The Yalta Conference Essay Example For Students

The Yalta Conference Essay The Yalta Conference was one of the most important events in history, let alone, this century. It took place from February 4 to February 11, 1945, at Yalta, Crimea, a port/resort. The three main individuals at this meeting were Churchill of Great Britain, Roosevelt of the United States and Stalin of the U.S.S.R, known back then, and now known as Russia. This meeting was to discuss the post war effects. The publics opinion of this was of a great Anglo-American- Soviet friendship. The agreement that as achieved at the conference was that a Coalition government would be set up in Poland. This guaranteed free election in Poland. It also gave eastern Poland to the Soviet Union and in return, Poland would receive land from Germany. Germany on the other hand was divided into four zones which were Great Britain, United States, France, and the Soviet Union. Germany had to pay all reparations of the war but not to the extent of World War I. One other major decision made in the conference was t he creation of the United Nations. This was a new world organization which worked for world peace as did the League of Nations. Along with the Soviet Union, Byelorussia and the Ukraine were admitted into the United Nations. Since Russia had influence on there voting, the United States was given 3 votes to be equal with the Soviet Union. After the conference, American public opinion was very high and all of the Allied nations responded favorably. There were also secret agreements that were made but kept secret until the end of the war. It was said that the Soviet Union were to enter the war against Japan two to three months after the end of the war in Europe. This was necessary in order for The Soviet Union to regroup because of the heavy causalities in Europe. The Soviet Union had a great advantage in the secret agreement. It received much land and did not have to do much in the end for it because of the use of the atomic bomb which ended the war much earlier then expected and the S oviet Union did not even have to fight Japan. In the classroom simulation of the Yalta Conference, the same results were not reached. The Soviet Union was not able to get most of its demands because in the classroom, most of the student looked at communism was not looked at very favorably. There were three groups that represented the United States, the Soviet Union and Great Britain. Out of the three, no one reached the same decision actually made in the conference. Most of the groups did not want the Soviet Union to join the war against Japan. Many groups also thought that the borders should be returned to the pre-war boundaries but that did not happen in the actual conference. The Yalta conference was good for the Soviet Union because of the heavy reparations it received and also much land was given to the by the decisions made at the conference. Over all it was a good conference because it ended the war in Europe without much argument amongst the major powers in the war. Germany was spared and was only responsible for minimal amount of reparations and Poland received a government that would work. Others might say that Germany did not get a harsh enough punishment but if they received a harsher punishment, we might have another world war. The conference allowed the major world powers to keep peace within the world but prevent and future breakouts of major wars. By far the most important part of the conference was the creation of the United Nations which is still in existence today and plays a major roll in communication amongst the countries so that there will be world peace. .u955eba842f952cd7598a6290515a9e4c , .u955eba842f952cd7598a6290515a9e4c .postImageUrl , .u955eba842f952cd7598a6290515a9e4c .centered-text-area { min-height: 80px; position: relative; } .u955eba842f952cd7598a6290515a9e4c , .u955eba842f952cd7598a6290515a9e4c:hover , .u955eba842f952cd7598a6290515a9e4c:visited , .u955eba842f952cd7598a6290515a9e4c:active { border:0!important; } .u955eba842f952cd7598a6290515a9e4c .clearfix:after { content: ""; display: table; clear: both; } .u955eba842f952cd7598a6290515a9e4c { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u955eba842f952cd7598a6290515a9e4c:active , .u955eba842f952cd7598a6290515a9e4c:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u955eba842f952cd7598a6290515a9e4c .centered-text-area { width: 100%; position: relative ; } .u955eba842f952cd7598a6290515a9e4c .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u955eba842f952cd7598a6290515a9e4c .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u955eba842f952cd7598a6290515a9e4c .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u955eba842f952cd7598a6290515a9e4c:hover .ctaButton { background-color: #34495E!important; } .u955eba842f952cd7598a6290515a9e4c .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u955eba842f952cd7598a6290515a9e4c .u955eba842f952cd7598a6290515a9e4c-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u955eba842f952cd7598a6290515a9e4c:after { content: ""; display: block; clear: both; } READ: The Naked Sun Essay We will write a custom essay on The Yalta Conference specifically for you for only $16.38 $13.9/page Order now

Decision Making in Romeo and Juliet Essays

Decision Making in Romeo and Juliet Essays Decision Making in Romeo and Juliet Essay Decision Making in Romeo and Juliet Essay As Elizabeth Kubler-Ross once wisely said, â€Å"I believe that we are solely responsible for our choices, and we have to accept the consequences of every deed, word, and thought throughout our lifetime†. Carefully analyzing the decision one is about to make with incorporating others opinions assists one in reducing the likelihood of consequences. Young adolescents of the present day are making decisions of which they have not thought thoroughly, and its effects are shown well in Gina Higgins poem, Hash for Cash. Similarly as shown in the illustration of the two obese boys, parents often make choices for their children that they think are the best for them but they are entirely the opposite. Decision making from only one point of view is adequately shown in the William Shakespeare’s play, Romeo and Juliet because in love one should not lose one’s senses of what is logical and what is completely obtuse. It is vital for an individual to cautiously consider one’s options as choices include consequences. All throughout one’s life an individual will make decision that at first seems perfect but in the long run one will abruptly approach the penalties in the future. With colossal amounts of information for young adults regarding issues that these individuals face in their everyday life, it is hard to comprehend why they are still making unwise choices. The poem, â€Å"Hash for Cash† (Gina Higgins) exceptionally portrays a young adult who is â€Å"stoned to the eyebrows† (Hash for Cash) because he or she has chosen to do drugs and irresponsible alcohol usage. These individuals may have heaps of excuses for why these individuals first got involved, but ultimately it was in their hands to refuse the urge of experimenting this new substance. The reason being that they knew about its consequences ? that would later take is in command of the person’s life. Subsequently â€Å"studies seem a waste of time†(Hash for Cash) and alas for most of these individuals, â€Å"reality [becomes] startling†(Hash for Cash) and the age where they were supposed to start living their life ? t abruptly ends due to the impractical mistake these individuals had selected to make earlier in their years. These adolescents’ lives could have taken a different route if they had thought twice about the decision they were embarking to make. If they parents had taken that moment in time to initiate the problem their child was going through these young adults may have had a brighter future. It is evident that a child is who he is from his or her s urroundings; especially his parent(s), and until that child is of ‘age’, decisions are made for him, particularly in the dietary department. The two obese children that are exposed in the illustration impeccably show the consequences that the children have to face, for the reason being that the parent(s) had not decided to consider the healthy alternative. Unfortunately the two boys in the photograph are having their childhood snatched away from them, because the food that they are consuming will cause them to comprise various health problems, such as Type 2 diabetes, heart disease, cancer, and many others. Ronald McDonald, the trademark for the company is shown to be sitting outside and enjoying the fresh air while these children are inside consuming an unhealthy diet, and pointing for more. In addition Ronald McDonald is not an obese man, unlike the children; therefore the company McDonalds is sending a hypocritical massage to the public about the affects of consuming Mcdonalds products. Thus, with all the information that is available the parent(s) of these children should have been able to make a logical decision about the food that they are going to be providing for their children. Just because the idea of it appeared appealing and one was in such haste, one should not make such a huge decision about their life without the reconsideration of its alternatives. The notorious Romeo and Juliet had made a decision that; alas lead to their demise. â€Å"A pair of star-cross’d lovers†(Romeo and Juliet) they were madly in love with each other, because they were both in love with the idea of having a companion for life. At the mere age of thirteen Juliet had already had a perspective about marriage and it was that, â€Å"It is an honour that I dream not of. (Romeo and Juliet) Likewise for Romeo for the reason that he had just recently gotten rejected from the women he had ‘loved’ before Juliet. After their first meeting they had already planned to get married, without anyone else’s input and support, clearly showcasing that they had not thought ahead of the consequences they would have to endure. This rushed process lead to several mis communications and hurdles, between Romeo and Juliet’s families and themselves. Romeo’s decision had caused the mortality of this childhood companion, Mercutio in a battle and his mother, Lady Montague because the â€Å"Grief of [her] son’s exile hath stopp’d her breath. †(Romeo and Juliet) These two lovers had helpers, which aided the two of to come together; Juliet’s Nurse and Friar Lawrence. These helpers were both of age and wise but the only incentive they had of helping Romeo and Juliet was because it might â€Å"turn [the] households’ rancour to pure love. †(Romeo and Juliet) If Romeo, Juliet, the Nurse and Friar Lawrence had clearly thought through and looked at the possible consequences, than more than Romeo and Juliet’s lives would have been saved. In love one might make wrong choices but they can be preventable, by just assessing through and ‘reading the fine print’ of the decision one is about to make. Likewise for parents, for the reason being that they should analyze the choices they are making for their children, because in their perspective it might be wiser but in the future it can become a heavy burden. Young adults are only a couple of years away from the world of adulthood, and the choices they make now, will greatly affect them in ever aspect of their life in the future. Thus one should look ahead into the future to the consequences of the decisions they are about to make so they can ask for aid and prevent it. This is very much shown with the community centre project in New York City, which happens to be a couple of blocks away from the site of the horrific events of 9/11. They people who had embarked on creating this centre with a mosque built in had not thought of the response they were going to get and the consequences that are going to be endured by everyone who is either Muslim or someone who is against the construction of the centre. If the people who had thought of this project and had considered of the consequences that they would have to undergo then people in the United States would not have been divided by distinctive religious beliefs. P. S : Dont copy/paste this and hand it in as your assignment at school.. not worth it. just go and learn. and by the way this essay isnt as good as it looks, not going to get you good grade at all.

Aerospace Development and the Boeing 787 Essay Example | Topics and Well Written Essays - 750 words

Aerospace Development and the Boeing 787 - Essay Example The 787-9 with a capacity of 290 seats and the 787-3 with 330 are set for a release in mid and late 2010 ("Program Fact Sheet"). The 787-8 and 787-9 are long distance carriers with a range of over 8,000 nautical miles. The 787-3 is a shorter distance aircraft with a maximum range of just over 3,000 nautical miles ("Technical Information"). The Boeing 787 boasts several innovative improvements that make it an environmentally friendly, efficient, and economical aircraft. The performance of the 787 is similar to the 747 and 777 that travel at a speed of Mach .85 ("Program Fact Sheet"). By using a higher ratio of carbon composite materials, the 787 has a weight savings of 30,000 to 40,000 pounds compared to an Airbus A330-200, which results in a 20% fuel savings ("Program Fact Sheet"). In addition, the 787 produces 20% fewer emissions and it is anticipated that maintenance costs will be reduced by 30% ("Program Fact Sheet"). Customer orders have been placed by major airlines from around the world. The largest orders have come from ANA at 50, Northwest Airlines at 18, JAL at 35, Continental Airlines at 20, Air China at 15, Air Canada at 14, China Eastern Airlines at 15, International Lease Finance Corp. (ILFC) at 22, LCAL (Low-Cost Aircraft Leasing) at 15, China Southern Airlines at 10, Air India at 27, Qantas at 45, Singapore Airlines at 20, and Jet Airways at 10 ("Boeings 787 Dreamliner Surpasses 500 Customer Orders", "Program fact Sheet"). Several other international airlines have placed smaller orders bringing the total to 514 aircraft. Delivery is currently set for early 2008 for the 787-8 and 2010 for the 787-9 and 787-3. The current orders for 514 aircraft represent the initial delivery of what Boeing anticipates will be 3,500 787 aircraft by the year 2023 ("Program Facts"). This will represent $400 billion in sales through this 20-year period. The major competitor for the soon to be released 787-8

Program Theory Assignment Example | Topics and Well Written Essays - 250 words

Program Theory - Assignment Example To successfully carry out evaluation on this program, data collection was very crucial. The research methods that were applied in the data collection process included observation and use of semi-structured interviews by the research assistants (Chen, Wan & Lin, 1997). These two methods fall under the wider qualitative techniques that are deemed efficient in uncovering the people’s experience to different situations. In addition, the data collection methods did not require many participants hence making it less costly to carry out. The main drawback of the research method is the fact that the participation of only a section of the population (residents of Nei-fu) made it hard to draw statistical inferences to the rest of the country. My program the non-infectious diseases reduction program is derived from the Centers for Disease Control whose main goal is to protect public health. The main aim of this program will be to encourage outdoor sports activities meant to keep a person physically fit and free from lifestyle diseases. Some of the components of this particular evaluation that would be useful in my program evaluation are both the process and outcome evaluation. This will help in the determination of the success of implementation of the program based on the observed outcome. It will only be possible to conduct the program evaluation after a specific period of time in order to establish whether participants of the program have been able to adopted healthy lifestyles or behaviors during their engagement in outdoor sporting activities. Since changing a person’s behavior takes a while, the considerable time to conduct the evaluation is after four

Special Ed. Essay Example for Free

Special Ed. Essay With the passage of the No Child Left Behind Act (NCLB) in 2001 and revisions of Individuals with Disabilities Education Act (IDEA), schools have implemented the pre-referral process encouraging individual based level of education for a particular student. Historically, before recent updates to state and federal special education guidelines, students typically received special attention to their specific needs through parent conferences, generic observations, a few general intervention techniques, psychological evaluation, or simply a review of report cards, social records. Since the implementation of IDEA, students are now receiving proactive approaches to match his or her level of need. Two such approaches of evaluating individual students are Positive Behavior Support (PBS) and Response to Intervention (RTI). Both PBS and RTI are structured on a different model, but both have the same goals. Each intervention approach takes into account components and accounts for critical universal factors that target a specific individual, group, or level. These two models offer a range of interventions that are scientifically applied to a student, based on the student’s level of needs through previous monitoring in the classroom. Response to Intervention (RTI) is defined as â€Å"the practice of providing high-quality instruction and interventions matched to student need, monitoring progress frequently to make decisions about changes in instruction or goals, and applying child response data to important educational decisions† (Batsche et al. , 2006). RTI has emerged as the more popular of the two intervention model’s and has been accepted by most schools in the United States, as the new way of thinking about early intervention and identifying a child’s educational disability. The RTI approach considers the application of an individual student’s difficulties in schools by evaluating student’s environment and then provides intervention as soon as the student shows signs difficulty, lack of focus, or academic problems. The goal of RTI is to ensure all students receive the highest quality of education and instruction and reduce any possible false referrals to unnecessary classes, or programs. RTI has a three tier model for also eliminating unqualified teachers as a reason for a student’s lack of performance, or grades. For example in, tier I of the three modeled tier, teachers are required to implement different teaching techniques in order to gauge a student’s performance and focus toward learning. This form of teaching is a method only most qualified teachers can provide in the RTI process. Tier one is described as a universal assessment using formal and informal instructional techniques. Tier two targets students that have not made progress in a given amount of time and are monitored frequently. These students are considered as having some academic weakness. Tier three is more of an intensive intervention and for students that do not respond to instruction form tier two. Tier three students may be eligible for special education classes and programs. When a student is evaluated and qualifies for tier three, the students will be specially monitored and eventually reviewed for receiving an individual educational program (IEP). Positive Behavior Intervention and Support (PBIS), is based more on a model of how to solve inappropriate behavior and prevent that behavior through teaching and reinforcing appropriate behaviors. â€Å"Positive Behavior Intervention and Support (PBIS) is a process for creating school environments that are more predictable and effective for achieving academic and social goals. For some schools, PBIS will enhance their current systems and practices, for others it will radically change the culture for the better† (www. cms. k12. nc. us). Positive Behavioral Intervention and Supports (PBIS) is a systemic approach to proactive, school-wide behavior based on a Response to Intervention (RTI) model. â€Å"The concept of PBIS has been researched in education for approximately 15 years† (www. cms. k12. nc. us) and has been implemented successfully in thousands of schools in over 40 states. PBIS applies evidence-based programs, practices and strategies for all students to increase academic performance, improve safety, decrease problem behavior, and establish a positive school culture. Schools implementing PBIS build on existing strengths, complementing and organizing current programming and strategies. The PBIS model had resulted in dramatic reductions in disciplinary interventions and increases in academic achievement. Data-based decision making is a hallmark of PBIS and is a scientific approach to the pre-referral process to special education. There are many ways to define, or explain the concepts of PBIS and RTI, but each provides a specific three tiered pre-referral process to special education that will enhance the quality of life for students participating in these interventions. Whichever intervention a student is placed, he, or she should receive a higher quality education and instruction. Elements common in these models indicate a system of intervention based on a student’s performance that will indicated whether there is a legitimate learning disability, not just the need for additional instruction for no reason. References RESPONSE TO INTERVENTION. (2006). In Encyclopedia of Special Education: A Reference for the Education of the Handicapped and Other Exceptional Children and Adults. Retrieved May 23, 2012, from: http:library. gcu. edu:2048/login? qurl=http%3A%2F%2Fwww. cred oreference. com/entry/ wileyse/response_to_intervention CPI Educate. Empower. Enrich. (2012). Retrieved May 23, 2012, from: http://www. crisisprevention. com/Resources/Knowledge-Base/Positive-Behavior-Support SEDL Advancing research, improving education (2012). Retrieved May 23, 2012, from : http://www. sedl. org/pubs/sedl-letter/v19n02/rti. html CMS Charlotte-Mecklenburg Schools. (2011). Retrieved May 23, 2012, from: http://www. cms. k12. nc. us/cmsdepartments/PBIS/Pages/default. aspx Response to Intervention (2012). Retrieved May 23, 2012, from: http://www. nasponline. org/resources/handouts/revisedPDFs/rtiprimer. pdf

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