Foul Play :: essays research papers

It was late in the evening. There was a man sitting in a chair and flipping channels eagerly between two baseball games on TV. The man's name was Les Sutton. He was a towering man standing 6'3". He was built, worked out a lot and looked like someone not to meet in a dark alley.Les was a detective. His skills of deduction were brilliant. He also had an assistant. Les's long time pal and partner's name was Jason Meisch. Jason was also very tall but he was more lanky, built more like a basketball player. He was also extremely bright but not as intelligent as Les. Although Les was his best friend and the same age, Jason still looked up to him like little kids look up to adults, with pure awe and admiration.The next day after Les had been channel surfing for baseball games, he and Jason got together and didn't have anything to do. Being the huge baseball fans that they were and living in the state of California where baseball is everywhere, they decided to go to a ballgame. They figured that they had a long boring afternoon in front of them so they went down to Chavez Ravine (the place where the LA Dodgers play) and got tickets to the Dodger game that was scheduled to start in about 15 minutes.Les and Jason were enjoying the game while eating hot dogs and drinking pop. The Dodgers were winning by the score of 5-4. Just then, catcher Mike Piazza, let another pitch go by him. "What the heck? Piazza is playing terrible today. He has let 4 balls by him and struck out all three times he has been at the plate," Les said.Jason agreed, "Yeah, that is kind of weird. I mean, he's an All-Star. It's not like him to play like this." The whole rest of the game they sat in their seats wondering why Mike Piazza was playing so bad. When they got home they were watching the news. They had a funny story on about how in Las Vegas there was a lot of money lost on that game because the Dodgers lost 7-5. As they watched that story they both looked at each other and exclaimed, "Piazza threw the game!"They didn't have anything else to do so they decided to try to figure out who paid Piazza to throw the game.

Electronic Medical Record Implementation: Costs and Benefits

Electronic Medical Record Implementation: Costs and Benefits Sheryl L. Venola Assignment 3 (24 July 2011) NURS 517 Intro to Health Care Financing Saint Xavier University Professor: Dr. Roger Green, DNP, MSN, BSN Abstract This paper discusses the adoption of an electronic medical record system purchased by Howard Regional Health System in Kokomo, Indiana; the rationale behind its timing and choice in expenditure; the ramifications of not implementing the system (e. g. recent health care legislation requirements); the benefits to the organization as well as to the patients it serves, and a cost effectiveness analysis. Additionally, the American Recovery and Reinvestment Act of 2009 is discussed including compliance mandates that will require eligible providers and health care institutions to meet electronic health technology implementation deadlines or face no compensation for their implementation as well as reductions in Medicare and Medicare reimbursements. Also included are discussions of the â€Å"meaningful use† guidelines established by the Centers for Medicare and Medicaid and the differences between electronic medical records and electronic health records. Finally, the advantages and disadvantages of electronic medical records are detailed. In response to the to changes in the health care delivery system as a result of the Affordable Care Act (ACA) signed into law in March of 2010, Howard Regional Health System (HRHS) has recently purchased the Cerner electronic medical record (EMR) system at a cost of $22,000,000. According to chief executive officer, James Alender, accountable care is the focus of this change in addition to stimulus money for electronic health record (EHR) system implementation, which could offset their initial expenditure by approximately $3,100,000 based on the volume of Medicare business the organization had in 2008 (Munsey, 2011). This monetary investment comes in the wake of health information technology implementation requirements set forth in the American Recovery and Reinvestment Act of 2009 (ARRA). The Recovery Act specifies that eligible providers and hospitals with a fixed Medicare and Medicaid patient populations must adopt EHR systems by 2015 or face reduction in their compensation under these programs (Department of Health & Human Services [DHHS], 2009). Additionally, the act assigned funds to the Centers for Medicare and Medicaid Services (CMS) to assess existing EHR systems and to provide incentives for eligible providers and hospitals in implementing such systems. With continued funding and legislative measures affecting the organization’s financial future, the adoption of the Cerner system seems to be one of the most important steps in ensuring its financial security in the years to come. If hospital executives and the Board of Trustees were to ignore the requirements set forth in the AARA and ACA legislation, the institution would be in serious jeopardy of losing not only is share of federal funding, but its ability to participate in health care delivery on any level at all. This would signal their demise and would certainly affect the surrounding community as it is one of two hospitals in Kokomo, Indiana, and is the only health care organization of its size in this region of the state. The patients Howard Regional serves will benefit from electronic recording of their health and medical information in many ways. Alender states that Kokomo’s â€Å"snowbirds† should have access to their records so they can be as mobile as they are, suggesting that this will reduce health care costs by reducing duplication of tests, if treatment is obtained away from home. He goes on to assert that digital records will allow more efficient movement of patients through the system allowing seriously ill patients to move more quickly through the emergency department, and other acute care departments within the system. Additionally, if that same patient requires further care away from HRHS, the treating hospital would have access to the previous records so that work already completed is not repeated (Munsey, 2011). Their medical information could be updated with each visit rather than their having to â€Å"provide the same information over and over again (Gurley, 2003). † Gurley also agrees that because patients and providers are better informed through electronic record-keeping, there is less duplication of testing as well as enhanced treatment coordination among health care providers. Along with the patients, the hospital reaps many tangible and intangible benefits from EMR as well. The information in the electronic record is easily accessible to multiple clinicians at multiple locations at the same time, with nearly immediate retrieval time. For this reason, it is updated frequently and is available for access at any workstation whenever the information is required making time spent with patients more efficient (Gurley, 2003). According to Shi and Singh (2003, p. 65), one of the most important aspects of electronic records is the integration of specific patient profiles with clinical decision making tools built into the software which provide evidence-based practice reminders and guidelines for effective, efficient treatment. This type of alert system can result in reduction of medication errors and in appropriate treatment options, saving both the patient and the clinician from harm. The data analysis capability of the EMR can also be used to identify developmen ts among patient populations allowing for early intervention when indicated. It can also be utilized to identify areas in which the organization may need to expand or scale back depending on the trends the data indicates (Dolan, 2011). Having used the Cerner system in the past, this RN noted that with the clinical record being streamlined in such a way that narrative documentation was necessary only by exception, completing it required less time, which left more time for bedside care along with completion of educational requirements, which were also mostly computerized. Hence, the savings could be significant and provide for increased nurse satisfaction related to the ability to provide more actual patient care as well as complete proficiencies without having to stay after a shift or come in on a day off. As mentioned above, EMR can reduce duplication of services, assist in fast-tracking acutely ill patients, reduce the duplication of tests and services that aren’t medically necessary (e. g. the patient’s condition has not changed substantially), allow clinicians to spend less time on documentation possibly reducing overtime, each of which can result in cost savings for the institution. According to Randall T. Huling Jr. , MD, president of Olive Branch Family Medical Center in Olive Branch, Mississippi, since switching over to EMR in January of 2010, they have increased revenue by an estimated $650,000 with an annual cost reduction of more than $85,000. Additionally, they have been able to raise provider productivity by 10,000 visits, raise their fee collection percentage from 68 to 72 percent, and increase the charges per patient from $157 to $172 (Byers, 2010). Wang et al (2003) performed a five-year cost-benefit analysis using primary data from several internal medicine clinics, using their own internally developed EMR system, utilizing a health care organization perspective framework and a conventional paper-based medical record as the reference point. Costs of implementation were approximated to be $3,400 per provider in the first year and included redesign of workflow processes, extraction of data from paper charts, and training. Yearly maintenance cost, including system and network administration and additional technical support personnel, were estimated to be $1,500 per provider annually. The temporary loss of productivity resulting from the transition to an electronic from a paper system, was interpreted using a decreasing loss rate of 20% in month one, 10% in the second month, and 5% in the third, returning to baseline in the following months. With annual averages for provider revenues, this cost amounted to $11,200 in the first year. Although their five-year net benefit per provider was $86,400 and the â€Å"net financial return to a health care organization from using an ambulatory medical record system is positive across a wide range of assumptions (Wang, et al, 2003, p. 401),† the authors cautioned that several variables could affect the net revenues organizations could expect. The patient mix can affect revenues depending on the number of capitated versus fee-for-service patients served by the health care organization. With capitated arrangements, savings to the patient resulting from decreased use of utilization of services, revenues accrue to the provider. However, less utilization of services in fee-for service arrangements result in loss of revenue to the provider, but the payer (i. e. the insurer) saves in expenses. They did postulate that these insurers might provide incentives to providers using EHR realizing that their profits could be increased with more providers utilizing these systems, The study evaluated cost savings from drug suggestions and warnings provided by the EMR software, which aided in prescribing of formulary drugs and prevention of adverse drug events. However, the study was not able to evaluate the intangible cost savings from averted malpractice claims, injury to patients, or reduced quality of life of clients. Additional tangible and intangible savings that were not included due to unavailability of sufficient data were reductions in malpractice premium costs, decreased staffing needs, less paper charting-related storage and supply costs, increased provider productivity, generic drug substitutions, enhanced reimbursement resulting from proper coding, and reduced denials related to insufficient documentation of medical necessity (Wang et al, 3003 p. 402). Limitations of the study cited by the authors included the fact that the research model was centered on primary data from their institution, published literature estimates, and an expert opinion panel which they convened. They also conceded that EMR implementation might produce other costs, including greater system integration expense for larger institutions dependant on the complexity of the various system interfaces involved. Additionally, although effectiveness of electronic medical record interventions has been well-established in inpatient settings, there is less certainty of their effects in the outpatient environment. Other costs could be related to decreased or lost productivity during unexpected network or computer system downtime, reassignment of clinical staff, or redesign of the workflow process (Wang et al, 2003, p. 402). Obviously the above results are based on one study utilizing results from a group of ambulatory clinics making it difficult to extrapolate data to a hospital setting even when that hospital has significant outpatient programs. Indeed, Thompson and Fleming (2008) pose questions regarding the uality and quantity of data found in existing literature, suggesting that health care institutions be cautious in their information sources in order to be better informed in the EMR decision-making process. The authors state that amount of comprehensive studies are lacking requiring hospitals to obtain more sources containing information they are seeking and rigorously compare data so that they can better extrapolate the results to their individual organizations (Thompson & Fleming, 2008 ). They also caution using staff time savings as a factor unless that variable is given a value and that it is used to actually cut costs. For example, if an average of 30 minutes per staff member is realized in utilization of the EMR, how will that impact staffing? Will staffing needs be reduced allowing for fewer staff members per shift, resulting in actual cost reductions? If staff are able to complete other duties that would have required use of overtime or coming in on days off, this would also decrease expenditures. However, the authors point out that staff members are often allowed to perform other tasks that don’t result in salary reductions, although this is implicit when staff time saving related to EMR is discussed (Thompson & Fleming, 2008). It is obvious that the decision to adopt an electronic medical record is not an easy one to make given all the variables discussed previously, but the information presented thus far has not taken into account the more recent changes produced by health care reform. These changes are discussed in the following paragraphs. The American Reinvestment and Recovery Act provides incentives for eligible providers (EP) and health care organizations (i. e. those who serve a defined percentage of Medicare and Medicaid recipients) for the implementation of EHR. The use on EMR and EHR are have often been used interchangeably, but they are not the same. An electronic medical record is the legal record of the care a patient receives from a health care provider or institution during their encounter with either entity. The electronic health record belongs to the patient and encompasses the entirety of their care across all providers within a community, region or state (Garets & Davis, 2006, pp. 2-3). For the purposes of reimbursement, however, providers must use a certified EHR (EHR Incentives, p. ). The recovery Act has appropriated $140,000,000 for each of fiscal years 2009 through 2015, with an additional $65,000,000 for 2016 to be used for administrative funding. Funds are to be made available until completely utilized. â€Å"In coordination with the Office of the National Coordinator (ONC) for Health Information Technology, CMS will develop the policies, such as the definition of ‘meaningful use,’ needed to implement the incen tive program (DHHS, 2009). In addition, it will be necessary to provide education to eligible participants to facilitate their understanding of all the conditions and guidelines regarding their eligibility, the selection of Medicare or Medicaid incentive programs, the incentive payments, and the demonstration of â€Å"meaningful use. † Recovery Act reporting compliance will require guidance to individual states, which will involve Federal and State staff time and require modification of accounting and payment data reporting systems (DHHS, 2009). When the aforementioned requirements were set forth by the DHHS in 2009, the meaningful use guidelines had not yet been established. Following is a link to the summary overview for meaningful use objectives of EHR* (Blumenthal & Tavenner, 2010) as it currently stands, which outlines the steps individual providers and health care institutions (hospitals, ambulatory care centers, clinics, et al) must take in order to receive stimulus funds for the costs associated with implementing electronic health systems (EHR). The initial payments will be made beginning in 2011 depending on each state’s timing in adoption of the Medicare and Medicaid programs. For hospitals, the calculation is based on the volume of Medicare and or Medicaid patients served, but the baseline payment is $2,000,000. Each program is separate, but EPs and institutions can apply for one or both programs, however if they choose only one program, they cannot later add the other, so it benefits them to choose both at the outset since they can drop out of either one at any time (EHR Incentives). Given the stakes of not participating, providers should work diligently to eet all the requirements set forth in order to maximize the return on investment they should obtain in simply adopting EHR. The incentives offered will merely help them realize those return sooner rather than later. Finally, given the state of internet security and the government’s desire to push providers toward electronic data capture, it is only natur al that there would be concerns regarding EMR and EHR technology. Advantages of EHR over paper records include an expansive storage capability, availability of the data from many access points at the same time, and nearly immediate retrieval time (Gurley, 2003). The paper record is fragmented and depending on the charts used (e. g. some tend to fly open when dropped, causing paper to be scattered), pieces of the record can be lost. Additionally, when a patient is hospitalized more than once, their old chart must be retrieved in order to provide continuity of care. Electronic systems bypass this and allow clinicians to obtain information from previous visits much more quickly allowing the patient to have a streamlined entry to and exit from the system. Electronic health records also have built-in medical alerts and reminders allowing providers to be notified of abnormal lab results, potential drug interactions, and timing of tests required for monitoring blood levels associated with certain conditions or as a side effect of medications. It can also provide evidence-based practice plans for certain diseases and disorders facilitating the provider’s choices in judging the right path in caring for each patient. The electronic software allows the clinician to capture information enabling them to provide payers with the outcome based criteria they require in reimbursing the physician. Finally, EHR provides a major step in ensuring patient safety by clearly written order entry by physicians avoiding the mistakes that can occur with handwritten orders when those entries are illegible (Gurley, 2003). The major disadvantage of EHR adoption appears to be the costs associated with implementing them. According to Kent Gale, start-up costs could range from between four and five million dollars for a smaller (200-bed) hospital to $100,000,000 for an organization with three hospitals. He went on to tate that a typical 400-bed facility with a more extensive EHR would likely spend between $20,000,000 and $30,000,000 (Byers 2010). Also, unless one is technologically-savvy, there can be considerable learning needs on the part of physicians and staff. In these cases, it is much better to have systems that are more intuitive and user-friendly in order to get everyone onboard. As previously mentioned, privacy concerns are at the forefront in people’s minds where electronic documentation is concerned. Security measures must be ever-evolving in order to meet the challenge and audits of access to medical data must be done to ascertain the appropriateness of information access. Paper records have also had the potential for unauthorized access without the knowledge of the patient or provider and these invasions of privacy are much harder to detect (Gurley, 2003). Essentially, the electronic record has its advantages and disadvantages, but with all the benefits they can provide to patients, providers, insurance companies, as well as the government in collection of statistics, it appears to be the best choice for all concerned. With a great deal of effort and constant vigilance, electronic health records can provide for safer, more cost efficient care, and conserve resources for use in other areas that are currently lacking. I believe that in the end, Howard Regional’s decision to adopt EHR will result in huge savings and increased revenues that will benefit not only the organization, but the communities they serve. References Blumenthal, D. , & Tavenner, M. (2010, August 5). The â€Å"Meaningful Use† Regulation for Electronic Health Records. New England Journal of Medicine, 363, 501-504. Retrieved from http://ww. nejm. rg/doi/full/10. 1056/NEJMp1006114? ssource=hcrc Byers, J. (2010, November). EMR implementation: One day at a time. CMIO: Information, Evidence & Effectiveness in Medicine, Digital. CMIO. net, 10-12. Retrieved from http://d27vj430nutdmd. cloudfront. net/5165/51383/51383. pdf Department of Health and Human Services Report (2009). Centers for Medicare & Medicaid Services: Medicare and Medicaid Incentives and Administrative Funding. Retrieved from http://www. hhs. gov/recovery/reports/plans/hit_implementation. pdf Dolan, P. L. (2011, May 2). Electronic medical records: What your data can tell you. American Medical Association: American Medical News. Retrieved from http://www. ama-assn. org/amednews. EHR Incentives: Eligibility. (n. d. ). Retrieved July 18, 2011, from Centers for Medicare and Medicaid Services website: https://www. cms. gov/pf/printpage. asp? ref=http://www. cms. gov/ehhttps://www. cms. gov/pf/printpage. asp? ref=http://www. cms. gov/ehhttps://www. cms. gov/pf/printpage. asp? ref=http://www. cms. gov/EHRIncentivePrograms/15_Eligibility. asprincentiveprograms/01_Overview. asprincentiveprograms/01_Overview. asp Garets, D. , & Davis, M. (2006, January 26). Electronic Medical Records vs. Electronic Health Records: Yes there is a difference [White Paper]. Retrieved from A HIMSS AnalyticsTM website: http://www. himssanalytics. org/ Gurley L. (2003). Advantages and Disadvantages of the Electronic Medical Record. American Academy of Medical Administrators, 2004. Retrieved from http://www. aameda. org/MemberServices/Exec/Articles/spg04/Gurley%20article. pdf Munsey, P. (2011, March 26). Howard Regional up to the challenge. Kokomo Perspective. com. Retrieved from http://www. kokomoperspective. com Shi, L, & Singh, D. A. (2008). Delivering health care in America: A systems approach. Sudbury, MA: Jones and Bartlett Publishers. Thompson, D. L. , & Fleming, N. S. (2008, July). Finding the ROI in EMRs. Healthcare Financial Manager, 62(7), 76-81. Retrieved from http://www. hfma. org/publications/hfm-Magazine/hfm-Magazine Wang, S. J. , Middleton, B. , Prosser, L. A. , Bardon, C. G. , Spurr, C. D. , Carchildi, P. J. , †¦ Bates, D. W. (2003, April 1). A cost benefit analysis of electronic medical records in primary care. American Journal of Medicine, 114(5), 397-403. Retrieved from http://www. amjmed. com/article/S0002-9343(03)00057-3/fulltext

The Battle Between Good Versus Evil - 960 Words

Were all so busy chasing the extraordinary that we forget to stop and be grateful for the ordinary (Brown 152). Novels are sources of magic, written with such delicacy and intricacy that they often leave the reader astounded by the power of words. The plot, concept, and language are so extraordinary that human eyes easily bypass the most ordinary objects of all in the story, ones that can only be read between the lines in order to reveal truly deep meanings. The connection to William Goldings prize-winning novel Lord of the Flies is undeniable. An island in the middle of the sea where several young boys strive for survival and create a society all on their own is remarkable. The novel tells the tale of a society run by children that†¦show more content†¦In the end, his civilization is what keeps the boys alive and sane for so long, despite losing his power and respect to Jack. Subsequently, the conch is not just a shell but also the sound of order, civilization, and politica l power between the good and the bad. Ralph finds it and uses it to call the boys together. He establishes a hand-raising rule, keeping to the rules of their civilized past. He organizes assemblies to discuss the issues tearing apart the island in order to keep everyone safe. After Jack gains power from hunting and breaks off to form his own group, Ralph and Piggy are nearly rendered helpless, especially since the conchs value diminishes. When they try to convince Jack to return and unite under the spell of the conch, Jack proves his separation by declaring, And the conch doesnt count at this end of the island(Golding 260). Finally, all chaos breaks loose when the large boulder kills Piggy and the conch shatters. All in one scene, the intellectual character dies, order and civilization is lost, and evil forces hunt the isolated common sense. Piggys dependence on the conch shows his desperateness for bringing wellness back to the savage majority, even though the evil wins in the mids t of the chaos. Altogether, good and evil reign in both Ralph and Jack religiously, morally, and politically with aid from Simon and Piggy. The character, Lord of the Flies, the fire made by PiggysShow MoreRelatedTheme Of Good And Evil In Beowulf1190 Words   |  5 PagesIn the beginning all was good; there was no evil. The start of evil was marked when a jealous angel, Satan, desired equality to God. He thrust an ever-lasting battle into play when he battled God for supremacy. One-third of all the angels in heaven, including Satan, were thrown from heaven onto Earth. God’s perfect creation became faulted when the fallen angel, Satan, tempted Adam and Eve into eating a forbidden fruit. By partaking of the forbidden fruit, sin was born on Earth. The birthing of suchRead MoreGood vs. Evil Found in Beowulf807 Words   |  3 PagesGood vs. Evil Found in Beowulf In the story of Beowulf, there are many different themes found. Many people argue the main theme found in this story. This has been argued for a very long time and will go on for many more years to come. Although many themes in this story stick out and a main theme will never be accepted, one main theme is very noticeable in the story of Beowulf. The main theme found in Beowulf is good versus evil. Good versus evil is very easy to recognize. â€Å"Some peopleRead MoreGood And Evil : Dr. Faustus1228 Words   |  5 Pagestheme of good versus evil is one of the most apparent as well as one of the most important themes throughout the play. Good and evil are represented as a battle or struggle in many ways such as constantly battling over winning various individuals souls, the concept of God versus the Devil, and the idea of religion versus science. 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Nathaniel Hawthorne explains this theory in his â€Å"Young Goodman Brown† story, where evil overcomes and defeats the good. Hawthorne does this by using these allegorical figures Young goodman Brown, Faith, and the old unnamed man. TheseRead MoreSymbolism Of Beowulf716 Words   |  3 PagesBeowulf battles snatched up 30 men and it is to be said that beowulf has the strength of 30 men. Beowulf is an epic poem translated by Burton Raff el. In Beowulf there is three battles with three different monsters, Grendel, Grendels mother, and a dragon. The three battles have a symbolic meaning throughout the whole book. The three battles in the epic poem represent more than just two enemies fighting for victory, they are battles between the internal good and monster who embody evil. BeowulfRead More Lord of the Flies by William Golding Essay1112 Words   |  5 Pagesa group of British schoolboys on a secluded island, in the midst of a war. Throughout this period the boys evolve from being civilised and let savagery take over. This book is well written and effectively presents the theme of the story: the evil that man is capable of. Once read, this book will stay in your memory for its provocative idea that humans are a flawed race. The story takes place on a remote, tropical island. As the island is secluded, there is no contact from the outside world

Judaism and the Economy Essay - 1222 Words

Judaism and the Economy While the Jewish population is small, its impact on the economy is extensive. For a group of people making up less than two percent of the United States populace, Jews are certainly a topic of much conversation and controversy. For a race so often targeted negatively and used as a scapegoat, it is surprising to realize the Jewish hand in America today. A question circulating for a while is whether or not Jews control America; Jews rule the film industry, the news and communication business is a Jewish kingdom, the American financial industry is essentially a Jewish franchise, and the professions are so dominated by Jews its shocking, so where does their influence run out? While the idea that America is run by†¦show more content†¦In a recently released study, researchers at Nova Southeastern University claim that the strategy boosts stock market returns. 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The hypothesis implies that because the market knows this will happen, you shouldn’t be able to profit from it, but seeing as the whole world knows when Rosh Hashanah and Yom Kippur will happen and there is still an abnormal return of one percent, the market isShow MoreRelatedSolution to the Current Global Economy: Judaism and Economic Reform, by Norman Solomon1103 Words   |  5 PagesIn the essay â€Å"Judaism and Economic Reform†, Norman Solomon, a Jewish-American journalist, presents a compelling argument on the basis of the need for economic reform while providing simple religious base solutions. While discussing two major economic problems that plague the world’s current economy, Solomon introduces the Jewish view of the global economy and their general view on economics as a whole. 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This natural progression might be thought of as the stair steps to truth, but whose truth is the real question we need to answer, and I can assure you that it cannotRead MoreSocio-Cultural Analysis Of Israel. Sgt Bush. Alc Class706 Words   |  3 Pagesdiscrimination throughout the centuries. Religion is defined as the worship of a particular system of faith, usually revolving around a superhuman, controlling power. The most worshiped religion in Israel is Judaism. Judaism is one of the oldest religions, believed to have began around 1800 B.C. Judaism has two founders, Abraham and Moses. Religion is a very pivitol part of Israels very being, manly because of the values the religion instills in its followers. Israel has been under scrutiny for centuriesRead MoreFactors Leading to the Holocaust Essay1462 Words   |  6 Pagestheir power to annihilate the followers of Judaism, while the Jews attempted to rebel, rioted against the government, and united as one. 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Summary and Critique - 679 Words

A Cost-Benefit Analysis of Electronic Medical Records in Primary Care Cost amp; Economic Analysis Kaira Ellis Maribel M. Howell Electronic medical record (EMR) systems are used to improve quality of care while increasing efficiency. However, there is little classified evidence regarding the benefits and costs of EMRs’. It is believed that by implementing an EMR system, there will be a significant increase in the facilitation of work flow and quality of patient care and safety (Bardon et al., 2003). The Cost-Benefit Analysis of Electronic Medical Records is conducted to estimate the net financial benefits or cost of implementing an EMR system in primary care. The hypothesis is that implementation of an EMR system in primary care can†¦show more content†¦Savings primarily accrued from drug expenditures (33%), decreased radiology utilization (17%), better capture of charges (15%), and decreased billing errors (15%). In one-way sensitivity analyses, the model was most sensitive to the proportion of patients whose care was capitated in with the net benefit ranging from $8,400 to $140,000. A five-wa y sensitivity analysis with the most pessimistic and optimistic assumptions showed results ranging from $2300 net cost to a $330,900 net benefit. These results indicated that the implementation of an EMR system in primary care can result in a positive financial return on investment to the health care organization among a wide range of assumptions. According to the major steps in CBA of Chapter 1, the study method was sufficient and well organized (Boardman, 2011). However, there are a few things that I would have done differently. I would have included pre-implementation data, conducted the study in more than one clinic, and included costs of paper records with the EMR system. In the CBA, there is no record of pre-implementation of the EMR. This study was performed after implementation to compare the EMR to one that was previously integrated. Pre-implementation data would have been helpful to see the quantitative impact of the results of the study, especially when applying monetary values. Conducting the study in more than one clinic of varying sizes would help to give better understanding in the functionality inShow MoreRelatedSummary and Critique1611 Words   |  4 Pagesï » ¿First Assignment - Summary and Critique Paul S. Martin, Twilight of the Mammoths: Ice Age Extinctions and the Rewilding of America, University of California Press, 2005, Prologue and Chapter 2 Summary The overkill hypothesis stresses the fact that people were the main technicians behind the late pleistocene extinction of fauna in Northern Eurasia and North and South America. 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Redbox Free Essays

Management Policy November 19, 2012 Red Box Red Box is the industry leader in DVD rental kiosks. It has established itself as an inexpensive and convenient method for customers to rent DVDs. Although Red Box is a cost leader in its segment, it is threatened by the slow but impending disappearance of the DVD format. We will write a custom essay sample on Redbox or any similar topic only for you Order Now Threat of New Entrants RedBox has a cost performance advantage over possible new entrants since it is owned by a publicly traded company and already has an established distribution channel relationship. RedBox has an advantage over new entrants in that it already has a well-known brand image amongst movie viewers. People often say â€Å"why don’t you go just rent it from RedBox† during conversations. However, consumers can readily switch over to Blockbuster or cable pay-per-services. Porter’s Five Forces I. Bargaining Power of Buyers The bargaining power of buyers is high since it is extremely easy and inexpensive for the consumers switch viewing mediums. II. Threat of Substitutes The thread of substitutes is high due to competitors such as Netflix, Blockbuster, cable and satellite T. V. companies. III. Bargaining Power of Suppliers The bargaining power of suppliers is high since there are only a handful of movie studios that are able to supply the DVDs. Movie studios can limit the quantity, as well as increase the price and royalty payments of DVDs. Other wholesalers can also increase the price and limit the supply of DVDs. IV. Intensity of Rivalry among Existing Competitors The intensity among existing competitors is fierce since Blockbuster has the ability to install more rental kiosks at existing stores and sign new contracts with existing retailers. Customers can buy new movies for $5 at retailers such as Walmart or get them shipped to their homes from retailers such as Amazon. V. The Threat of Substitutes The threat of substitutes is high. A motion picture DVD is difficult to duplicate unless it is burned illegally. However, digital formats of movies are becoming more prevalent and as the smart phone population grows. Cellular signal carriers are also rapidly increasing their bandwidth and it is predictable, soon mobile signals will be as strong as or stronger than current broad band signals offered by cable providers. Automakers will eventually install TV monitors in each family vehicle that will allow children to watch movies downloaded or streaming live, instead of viewing DVDs. S. W. O. T. I. Strengths Redbox is owned by a publicly traded company and has the funding of its shareholders. Redbox has pre-existing retail contacts that were established by its parent company, Coinstar that enables them to expand faster than competitors who need to establish new contacts. II. Weaknesses Redbox is under the mercy of the movie studios. Should any movie studio decide to terminate their contract with Redbox, it will lose a significant percentage of its suppliers considering there are only a handful of movie studios. The movie studios also have influence on wholesale distributors, which can affect Redbox’s supply chain. III. Opportunities Redbox can enter the home digital rental market to directly compete with Netflix. It can also start selling other products, such as popcorn and soda, with its DVDs, in its vending machines. IV. Threats Redbox is threatened by the ever growing population of mobile users who will be able to download movies to their portable devices at speeds greater than DSL in the near future. Redbox is also under threat from pirated copies of movies that are prevalent worldwide. How to cite Redbox, Essay examples