPOE could reduce medical errors and ADEs.
At Brigham and Women’s
12. Hospital, $11.8 million dollars was spent to cover the cost of
adoption and implementation of a
CPOE system. This is a large cost for any facility yet the CPOE
system saved the hospital over
$28 million dollars (Kaushal et. al., 2006). The size of a health
care facility is not the only factor
to consider when looking at the adoption rate. Geographic areas,
private or public regulation,
teaching hospitals, are all factors to consider with adoption
rates. Hospitals that have a higher
bed capacity are more likely than smaller hospitals to adopt,
this is due to the insufficient funds
smaller hospitals have (Furukawa, Raghu, Spaulding, & Vinze,
2006). In an effort to help with
the costs of the CPOE system implementation, incentives have
been given out by the
Government to facilities that adopt an EHR (GEC, 2009). On
the other hand facilities that do not
comply with MU and adopt a CPOE system will receive
penalties by the Government which will
result in lower reimbursements (Harrison & Lyerla, 2012).
Starting in 2015, one percent
penalties will go into effect by the Recovery Act (DHHS, 2011).
The percentage will then
13. increase in 2016 and in 2017 where it will stay at a five percent
penalty (GEC, 2009).
The purpose of this research project was to examine the cause
of medical errors and to
determine if adopting a CPOE system would be an effective
solution to this problem.
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METHODOLOGY
The methodology for this study was a literature and case studies
review. The electronic databases
of Academic Search Premier, ProQuest, Science Direct,
PubMed, EBSCOhost and Google
Scholar, were searched for the terms ‘CPOE’, OR
‘Computerized Physician Order Entry’, OR
‘Meaningful Use’, OR, ‘Electronic Prescribing’ AND ‘Medical
Errors’ OR ‘ADEs’, OR
14. ‘Adoption’, OR ‘Implementation’. Reputable websites from the
AHRQ, Health Affairs, and
CMS were also used. Additionally, citations and abstracts
identified by the search were assessed
in order to identify relevant articles.
Attempting to stay current in research, only articles published
from 2002-2013 were
included in the review process. The search was limited to
sources attainable as full texts, and
those written in the English language. Original articles and
research studies including primary
and secondary data were included. The methodology and results
of the identified texts were
analyzed and key papers were identified and included within the
research query. Thirty
references were used for this study, nine of which were utilized
in the results. In addition, a semi-
structured interview with the Chief Information Officer (CIO)
or as referred in the rest of the
text, as Expert of CPOE systems in a hospital setting was added
to the data collected (Appendix
A). This Expert will be referred to as Expert in CPOE Systems
within this study. The interview
15. was recorded, and only relevant and pertinent answers were
used to support the information
found in the literature review.
The use of the conceptual framework by Queenan et. al. in the
current study is
appropriate as the focus is on prevention, failure detection, and
appraisal of CPOE systems.
Figure 1 depicts three uses for CPOE. CPOE is used for
prevention by having alerts in the event
of a medication interaction that could harm the patient. With the
difficulty of providers ordering
tests not knowing the patient just received the same test
recently, CPOE can check a patients past
history of tests given. Next is the use for failure detection, since
CPOE is electronic, there exists
a capability to track documentation of patients charts and prior
test results. Lastly, is the use for
appraisal; CPOE can check for dosing recommendations,
preventive care eligibility and can
check to see if a test ordered would give them positive results
(Queenen et. al., 2011).
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Figure 1
Source: Queenan et. al. (2011)
Figure 1. Prevention–Appraisal–Failure Conceptual Framework
Model in the Context of CPOE
Use.
RESULTS
Benefits of CPOE Adoption
Adopting and implementing a CPOE system has a number of
benefits. Most importantly
are the benefits the patient will gain from going to a facility
that has made the transition from
paper to electronic charts.
A medical group experienced a 70% reduction in medical errors
when electronic prescribing was
17. implemented Devine et. al. (2010). Within the same study, many
benefits were noted for an
independent medical group. Some of the benefits included were
a decrease in patient paper
charts, improvements in accessible patient information,
additional coordination of care, reduction
in prescription ordering by the physician, and by having total
support by the organization helped
the process of implementing the new system.
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The Expert in CPOE Systems mentioned that one of the biggest
benefits to adoption at
the hospital he is employed with was the turnaround time.
Providers are able to utilize
electronically order entry of a service for the patient, thus
resulting in faster patient care. An
additional benefit the hospital experienced is instant access to
patient’s previous medical history.
18. CPOE Use for Prevention
CPOE systems can be tailored to individual healthcare
facilities. Once an organization
identifies its main problem, whether it is with a certain age
group of patients or increased
medical errors during a certain procedure, the facility can adopt
a system within CPOE to help
decrease the errors. In 2004, a study was performed on a
Massachusetts medical center that was
experiencing problems with potentially inappropriate
medication with older patients.
Programmers were able to develop a program within CPOE that
would alert physicians once a
patient’s medication order would be placed (Mattison, Afonso,
Ngo, & Mukamal, 2010). The
same authors explain that the study was performed and tracked
before and after the new system
was embedded into their CPOE system. The researchers
demonstrated the alert system prevented
numerous potentially inappropriate medication orders to their
older patients. In addition, the use
for CPOE to prevent medical errors was found to be successful
at that medical facility in
Massachusetts (Mattison, Afonso, Ngo, & Mukamal, 2010).
19. CPOE Use for Appraisal
A CPOE system has many capabilities for providers. The
initial stage of a medication
error begins when a provider prescribes the patient medication
(Riedmann et al., 2011).
Implementing a CPOE system can help clinicians and physicians
have a check and balance
system. Doolan & Bates (2002) reported; CPOE coupled with a
CDSS can check for all drug
interactions and for the recommended doses for patients with
limited organ function. The authors
stated, the technology can reduce medical errors and ensure
appropriate tests are ordered while
alerting the provider when a duplicate test has been ordered.
Further, it was reported, CPOE can
allow users to utilize drug references and provide specific drug
recommendations for a patient.
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CPOE Use for Failure Detection
In 2004, eight billion dollars was estimated to be wasted on
duplicate tests for a patient
(Jha, Chan, Ridgway, Franz, & Bates, 2009). Often time’s
patients who go to the doctor
excessively might not remember what tests were performed
from one doctor’s visit to the next.
One of many perks to implementing a CPOE system is the
rewards it can offer for the patient and
hospital by reducing the extra healthcare costs. Using a CPOE
system, the ordering physician has
instant access to a patients’ electronic health record, including
testing and the results of those
tests (Callen, Westbrook, & Braithwaite, 2006).
Within a CPOE system interruptive or non-interruptive “pop
ups” can be installed to
decrease unnecessary testing. The same authors stated that “pop
ups” can allow a physician to
know when a test has been selected and if that patient has
21. previously had the test performed or
not. The interruptive “pop ups” can halt the physician from
going any further in the ordering
process, and the non-interruptive “pop ups” inform the
physician but does not interfere with
ordering tests (Baron & Dighe, 2011).
Barriers of CPOE Adoption
Barriers to implement CPOE systems begin with cost. CPOE
systems are costly and the
cost threatens small clinics while sufficient funds to adopt are
not available. Another barrier to
implementation is the limited function of a basic CPOE system.
If the standard CPOE system is
adopted and does not have any added features, for example, for
increased medical error
reduction, then this can become another barrier for the facility.
With additional features of an
integrated system, medical errors can be reduced more
effectively.
According to the Expert in CPOE Systems another barrier to
the implementation of a
CPOE system is the hesitation by physicians to adopt because
22. all they have known their entire
medical career is how to use paper charts which has worked for
so many decades, why would
they want to learn a whole new way of charting electronically
now. One concern physicians do
have is on patient satisfaction. If the doctor goes into a patient
room then they think that patients
will not be satisfied by the loss of eye contact, decreased
opportunity for psychosocial
communication, and less sensitivity to the patient from missed
nonverbal cues. This was
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measured by rating patient satisfaction before and after the
implementation of a CPOE. The
overall results illustrate there was no significant decrease in
patient satisfaction (Irani,
Middleton, Marfatia, Omana, & D’Amico, 2009).
One of the purposes of going electronic was the ability of
23. providers to have easy access
to a patient’s medical record; also the speedy access of records
was a benefit. Physicians have
the ability to be at home or another office and have access to a
patient’s past visit with for
example, a specialist. Unfortunately, some systems have a lack
of interoperability with other
systems hindering the physician ability to access to a patient’s
medical record (Yaffee, 2011). If
a physician cannot access needed information it defeats the
purpose of having the system.
A few studies have shown that implementing a CPOE system
can do more harm than
good. It is important for all health care personnel to have in
depth knowledge of what a CPOE
system can offer. A way to get that knowledge is researching
and reading studies on the subject.
If there are not many studies on the topic then those individuals
will not have all the knowledge
required to make an educated decision about adopting a CPOE
system.
. If CPOE is going to be effective then other systems need to be
integrated into it. As reported
earlier one of those systems could be the CDSS’s. Additionally,
24. pharmacy and EHR systems can
impact medical error reduction (Aartz & Koppel, 2009). While
there are few barriers to adopt
and implement CPOE none of the ones reported are significant
enough to change the facilities
decision about implementing such a system.
DISCUSSION
The purpose of this research was to examine implementing a
CPOE system in medical facilities
to reduce the number of medical errors and ADEs. The results
of the literature and case studies
review and the interview with an Expert in CPOE Systems have
demonstrated, implementing a
CPOE has positive effects on the number of preventable medical
errors. This literature review
supports the adoption and implementation of CPOE in most
healthcare facilities.
While preventable medical errors and ADEs continue to
increase, it is important for
healthcare facilities to implement a CPOE system for the
clinical staff and providers to utilize. A
25. CPOE system with CDSS capability can be used to diminish
individual facilities’ preventable
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medical error rates and this is proven by this literature review.
CPOE is seen as a significant
technology to enhance patient safety (Aarts & Koppel, 2009).
CPOE has been around since the
1970s, yet only recently has it become more popular and found
to be very effective in healthcare
facilities. With the recent mandate of EHR and all the
incentives and penalizations a facility can
receive CPOE is gaining popularity every day while as facilities
try to demonstrate MU.
This literature review was limited due to the restrictions in the
search strategy used, such
as the number of databases accessed, and publication and
researcher bias may have affected the
availability and quality of the research identified during the
examination. Future research should
26. address the cost effectiveness, Return over the Investment
(ROI) and effectiveness of CPOE
systems. The adoption and implementation process can take a
very long time. Extensive studies
need to be done to make sure the most effective system for the
individual organization is
adopted. Training needs to be available for all authorized
personnel using the system, as well as,
technical support needs to be accessible at all hours of the day
(Crosson et. al., 2011). Hospitals
are open twenty-four hours a day and seven days a week and
hospital employees need to be able
to contact technical support in the event of a system error or
malfunction. Once all employees are
trained and ready for the change from paper to electronic forms
of charting the transition process
should run a lot smoother.
CONCLUSION
CPOE has been demonstrated to have a vast ability to improve
the overall healthcare system in
the U.S. This literature review has indicated that adoption of
CPOE in hospitals and medical
27. clinics have significantly decreased medical errors and ADEs
among the population.
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APPENDIX A
Questions asked in semi-structured interview of an Expert of
CPOE systems on April 25, 2013
• How is CPOE related to EHR and EMR?
• Has CPOE reduced medical errors at CHH? How?
• How much did the CPOE system cost here? Ball park figure?
37. • What have been the barriers to adoption so far?
• What has been the main challenge to adoption?
• What has been the biggest benefit to CPOE adoption?
• When did you adopt CPOE, how long did it take to train
physicians?
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Use of Electronic Technologies to Promote Community and
Personal
Health for Individuals Unconnected to Health Care Systems
Ensuring health care ser-
38. vices for populations outside
the mainstream health care
system is challenging for all
providers. But developing
the health care infrastructure
to better serve such uncon-
nected individuals is critical
to their health care status, to
third-party payers, to overall
cost savings in public health,
and to reducing health dis-
parities.
Our increasingly sophisti-
cated electronic technolo-
gies offer promising ways to
more effectively engage this
difficult to reach group and
increase its access to health
39. care resources. This process
requires developing not only
newer technologies but also
collaboration between com-
munity leaders and health
care providers to bring un-
connected individuals into
formal health care systems.
We present three strate-
gies to reach vulnerable
groups, outline benefits and
challenges, and provide
examples of successful
programs. (Am J Public
Health. 2011;101:1163–1167.
d o i : 1 0. 21 0 5/ A J P H . 2 0 10 .
30 0 00 3 )
John F. Crilly, PhD, MPH, MSW, Robert H. Keefe, ACSW,
40. PhD, and Fred Volpe, MPA
DURING THE PAST DECADE,
the United States has experien-
ced a rapid growth of electronic
health information technology in
hospital and health care provider
systems to enhance access and
quality for service recipients. State
health departments have devel-
oped health information ex-
changes across large health care
networks, insurance providers,
and independent physician prac-
tices, and the use of electronic
health records has greatly accel-
erated.1 These initiatives evince
progress toward achieving a fully
connected national health care
system by 2014.2
Nevertheless, cities and
counties struggle to understand
the health care needs of individ-
uals who do not or cannot easily
access formal health care net-
works but use expensive services
for emergency and routine care.
Health information technology is
currently designed to benefit pri-
marily populations already con-
nected to such systems. As systems
increase their use of health data to
influence treatment and policy,
developing strategies to include
41. individuals who are largely out-
side health care networks is criti-
cal.
The US health care system has
been criticized for low-quality care
that produces multiple medical
errors3,4 and high-cost services
that limit access to care,5 perpetu-
ating health disparities. Primary
care focused on preventing illness
and death is associated with more
equitable distribution of health
and better outcomes than is spe-
cialty care6---8; countries directing
resources to primary care and
enhancing population health have
lower costs and superior out-
comes.9 Although the United
States has the world’s most ex-
pensive health care system, other
countries regularly surpass the
United States on most health in-
dicators, including quality, access,
efficiency, equity, and healthy
lives.10 Capturing data on individ-
uals unconnected to health care
systems can improve health care
access and outcomes while reduc-
ing costs––important public health
goals.
The federal government allows
states and local communities to
develop their own health care in-
42. frastructures. By making changes
at the local level, communities can
become more effective in using
existing services to capture health
care data for hard to reach pop-
ulations. We have examined sev-
eral strategies for using existing
electronic technologies to better
connect such individuals to some
aspect of their local health care
system.
THE PROBLEM OF HEALTH
CARE ACCESS AND
POSSIBLE RESPONSES
Converging social problems
(e.g., geographic isolation, limited
education, poor health, poverty,
and the marginalization of vul-
nerable groups including people of
color and the rural poor) inhibit
certain individuals’ access to
health care services.5 People who
have the poorest health tend to
receive the least health care, and
those with limited health options
because of inadequate insurance
or unavailable providers often use
high-cost services, such as urgent
care and emergency rooms, which
may not be appropriate to their
needs. This problem is significant:
nearly 75 million adults––42% of
the population younger than 65
43. years––had either no or inade-
quate insurance in 2007.11 Lack of
consistent, documented contact
impedes the accumulation of
meaningful health data for health
care planning and intervention
development. Uninsured or un-
derinsured groups are at risk for
remaining isolated despite health
care reform.
Although few health care ser-
vice data may be collected from
these groups, there are other ways
to track service use. Data from
contacts with other community-
based, nonhealth services can be
employed to target specific com-
munity health needs. For example,
some groups without regular
health care may have contact with
departments of social services,
criminal justice, specialty courts
(e.g., drug, mental health, veterans,
and family), or schools. Data
extracted from these systems, us-
ing secure data transfer protocols
already developed by health in-
formation exchanges, could help
address and evaluate the health
and service needs of these groups.
These data can then be used to
develop and strategically imple-
ment novel health-promotion and
grassroots interventions.
44. Similar approaches have been
applied to track or monitor clinical
intervention outcomes,12,13 clinical
trials,14 adherence to specific
COMMENTARY
July 2011, Vol 101, No. 7 | American Journal of Public Health
Crilly et al. | Peer Reviewed | Commentary | 1163
interventions,15,16 and infections.17
Broader cross-systems data-use
collaborations between commu-
nity and health care providers to
increase care among uncon-
nected groups have also been
successful.18---21 Clinical trials of
cross-program multidisciplinary
interventions have reduced such
health-related stressors as high
blood pressure and cardiac
problems among poor families,22,23
disseminated HIV prevention
programs in African American
communities,24 delivered inner-
city tuberculosis prevention
efforts,25 and decreased negative
birth outcomes among low-
income African Americans.26
Initiatives derived from these
concepts are already under way in
45. some communities. The Partnership
for Results in Auburn, New York
(http://www.partnershipforresults.
org), developed a cross-systems data
access and sharing collaboration
around children at risk for school
violence. San Francisco Children’s
System of Care (http://nccc.
georgetown.edu/documents/
ppsanfran.pdf) developed and
expanded their collaboration to
collect individual-level data on
youth across a series of systems,
including schools and probation,
to target and evaluate novel in-
terventions.
Access to health-related infor-
mation and health promotion has
expanded with the growth of the
Internet,27,28 particularly in the
mental health field, which is rap-
idly developing online versions of
actual treatment.29 No-cost per-
sonal health records are available
online, allowing individuals to
bank and control their own health
data. Broadband Internet access
and mobile wireless are available
in all urban and most nonurban
areas, offering new opportunities
to reach individuals outside health
care networks.
TECHNOLOGY TO REDUCE
BARRIERS TO HEALTH
46. CARE
Developing cohesive, commu-
nity-based strategies for using
health information technology and
electronic communication tech-
nologies optimally is critical to
dismantle barriers to health care
and health information.4 To help
communities reduce such impedi-
ments, we propose several strate-
gies.
Communities: Collaborations
for Health-Focused Use of
Community-Based Data
Individual-level data exist in
public and private agencies and
institutions (e.g., social services,
criminal justice, colleges, and trade
schools). These data are confiden-
tial and protected and typically
include personal identifiers and
service use history. Because of
their size and scope, these systems
have a similar database infra-
structure and often contain data
on the same individual. Collective
data from these systems could
help drive new forms of commu-
nity-wide health promotion and
service delivery. To build such
systems, three tasks are essential.
47. Task 1: Engaging the community.
It is essential to understand a
community’s political geography
and to identify entities that will
form the infrastructure to facilitate
and coordinate the use of data
from extant systems for that com-
munity to use. Choosing key
leaders from potential participat-
ing agencies that will form the
collaborative should be according
to their willingness, influence, and
ability to collaborate and properly
use centralized data. The collabo-
rative can then team with broader
health-focused organizations, such
as local health departments in
urban areas and offices of rural
health in state health departments,
to build the initial support base
and vision.
Task 2: Developing a plan. Once
formed, members of a collabora-
tive must develop an action plan.
A critical component is an assess-
ment of the content of all partici-
pating data systems. The plan may
involve building a comprehensive
data dictionary of potential data
fields applicable to health-related
risk. A feasible system must be
relatively simple, low cost, risk
controlled, time efficient, and
48. beneficial for participating
agencies. A key collaborator in this
task is a regional health informa-
tion exchange, which can assist in
providing a secure information
exchange environment. Particu-
larly important are the consent
and data security processes30 and
the development of effective data
use agreements that limit liability
regarding the unintended use of
data.31
Task 3: Forming a collaborative.
Building a collaborative to drive
this process and use the data re-
quires input from various experts,
including researchers, program
developers, and trainers, who can
introduce fresh ideas regarding
program development, care deliv-
ery, and outcomes tracking and
measurement. Indicators of the
success of the initiatives may in-
clude fewer missed days of work
or school, decreased emergency
room visits, and better communi-
cation among multiple health care
systems. Ideally, the collabora-
tive’s leadership should be based
at local public health departments
because of their community-wide
scope.
Veterans returning from over-
seas could serve as a test case for
49. how such a system might work.
Despite available care, many vet-
erans do not connect with the
Veterans Affairs health care
system and struggle for long pe-
riods with adjustment problems
affecting their physical and mental
health. Identifying points of entry
into community systems such as
schools or social services may help
these systems better meet the
needs of veterans with high-risk
burdens but only minimal in-
volvement with health or mental
health services. The Veterans Af-
fairs health care system has al-
ready obtained much information
that may be used to improve
returning veterans’ quality of
care.32,33
Health Care Systems:
Reaching Out Through
Electronic Means
Although the Internet can serve
as a conduit for reaching geo-
graphically and socially isolated
individuals, understanding its cur-
rent usability and limits is neces-
sary for effective planning. Inter-
net access occurs through (faster)
broadband or (slower) dial-up
50. depending on geography.34 Some
areas have no access at all; some
households choose not to use the
Internet (Table 1).
The Internet is the primary way
most users (67%) obtain health
care information,36 but only 63%
of US households have an Internet
connection. Urban areas have
greater broadband access than do
nonurban areas, which typically
have more dial-up connections.
Whites use computers to connect
to the Internet more often than do
African Americans (59% and
45%, respectively), but more Af-
rican Americans (48%) use mobile
wireless devices than does the
general population (32%).28
Wireless handheld devices are
better options for contact in rural
areas because signal delivery is
more flexible, although gaps per-
sist as the result of terrain or
geography. Consequently, reaching
COMMENTARY
1164 | Commentary | Peer Reviewed | Crilly et al. American
Journal of Public Health | July 2011, Vol 101, No. 7
individuals electronically may re-
51. quire a multifaceted approach.
Health-related Web sites pro-
vide information on specific med-
ical diagnoses (e.g., diabetes), gen-
eral medical guidance (e.g., http://
www.WebMD.com), access to
medical literature (e.g., http://
www.PubMed.com), and treat-
ment options for mental health
conditions.29 Sites such as http://
www.patientslikeme.com allow
individuals to report their symp-
toms and evaluations of medica-
tions or treatments.37 Message
dissemination technology can now
rapidly access targeted groups in
communities for specific safety or
health purposes.38 Twitter tech-
nology is increasingly used in pri-
vate industry39 and is gaining ac-
ceptance in medical settings.40
Effective use of these technolo-
gies by health care systems can
increase their range to reach un-
connected individuals. Handheld
devices can receive brief an-
nouncements, appointment re-
minders, or health tips. Wellness
webs (composed of individuals
with similar health-related needs
who are connected electronically
to enhance their ability to work
together and better meet their
health goals) targeting individuals
52. to receive messages according to
need or interest can be built
through collaborations among
community agencies, insurance
companies, and providers. These
technologies may also facilitate
connection with African Ameri-
cans and Hispanics. Technology
alone cannot alleviate disparities
in health care access, but a na-
tional study finds that although
people with higher incomes use
the Internet more for their health
records, people with lower in-
comes and people without college
degrees are likely to benefit more
from having their health informa-
tion online.36 Connection fosters
more regular, better coordinated
care, with improved outcomes.
Individuals: Building and
Maintaining Personal Health
Records
Many health care systems and
insurance companies offer public
health records (PHRs) to help pa-
tients coordinate their care and
keep in touch with their providers.
PHRs allow patients to view parts
of their own health record (e.g., lab
results, medication history), input
53. data (e.g., weight, blood pressure),
and schedule appointments. In-
surance companies are the pri-
mary providers of PHRs (51%),
followed by health care providers
(26%), but other health-related
organizations offer PHRs to mem-
bers (e.g., the American Heart
Association).36
Recently, both Google (Google
Health) and Microsoft (HealthVault)
introduced publicly available,
Internet-based PHRs at no cost.
Although these providers pledge
that PHR data will be secure and
not exploited for advertising or
other commercial purposes, users’
trust must be developed. Only
25% of potential users report
a willingness to use a PHR from
a private corporation.36 Despite
these concerns, PHR options have
considerable value. PHRs contain
functions that can import data
over the Internet directly from
specific health devices (e.g., blood
pressure monitors, weight scales,
blood glucose tests) plugged into
computers or handheld devices.
Both Google and Microsoft prod-
ucts allow individuals to designate
specific entities for data sharing.
With this feature alone, commu-
nities can implement and monitor
54. targeted health-promotion pro-
jects and measure progress and
outcomes from self-reported data
through a central location that
links participants. As individuals
join health care systems, become
insured, or relocate, they can ex-
port and import data to electronic
health records and back into PHRs
no matter where they receive care.
MOVING FORWARD
Although they do pose some
risks, using electronic technologies
to improve conventional health
services offers opportunities to
reduce health disparities. It is in-
structive to examine successful
community programs and imper-
ative to continue assessing how
best to harness these technologies
to advance public health goals
without compromising privacy
or security. Researchers should
conduct rigorous reviews of the
literature to identify promising
programs and recommend appro-
priate policies and safeguards.
Developing new avenues of
communication with various
health care systems has already
helped unconnected individuals
access health care in some regions.
55. Through strategic collaborations
using established technologies, or-
ganizations such as participants in
the Substance Abuse and Mental
Health Services Administration’s
Drug Free Communities program
have been successful, including
incorporating accountability mea-
sures. One program in Florida
(http://www.onevoiceforvolusia.
org/data.htm) has included in its
mission promoting cross-system
data-gathering capabilities to ad-
dress high-risk groups. Inclusive
consensus building and commu-
nity action planning approaches
have produced successful systems-
level interventions in several US
cities and counties,41---43 enabling
vulnerable groups to take charge
of their health information.44 Such
initiatives not only create alterna-
tive access but also have important
policy implications aligned with
Healthy People 2020 objectives.45
TABLE 1—US Internet Connection Types and Use by Region:
October 2007
South (n = 43 370) Midwest (n = 26 714) West (n = 26 203)
Northeast (n = 21 553)
Urban
(n = 32 510), No. (%)
57. Overall use 19 740 (60.7) 5677 (52.3) 12 494 (61.1) 3764 (60.2)
15 390 (66.0) 1918 (66.6) 11 450 (63.1) 2287 (67.3)
Source. Data from the US Census Bureau, Current Population
Survey, Internet Supplement, October 2007.35
COMMENTARY
July 2011, Vol 101, No. 7 | American Journal of Public Health
Crilly et al. | Peer Reviewed | Commentary | 1165
For example, health policy deci-
sions are generally derived from
medical data from health care
systems and insurance compa-
nies.46 Using these data as the
primary source can invite the ap-
pearance of full knowledge when
the data actually represent only
individuals connected to the sys-
tem; excluding the unconnected
generates an incomplete picture
that can perpetuate disparities in
access and outcomes.
The new federal health reform
legislation is already promoting
creative changes by increasing
funds for community health
centers to boost the number of
treated patients.47 Under this
legislation, millions of Americans
will gain access to care previously
58. unavailable to them. There is an
urgent need to effectively handle
this expected rapid growth. Shift-
ing greater focus, responsibility,
and control to the local commu-
nity constitutes one encouraging
approach. For example, collabo-
ration to better distribute care
may prompt more efficacious
distribution of health care fund-
ing. At the time of this study,
health care dollars flowed directly
to formal providers as reim-
bursement for services rendered.
The distribution of funds depends
entirely on the delivery structure
of those entities, not the broader
needs of the community. Without
appropriate strategies and infra-
structure, communities will have
little power to create meaningful,
effective partnerships with health
care systems to assist their mem-
bers in need.
Obviously, the challenges, limi-
tations, and risks of using these
technologies must be understood
and continuously evaluated. New
applications for health-related
purposes raise many security and
privacy concerns that require the
attention of consumer health
advocates and health policy ana-
lysts. Although the Internet re-
59. mains the largest venue for access-
ing health-related information and
health-monitoring tools, it is neither
ubiquitous nor a panacea.
Electronic technologies must
be more broadly and effectively
implemented to realize their po-
tential to improve health out-
comes for vulnerable populations,
lower costs, and reduce health
disparities. To advance this
promising application, we need to
devote more attention to devel-
oping creative approaches to help
people access appropriate re-
sources, devising better safe-
guards, measuring effects and
evaluating programs, and sharing
information about programs that
are working. But by exploring
how to use technology to reach
unconnected individuals, com-
munity systems and health care
providers can begin to address
the problem––and enhance the
coordination of health care for
millions of Americans. j
About the Authors
At the time of this study, John F. Crilly
was with the Department of Psychiatry,
University of Rochester Medical Center,
Rochester, NY, and the US Department of
Veterans Affairs, Canandaigua, NY. Robert
H. Keefe is with the School of Social
60. Work, State University of New York,
Buffalo. Fred Volpe is with the Drug Free
Communities Program, Substance
Abuse and Mental Health Services
Administration, Leesburg, VA.
Correspondence should be sent to Robert
H. Keefe, PhD, ACSW, Associate Professor,
School of Social Work, 685 Baldy Hall,
University at Buffalo, State University of New
York, Buffalo, NY 14260-1050 (e-mail:
[email protected]). Reprints can be
ordered at http://www.ajph.org by clicking
the ‘‘Reprints/Eprints’’ link.
This commentary was accepted August
11, 2010.
Contributors
J. F. Crilly conceptualized the article and
led the writing of the initial draft. R. H.
Keefe edited the initial draft, aided in
writing, and led the revisions. F. Volpe
outlined the strategies and provided
examples of programs that have shown
some success.
Acknowledgments
The authors acknowledge Diana J. Biro,
PhD, for her assistance editing the article.
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Crilly et al. | Peer Reviewed | Commentary | 1167
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70. “Competencies for Nurse Informaticists”
Program Transcript
[MUSIC PLAYING]
PATRICIA BUTTON: You know, in terms of the competencies
of nurse
informaticians, there's really been a lot of really excellent work
done in the past 5
to 10 years, both from the ANA, the American Nurses
Association, and the
TIGER Initiative. And really outlining what are the key
competencies. And I think
just an overarching statement about the competencies of
informaticians is-- being
an informatician is not knowing how to use PowerPoint.
I mean, it's not being computer literate. That certainly is part of
it. Much more
important is really having an appreciation of the management of
data,
information, knowledge, from all the different perspectives of
71. how those provide
value in the delivery of care.
I would really encourage you to look at the competencies that
the ANA and
TIGER have sort of keyed in on. And I think what it will really
do is help you
understand that yes, you need to be computer literate. You need
to know how to
use a whole variety of applications.
But it's really in the name of understanding what infrastructure
is available
technically to support the use of these systems in a very
productive and impactful
way. And in order to do that, there is a whole other layer of
competencies in
terms of defining use cases, understanding requirements,
definitions,
understanding how to structure content to make it quote,
"computable," ie, that it
can be used in a computer system and support the collection of
data. So I mean,
there really are layers or categories of competencies, again, that
both ANA and
TIGER have done a fantastic job of outlining.
The skills that serve me very well in this role are understanding
what is
technically necessary to actually embed content in the software
workflow in a
way that that will be available sort of at the right time in the
clinical process to
really impact what clinicians are doing. There's that piece of it.
There's very much
understanding, and this really is an informatics competency,
73. professional organization takes in information from other
organizations in order to
apply certification to those competencies.
So when we look at the American Nurses Association
competencies for staff
nurse or nurse informatician, we begin to see, if we choose it as
a specialty, that
it has key characteristics associated with it, for instance, in
understanding of
databases, how databases are structured, do you understand the
scope of
practice, what are the characteristics of the scope of practice for
a nurse
informatician. Ethics is clearly a component of a nurse
informatician certification.
So we begin to look at those competencies to be established.
When we look at an organization like TIGER, TIGER is not an
organization. It is a
501(c) foundation. And it supports the dissemination of
information to get out to
professional organizations some of the components that need to
be in the
standard. So we look to our professional organizations to
establish our
competency, but we look to multiple organizations to feed into
the profession to
help us establish our competencies.
74. One of the things that I think sometimes we get confused in
competencies and
informaticians is that we lose sight of the fact that you need to
have nurse
competencies, that you need to understand nursing data. You
can chart all day
sometimes and never put in any information that's about nursing
and the patient's
well being to be able to impact with nursing care. So we need to
be aware that
nursing data, on a lot of competency evaluations, that's where
most people will
fall behind because they see themselves more in a project
implementer, that they
know project planning, which is not centric to a nurse
informatician.
It's not core to their unique knowledge. It's part of their
knowledge, but it's not
core to their individual knowledge. We shouldn't get confused
that someone who
does project management or rolls out an implementation
program is a nurse
informatician. That to be a nurse informatician, you're
competent in the nursing
knowledge that's needed to be assigned to that profession and
that scope of
practice.
What competencies do, I believe, are key in being a vice
president of nursing for
a large HIT vendor or a software developer, ie, which is Cerner
Corporation. I
think there are a couple. Number one is to know what is and
what is not nursing.
And I think many times there is a lot of gray areas about what is
76. people. And in a matrix structure, you're not about how many
people report to
you, but how many people can you work with to get across a
certain concept or a
certain type of driver that needs to happen within the
organization for culture.
Those are really key components.
I think the other thing is that you have to be above reproach. I
think that is a key
component for anyone in executive leadership. You have to be a
part of the
discipline, and you have to be knowledgeable of the discipline.
And keeping up with the discipline means you go to school
forever. And it's
important to understand life-long learning, especially as an
informatician.
Because we know the data's going to change. We know the
professions are
going to change. So we need to be aware of that.
Another key component of competency, besides just knowing
the scope of
practice and licensure requirements and copyrights and
infringements and
trademarks and all of those things, is to understand that you're
always
representing your corporation. No matter where you are, 24
hours a day, seven
days a week. When you're out and about, you have no other
choice but to be on
good behavior.
77. And it's important because I think a lot of people think that you
can just separate
your job from your personal life and all the other things and
with technology, it's
kind of voided. I mean, people have Facebooks. When we
interview people
today, we go and check their Facebook. We pull their credit
ratings. There's a
whole different host of things today that technology has done
that bring your
personal life into you as a person when you're hired in a
corporation. And I think
that's really key as a competency is to be mindful of what your
impression is
upon those that you work with.
And I think the other thing that is really key is to understand
the roles that people
have in your organization. That they may not be reporting to
you, but you have a
responsibility in the corporation to make sure that the work is
being done.
However you decide to get it done, you have to make sure it
gets done. And I
think that's a real group process skill. And I think that's
different than initial hire.
And of course, you have to know your products. You have to
your products
backwards and forwards. You have to know what they're going
to do, where
they're going to go.
And I think one of the other key components is vision. You
have to have a vision
79. parities.
Our increasingly sophisti-
cated electronic technolo-
gies offer promising ways to
more effectively engage this
difficult to reach group and
increase its access to health
care resources. This process
requires developing not only
newer technologies but also
collaboration between com-
munity leaders and health
care providers to bring un-
connected individuals into
formal health care systems.
We present three strate-
gies to reach vulnerable
groups, outline benefits and
80. challenges, and provide
examples of successful
programs. (Am J Public
Health. 2011;101:1163–1167.
d o i : 1 0. 21 0 5/ A J P H . 2 0 10 .
30 0 00 3 )
John F. Crilly, PhD, MPH, MSW, Robert H. Keefe, ACSW,
PhD, and Fred Volpe, MPA
DURING THE PAST DECADE,
the United States has experien-
ced a rapid growth of electronic
health information technology in
hospital and health care provider
systems to enhance access and
quality for service recipients. State
health departments have devel-
oped health information ex-
changes across large health care
networks, insurance providers,
and independent physician prac-
tices, and the use of electronic
health records has greatly accel-
erated.1 These initiatives evince
progress toward achieving a fully
connected national health care
system by 2014.2
81. Nevertheless, cities and
counties struggle to understand
the health care needs of individ-
uals who do not or cannot easily
access formal health care net-
works but use expensive services
for emergency and routine care.
Health information technology is
currently designed to benefit pri-
marily populations already con-
nected to such systems. As systems
increase their use of health data to
influence treatment and policy,
developing strategies to include
individuals who are largely out-
side health care networks is criti-
cal.
The US health care system has
been criticized for low-quality care
that produces multiple medical
errors3,4 and high-cost services
that limit access to care,5 perpetu-
ating health disparities. Primary
care focused on preventing illness
and death is associated with more
equitable distribution of health
and better outcomes than is spe-
cialty care6---8; countries directing
resources to primary care and
enhancing population health have
lower costs and superior out-
comes.9 Although the United
States has the world’s most ex-
pensive health care system, other
82. countries regularly surpass the
United States on most health in-
dicators, including quality, access,
efficiency, equity, and healthy
lives.10 Capturing data on individ-
uals unconnected to health care
systems can improve health care
access and outcomes while reduc-
ing costs––important public health
goals.
The federal government allows
states and local communities to
develop their own health care in-
frastructures. By making changes
at the local level, communities can
become more effective in using
existing services to capture health
care data for hard to reach pop-
ulations. We have examined sev-
eral strategies for using existing
electronic technologies to better
connect such individuals to some
aspect of their local health care
system.
THE PROBLEM OF HEALTH
CARE ACCESS AND
POSSIBLE RESPONSES
Converging social problems
(e.g., geographic isolation, limited
education, poor health, poverty,
and the marginalization of vul-
nerable groups including people of
color and the rural poor) inhibit
83. certain individuals’ access to
health care services.5 People who
have the poorest health tend to
receive the least health care, and
those with limited health options
because of inadequate insurance
or unavailable providers often use
high-cost services, such as urgent
care and emergency rooms, which
may not be appropriate to their
needs. This problem is significant:
nearly 75 million adults––42% of
the population younger than 65
years––had either no or inade-
quate insurance in 2007.11 Lack of
consistent, documented contact
impedes the accumulation of
meaningful health data for health
care planning and intervention
development. Uninsured or un-
derinsured groups are at risk for
remaining isolated despite health
care reform.
Although few health care ser-
vice data may be collected from
these groups, there are other ways
to track service use. Data from
contacts with other community-
based, nonhealth services can be
employed to target specific com-
munity health needs. For example,
some groups without regular
health care may have contact with
departments of social services,
84. criminal justice, specialty courts
(e.g., drug, mental health, veterans,
and family), or schools. Data
extracted from these systems, us-
ing secure data transfer protocols
already developed by health in-
formation exchanges, could help
address and evaluate the health
and service needs of these groups.
These data can then be used to
develop and strategically imple-
ment novel health-promotion and
grassroots interventions.
Similar approaches have been
applied to track or monitor clinical
intervention outcomes,12,13 clinical
trials,14 adherence to specific
COMMENTARY
July 2011, Vol 101, No. 7 | American Journal of Public Health
Crilly et al. | Peer Reviewed | Commentary | 1163
interventions,15,16 and infections.17
Broader cross-systems data-use
collaborations between commu-
nity and health care providers to
increase care among uncon-
nected groups have also been
successful.18---21 Clinical trials of
cross-program multidisciplinary
interventions have reduced such
85. health-related stressors as high
blood pressure and cardiac
problems among poor families,22,23
disseminated HIV prevention
programs in African American
communities,24 delivered inner-
city tuberculosis prevention
efforts,25 and decreased negative
birth outcomes among low-
income African Americans.26
Initiatives derived from these
concepts are already under way in
some communities. The Partnership
for Results in Auburn, New York
(http://www.partnershipforresults.
org), developed a cross-systems data
access and sharing collaboration
around children at risk for school
violence. San Francisco Children’s
System of Care (http://nccc.
georgetown.edu/documents/
ppsanfran.pdf) developed and
expanded their collaboration to
collect individual-level data on
youth across a series of systems,
including schools and probation,
to target and evaluate novel in-
terventions.
Access to health-related infor-
mation and health promotion has
expanded with the growth of the
Internet,27,28 particularly in the
mental health field, which is rap-
86. idly developing online versions of
actual treatment.29 No-cost per-
sonal health records are available
online, allowing individuals to
bank and control their own health
data. Broadband Internet access
and mobile wireless are available
in all urban and most nonurban
areas, offering new opportunities
to reach individuals outside health
care networks.
TECHNOLOGY TO REDUCE
BARRIERS TO HEALTH
CARE
Developing cohesive, commu-
nity-based strategies for using
health information technology and
electronic communication tech-
nologies optimally is critical to
dismantle barriers to health care
and health information.4 To help
communities reduce such impedi-
ments, we propose several strate-
gies.
Communities: Collaborations
for Health-Focused Use of
Community-Based Data
Individual-level data exist in
public and private agencies and
institutions (e.g., social services,
87. criminal justice, colleges, and trade
schools). These data are confiden-
tial and protected and typically
include personal identifiers and
service use history. Because of
their size and scope, these systems
have a similar database infra-
structure and often contain data
on the same individual. Collective
data from these systems could
help drive new forms of commu-
nity-wide health promotion and
service delivery. To build such
systems, three tasks are essential.
Task 1: Engaging the community.
It is essential to understand a
community’s political geography
and to identify entities that will
form the infrastructure to facilitate
and coordinate the use of data
from extant systems for that com-
munity to use. Choosing key
leaders from potential participat-
ing agencies that will form the
collaborative should be according
to their willingness, influence, and
ability to collaborate and properly
use centralized data. The collabo-
rative can then team with broader
health-focused organizations, such
as local health departments in
urban areas and offices of rural
health in state health departments,
to build the initial support base
88. and vision.
Task 2: Developing a plan. Once
formed, members of a collabora-
tive must develop an action plan.
A critical component is an assess-
ment of the content of all partici-
pating data systems. The plan may
involve building a comprehensive
data dictionary of potential data
fields applicable to health-related
risk. A feasible system must be
relatively simple, low cost, risk
controlled, time efficient, and
beneficial for participating
agencies. A key collaborator in this
task is a regional health informa-
tion exchange, which can assist in
providing a secure information
exchange environment. Particu-
larly important are the consent
and data security processes30 and
the development of effective data
use agreements that limit liability
regarding the unintended use of
data.31
Task 3: Forming a collaborative.
Building a collaborative to drive
this process and use the data re-
quires input from various experts,
including researchers, program
developers, and trainers, who can
introduce fresh ideas regarding
program development, care deliv-
ery, and outcomes tracking and
89. measurement. Indicators of the
success of the initiatives may in-
clude fewer missed days of work
or school, decreased emergency
room visits, and better communi-
cation among multiple health care
systems. Ideally, the collabora-
tive’s leadership should be based
at local public health departments
because of their community-wide
scope.
Veterans returning from over-
seas could serve as a test case for
how such a system might work.
Despite available care, many vet-
erans do not connect with the
Veterans Affairs health care
system and struggle for long pe-
riods with adjustment problems
affecting their physical and mental
health. Identifying points of entry
into community systems such as
schools or social services may help
these systems better meet the
needs of veterans with high-risk
burdens but only minimal in-
volvement with health or mental
health services. The Veterans Af-
fairs health care system has al-
ready obtained much information
that may be used to improve
returning veterans’ quality of
care.32,33
90. Health Care Systems:
Reaching Out Through
Electronic Means
Although the Internet can serve
as a conduit for reaching geo-
graphically and socially isolated
individuals, understanding its cur-
rent usability and limits is neces-
sary for effective planning. Inter-
net access occurs through (faster)
broadband or (slower) dial-up
depending on geography.34 Some
areas have no access at all; some
households choose not to use the
Internet (Table 1).
The Internet is the primary way
most users (67%) obtain health
care information,36 but only 63%
of US households have an Internet
connection. Urban areas have
greater broadband access than do
nonurban areas, which typically
have more dial-up connections.
Whites use computers to connect
to the Internet more often than do
African Americans (59% and
45%, respectively), but more Af-
rican Americans (48%) use mobile
wireless devices than does the
general population (32%).28
Wireless handheld devices are
91. better options for contact in rural
areas because signal delivery is
more flexible, although gaps per-
sist as the result of terrain or
geography. Consequently, reaching
COMMENTARY
1164 | Commentary | Peer Reviewed | Crilly et al. American
Journal of Public Health | July 2011, Vol 101, No. 7
individuals electronically may re-
quire a multifaceted approach.
Health-related Web sites pro-
vide information on specific med-
ical diagnoses (e.g., diabetes), gen-
eral medical guidance (e.g., http://
www.WebMD.com), access to
medical literature (e.g., http://
www.PubMed.com), and treat-
ment options for mental health
conditions.29 Sites such as http://
www.patientslikeme.com allow
individuals to report their symp-
toms and evaluations of medica-
tions or treatments.37 Message
dissemination technology can now
rapidly access targeted groups in
communities for specific safety or
health purposes.38 Twitter tech-
nology is increasingly used in pri-
vate industry39 and is gaining ac-
ceptance in medical settings.40
92. Effective use of these technolo-
gies by health care systems can
increase their range to reach un-
connected individuals. Handheld
devices can receive brief an-
nouncements, appointment re-
minders, or health tips. Wellness
webs (composed of individuals
with similar health-related needs
who are connected electronically
to enhance their ability to work
together and better meet their
health goals) targeting individuals
to receive messages according to
need or interest can be built
through collaborations among
community agencies, insurance
companies, and providers. These
technologies may also facilitate
connection with African Ameri-
cans and Hispanics. Technology
alone cannot alleviate disparities
in health care access, but a na-
tional study finds that although
people with higher incomes use
the Internet more for their health
records, people with lower in-
comes and people without college
degrees are likely to benefit more
from having their health informa-
tion online.36 Connection fosters
more regular, better coordinated
care, with improved outcomes.
93. Individuals: Building and
Maintaining Personal Health
Records
Many health care systems and
insurance companies offer public
health records (PHRs) to help pa-
tients coordinate their care and
keep in touch with their providers.
PHRs allow patients to view parts
of their own health record (e.g., lab
results, medication history), input
data (e.g., weight, blood pressure),
and schedule appointments. In-
surance companies are the pri-
mary providers of PHRs (51%),
followed by health care providers
(26%), but other health-related
organizations offer PHRs to mem-
bers (e.g., the American Heart
Association).36
Recently, both Google (Google
Health) and Microsoft (HealthVault)
introduced publicly available,
Internet-based PHRs at no cost.
Although these providers pledge
that PHR data will be secure and
not exploited for advertising or
other commercial purposes, users’
trust must be developed. Only
25% of potential users report
a willingness to use a PHR from
94. a private corporation.36 Despite
these concerns, PHR options have
considerable value. PHRs contain
functions that can import data
over the Internet directly from
specific health devices (e.g., blood
pressure monitors, weight scales,
blood glucose tests) plugged into
computers or handheld devices.
Both Google and Microsoft prod-
ucts allow individuals to designate
specific entities for data sharing.
With this feature alone, commu-
nities can implement and monitor
targeted health-promotion pro-
jects and measure progress and
outcomes from self-reported data
through a central location that
links participants. As individuals
join health care systems, become
insured, or relocate, they can ex-
port and import data to electronic
health records and back into PHRs
no matter where they receive care.
MOVING FORWARD
Although they do pose some
risks, using electronic technologies
to improve conventional health
services offers opportunities to
reduce health disparities. It is in-
structive to examine successful
community programs and imper-
ative to continue assessing how
95. best to harness these technologies
to advance public health goals
without compromising privacy
or security. Researchers should
conduct rigorous reviews of the
literature to identify promising
programs and recommend appro-
priate policies and safeguards.
Developing new avenues of
communication with various
health care systems has already
helped unconnected individuals
access health care in some regions.
Through strategic collaborations
using established technologies, or-
ganizations such as participants in
the Substance Abuse and Mental
Health Services Administration’s
Drug Free Communities program
have been successful, including
incorporating accountability mea-
sures. One program in Florida
(http://www.onevoiceforvolusia.
org/data.htm) has included in its
mission promoting cross-system
data-gathering capabilities to ad-
dress high-risk groups. Inclusive
consensus building and commu-
nity action planning approaches
have produced successful systems-
level interventions in several US
cities and counties,41---43 enabling
vulnerable groups to take charge
of their health information.44 Such
initiatives not only create alterna-
96. tive access but also have important
policy implications aligned with
Healthy People 2020 objectives.45
TABLE 1—US Internet Connection Types and Use by Region:
October 2007
South (n = 43 370) Midwest (n = 26 714) West (n = 26 203)
Northeast (n = 21 553)
Urban
(n = 32 510), No. (%)
Nonurban
(n = 10 861), No. (%)
Urban
(n = 20 461), No. (%)
Nonurban
(n = 6253), No. (%)
Urban
(n = 23 322), No. (%)
Nonurban
(n = 2882), No. (%)
Metro
97. (n = 18 154), No. (%)
Nonurban
(n = 3399), No. (%)
Dial-up 2872 (8.8) 1976 (18.2) 1752 (8.6) 1374 (22.0) 2093
(9.0) 531 (18.4) 1345 (7.4) 632 (18.6)
Broadband 16 772 (51.6) 3682 (33.9) 10 689 (52.2) 2379 (38.0)
13 227 (56.7) 1376 (47.7) 10 088 (55.6) 1635 (48.1)
No use 9704 (29.9) 4073 (37.5) 5693 (27.8) 1776 (28.4) 5883
(25.2) 724 (25.1) 5421 (29.9) 859 (25.3)
Overall use 19 740 (60.7) 5677 (52.3) 12 494 (61.1) 3764 (60.2)
15 390 (66.0) 1918 (66.6) 11 450 (63.1) 2287 (67.3)
Source. Data from the US Census Bureau, Current Population
Survey, Internet Supplement, October 2007.35
COMMENTARY
July 2011, Vol 101, No. 7 | American Journal of Public Health
Crilly et al. | Peer Reviewed | Commentary | 1165
For example, health policy deci-
sions are generally derived from
medical data from health care
systems and insurance compa-
nies.46 Using these data as the
primary source can invite the ap-
pearance of full knowledge when
the data actually represent only
98. individuals connected to the sys-
tem; excluding the unconnected
generates an incomplete picture
that can perpetuate disparities in
access and outcomes.
The new federal health reform
legislation is already promoting
creative changes by increasing
funds for community health
centers to boost the number of
treated patients.47 Under this
legislation, millions of Americans
will gain access to care previously
unavailable to them. There is an
urgent need to effectively handle
this expected rapid growth. Shift-
ing greater focus, responsibility,
and control to the local commu-
nity constitutes one encouraging
approach. For example, collabo-
ration to better distribute care
may prompt more efficacious
distribution of health care fund-
ing. At the time of this study,
health care dollars flowed directly
to formal providers as reim-
bursement for services rendered.
The distribution of funds depends
entirely on the delivery structure
of those entities, not the broader
needs of the community. Without
appropriate strategies and infra-
structure, communities will have
little power to create meaningful,
effective partnerships with health
99. care systems to assist their mem-
bers in need.
Obviously, the challenges, limi-
tations, and risks of using these
technologies must be understood
and continuously evaluated. New
applications for health-related
purposes raise many security and
privacy concerns that require the
attention of consumer health
advocates and health policy ana-
lysts. Although the Internet re-
mains the largest venue for access-
ing health-related information and
health-monitoring tools, it is neither
ubiquitous nor a panacea.
Electronic technologies must
be more broadly and effectively
implemented to realize their po-
tential to improve health out-
comes for vulnerable populations,
lower costs, and reduce health
disparities. To advance this
promising application, we need to
devote more attention to devel-
oping creative approaches to help
people access appropriate re-
sources, devising better safe-
guards, measuring effects and
evaluating programs, and sharing
information about programs that
are working. But by exploring
how to use technology to reach
100. unconnected individuals, com-
munity systems and health care
providers can begin to address
the problem––and enhance the
coordination of health care for
millions of Americans. j
About the Authors
At the time of this study, John F. Crilly
was with the Department of Psychiatry,
University of Rochester Medical Center,
Rochester, NY, and the US Department of
Veterans Affairs, Canandaigua, NY. Robert
H. Keefe is with the School of Social
Work, State University of New York,
Buffalo. Fred Volpe is with the Drug Free
Communities Program, Substance
Abuse and Mental Health Services
Administration, Leesburg, VA.
Correspondence should be sent to Robert
H. Keefe, PhD, ACSW, Associate Professor,
School of Social Work, 685 Baldy Hall,
University at Buffalo, State University of New
York, Buffalo, NY 14260-1050 (e-mail:
[email protected]). Reprints can be
ordered at http://www.ajph.org by clicking
the ‘‘Reprints/Eprints’’ link.
This commentary was accepted August
11, 2010.
Contributors
J. F. Crilly conceptualized the article and
led the writing of the initial draft. R. H.
Keefe edited the initial draft, aided in
101. writing, and led the revisions. F. Volpe
outlined the strategies and provided
examples of programs that have shown
some success.
Acknowledgments
The authors acknowledge Diana J. Biro,
PhD, for her assistance editing the article.
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