Science and Technology (Early Development) free essay sample

Early developments The key disciplinary components of STS took shape independently, beginning in the 1960s, and developed in isolation from each other well into the 1980s, although Ludwig Flecks monograph (1935) Genesis and Development of a Scientific Fact anticipated many of STSs key themes: Science studies, a branch of the sociology of scientific knowledge that places scientific controversies in their social context. History of technology, that examines technology in its social and historical context. Starting in the 1960s, some historians questioned technological determinism, a doctrine that can induce public passivity to technologic and scientific natural development. At the same time, some historians began to develop similarly contextual approaches to the history of medicine. History and philosophy of science (1960s). After the publication of Thomas Kuhns well-known The Structure of Scientific Revolutions (1962), which attributed changes in scientific theories to changes in underlying intellectual paradigms, programs were founded at the University of California, Berkeley and elsewhere that brought historians of science and philosophers together in unified programs. We will write a custom essay sample on Science and Technology (Early Development) or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Science, technology, and society In the mid- to late-1960s, student and faculty social movements in the U. S. , UK, and European universities helped to launch a range of new interdisciplinary fields (such as Womens Studies) that were seen to address relevant topics that the traditional curriculum ignored. One such development was the rise of science, technology, and society programs, which are also—confusingly—known by the STS acronym. Drawn from a variety of disciplines, including anthropology, history, political science, and sociology, scholars in these programs created undergraduate curricula devoted to exploring the issues raised by science and technology. Unlike scholars in science studies, history of technology, or the history and philosophy of science, they were and are more likely to see themselves as activists working for change rather than dispassionate, ivory tower researchers[citation needed]. As an example of the activist impulse, feminist scholars in this and other emerging STS areas addressed themselves to the exclusion of women from science and engineering. Science, engineering, and public policy studies emerged in the 1970s from the same concerns that motivated the founders of the science, technology, and society movement: A sense that science and technology were developing in ways that were increasingly at odds with the publics best interests. The science, technology, and society movement tried to humanize those who would make tomorrows science and technology, but this discipline took a different approach: It would train students with the professional skills needed to become players in science and technology policy. Some programs came to emphasize quantitative methodologies, and most of these were eventually absorbed into systems engineering. Others emphasized sociological and qualitative approaches, and found that their closest kin could be found among scholars in science, technology, and society departments. [citation needed] During the 1970s and 1980s, leading universities in the U. S. , UK, and Europe began drawing these various components together in new, interdisciplinary programs. For example, in the 1970s, Cornell University developed a new program that united science studies and policy-oriented scholars with historians and philosophers of science and technology. Each of these programs developed unique identities due to variation in the components that were drawn together, as well as their location within the various universities. For example, the University of Virginias STS program united scholars drawn from a variety of fields (with particular strength in the history of technology); however, the programs teaching responsibilities—it is located within an engineering school and teaches ethics to undergraduate engineering students—means that all of its faculty share a strong interest in engineering ethics.

What Is An Air Pollution Essay Sample Essay Example

What Is An Air Pollution Essay Sample Essay Example What Is An Air Pollution Essay Sample Essay What Is An Air Pollution Essay Sample Essay What cause air pollution Air pollution control is an integral part of environmental management as it is directly related to climate change. The effects of air pollution are often far-reaching and are spatially harder to control once the damage is done. In the United States, state governments are required to adopt air quality control measures through legislative process. These measures are submitted to EPA for approval and then included in each states implementation plans. The U.S Environmental Protection Agency (EPA), whose mandate is to enforce environmental health laws and regulations, has put in place various measures for air quality control. This measures include setting standards for ambient air quality, determine hazardous emissions and conducting extensive research on appropriate pollution prevention techniques.; The provisions are provided in the Clean Air Act to curb both state and interstate air pollution issues. EPA provides technical guidance for implementation of environmental plans in each state.; More specifically, some of this measures include the following:; Emissions Control EPA has placed standards for emissions from mobile and stationary sources of air pollution like manufacturing industries to ensure use of cleaner fuels and technologies. Additionally, there are economic incentives in banking and trading for using cleaner technologies. This is also combined with the command-and-control regulations that have for long been used by EPA. Controlling air pollution at the sources This is a preventive strategy instituted to reduce or eliminate air pollution at its source. This is done first by identifying sources of air pollution and subsequently ensuring use of approved fuels and raw materials, using non-polluting/less polluting industrial processes and improving process efficiency.; The Clean Air Technology Center This is a vital resource for the prevention and control of air pollution. This center provides a platform for research and use of effective processes. It features wet scrubbers, electrostatic precipitators, condensers, absorbers, mechanical collectors among other clean production mechanisms. It also serves as a resource for research of renewable and cost effective energy resources. EPA encourages industries to reduce emissions and account for these emissions. The Agency also encourages voluntary initiatives to achieve emission reduction through trading programs like the Emission Reduction Credits(ERC). Business operators receive credit for reducing emissions below; the set limits.; Creating Awareness The government also has various mechanisms for educating the public and private sectors on efficient use of clean and renewable energy sources at both local and national levels. EPA provides guidelines for controlling indoor air pollution in households and workplaces. Also, during formulation of air control policies the public is widely consulted to ensure appropriate measures are formulated. Public participation helps to streamline implementation of this laws. Likewise, the same forums are used to communicate, guide and interpret already instituted laws and policies.; Pollution Control Subsidies This comes in form of financial support from the government for environmentally friendly activities.; A polluter is rewarded for reducing emissions either through receiving grants, favorable tax reliefs or lower interest rates. EPA voluntary programs encourage companies to implement environmental best practices which gives them a good public image and encourages more business to follow suit.

Don’t Miss the National Career Summit †FREE This Week!

Don’t Miss the National Career Summit – FREE This Week! The job search process has become more complicated in the last several years. No longer can a job seeker simply look up interesting positions in the Classifieds, then send in a resume and cover letter on nice bond paper, hoping to get an interview. There is a whole world job seekers need to know about that includes job search strategy, branding, networking, social media, and more. Writing is still a key piece of the job search process, and the Essay Expert focuses almost exclusively on writing resumes and writing LinkedIn profiles (in the other aspects of the business, we edit business documents and help students write college application essays). If you need to bring your written documents up a level or two, we are a great resource. Although I will be taking a Job Search Strategist Course starting this week, I still plan to provide clients primarily with writing services. For the other aspects of the job search, I’m thrilled to announce the National Career Summit, which is being offered FREE by a top-notch group of career experts this week. You may have noticed my announcement of the event in my newsletter – it started November 4 – and there is still a week to go. If you are a job seeker or considering starting a business, this is a rare opportunity to learn from the best! Some of the topics include: Building Your Online Reputation Preparing Veterans and Others for Federal Employment (a great tribute to Veteran’s Day) Entrepreneurship: Creating a Business Plan Great Jobs for Everyone 50+ Networking (On and Off Line) Twitter and Facebook for Job Seekers How to Do Research to Find the Job You Want It’s quite a full schedule for the week – a tremendous opportunity really. If you consider job seeking as a full-time job, then it will be a clear choice for you to spend a couple of hours a day learning from these experts. Sign up for the National Career Summit here. View the schedule here. Events are being recorded and can be accessed after the telesummit is over for a small fee. Register now and take advantage of this weeks session at no cost! I’m so convinced you’ll get value from this summit that I am announcing it even though I am not one of the speakers! It’s important to me to provide resources to my readers and this is a great one. It’s also important to me to support my colleagues who are doing such important work supporting job seekers and entrepreneurs to reach their goals. I highly encourage you to participate in the presentations that look useful to you. If you do participate, please let me know how the sessions went!

Nursing Cancer Patient Case Assignment Example | Topics and Well Written Essays - 2500 words

Nursing Cancer Patient Case - Assignment Example Osteoporosis is a chronic progressive metabolic disease of the bone characterized by low bone mass and micro-architectural deterioration of the tissue of the bones (Serota and Lane, 2006). It affects 16% of women and 7% of men above 50 years of age (Tenenhouse et al, qtd. in Targownik, Lix and Metge, 2008). The most dreaded complication of fall in this age group of people is hip fracture. Burt is 68 years old. Aging is a natural physiological process and there are many changes which occur in the various organs of the body. The common health problems frequently encountered in the elderly are altered response to medication, altered nutritional status, urinary incontinence, urine retention, fecal incontinence, pressure ulcers, mood disorders, dizziness, dementia and functional impairment, immobility and impaired gait (Nettina, 2006). Elderly people are more prone to falls and fractures, cognitive dysfunction, postural hypotension, electrolyte disorders, cardiac failure and polypharmacy. Burt needs to be given several medications because of his health condition. Pharmacokinetics of the aged is different and hence the effects of the drugs are more. The factors which contribute to altered pharmacokinetics are decrease in lean body mass and total body weight, increased percentage of body fat, decreased protein binding of drugs, increase in volume of distribution for lipophilic drugs that penetrate the central nervous system, decline in the metabolic capacity of the liver, decreased liver mass and hepatic blood flow, decreased renal blood flow and glomerular filtration rate. There may also be changes in the receptor numbers, affinity, and post receptor cellular effects. Along with these, there are also changes in the homeostatic mechanisms (Tregaskis and Stevenson, 1990). Dementia is a haunting problem amongst elderly who frequently get admitted to acute care settings for other health problems. Due to dementia, proper treatment is difficult to institute.

The Homestead Strike 1892 compared to The Great Sit Down Strike 1937 Research Paper

The Homestead Strike 1892 compared to The Great Sit Down Strike 1937 - Research Paper Example The strike was able to attain goals meant for the benefit of the workers. They averted the reopening of the plants thus resulting in the recognition of their right to organize, a right which has been repeatedly denied by this corporation (Weinstone, 1). The union was formally recognized as the collective bargaining agency for its members in all the plants (Weinstone, 1). The union was able to put a stop to the open-shop system practiced by this American industry (Weinstone, 1). It was also able to successfully bargain wage increases for the GM workers and for the auto workers in other plants. Finally, it also successfully bargained â€Å"an agreement to open negotiations between the union and the corporation for the demands on wages, hours and working conditions† (Weinstone, 1). Aside from the above successes, the union was also able to resist and hold off forceful efforts to remove the sit-down strikers, who only left the plants when their conditions were met (Weinstone). Fin ally, this strike successfully endorsed â€Å"the policy of industrial unionism, of militant unionism and progressive leadership based upon rank-and-file democracy,† which confirmed that such system is â€Å"the only correct form of organization† that â€Å"can effectively meet and defeat the corporations of big capital† (Weinstone, 1). The tactics used by the union includes first by strategically locking themselves in, â€Å"making it difficult to dislodge them without the use of considerable force and numbers, while at the same time, by taking over the gates, they obtained the possibility of freely coming and going and thereby relieved the strain which they would otherwise have found a serious factor in their ‘voluntary imprisonment’† (Weinstone, 1). The workers went on shifts hence, were able to withstand continued stay inside the plants for a long time. They were also able to create a â€Å"complete and efficient organization† by s etting up an elected strike committee, various sub-committees, captains, including health and sanitation, patrol and policing, trial committee† (Weinstone, 1). The elected strike committee was the one assigning particular duties to every worker which includes the â€Å"reception of visitors, guarding, and cleaning up† (Bliven, 377). Through this, they were able to utilize an effective strategy that heightened their awareness and control against any possible attacks against them (Weinstone, 1). The workers â€Å"barricaded themselves within the plants† and readied themselves to employ devices available to secure their positions within the plant† (Weinstone, 1). Their preparedness can be best illustrated in the following: covering â€Å"the windows with bullet-proof metal sheets† and at the same time a way wherein fire hoses could be placed to prevent â€Å"any gas or firearm attack†; systematizing and drilling squads in using water hoses; organ izing â€Å"a police patrol† making rounds at given hours, to monitor â€Å"the movement of people in adjoining wings of the building† to prevent any â€Å"surprise attacks† (Weinstone, 1). The strikers also were said to hold â€Å"court every morning†, and those found guilty of inappropriate behavior such as â€Å"bringing liquor into the plant or circulating rumors† was removed from the plant (Lovett, 123). The workers could even â€Å"take classes in parliamentary procedure, collective

Childhood Obesity Solutions Essay Example for Free

Childhood Obesity Solutions Essay Prevalence of childhood obesity has increased greatly in the recent years, so much so that the number of children considered overweight by the Centers for Disease Control and Prevention (CDC) has nearly quadrupled among children aged 6-11 years old (Cawley, Meyerhoefer, and Newhouse, 2007, p.506). Many members of the public, media, and congress have declared childhood obesity as a major public health concern, considering it to be an â€Å"important cause and consequence of wider disparities in health† (Freudenberg, Libman, and O’Keefe, 2010). Director of the division of nutrition, physical activity and obesity at the CDC, Dr. William H. Dietz, went as far as to say â€Å"This may be the first generation of children that has a lower life span than their parents† (Roberts Wilson, 2012). Though it is evident steps are needed to be taken to help protect the health and futures of our youth, those with the most power to actually make a visible, long lasting environmental change are the most reluctant to do so. Policymakers have alternate interests in finances that water down their attempts to take charge. Sadly, often times playing the social problems game takes precedence over the more genuine social problems work. As a Washington Post article so boldly states â€Å"In the political arena, one side is winning the war on child obesity. The side with the fattest wallets.† (Roberts Wilson, 2012) Proposals that frame childhood obesity as being an inevitable result of increasing environmental surroundings by unhealthful foods are too often neglected by government officials more willing to frame childhood obesity as an individual problem. Indeed it is more convenient to claim providing freedom of choice to individuals who are capable of making their own decisions, emphasizing self regulation, and freeing themselves of responsibility to their nation to lead in financially beefy actions. This essay seeks to demonstrate that childhood obesity should no longer be considered an individual cause stemming from lifestyle choices which can be changed through minor solutions such as education in physical activity and nutrition. Unfortunately, this social problems ownership has become the taken-for-granted frame for this problem (Loseke, 2003, p.69). Childhood obesity really is a social problem which is a direct result from our environment, social structures emphasizing fast, unhealthy, frankly JUNK food which is readily available in any given neighbourhood and continuously marketed through all mediums to increase profits to some select wealthy individuals. I will stress that the only solutions met by this pressing issue have been solely symbolic solutions which have been prematurely praised as they are false attempts to appear loyal to the public, communities, and school systems, while truly remaining loyal to the corporations, who some may very well be held entirely accountable. Within this paper the exploration of three chosen symbolic solutions to date will include: American Government’s distribution of the Physical Activity Guidelines for Americans Midcourse Report: Strategies for Increasing Physical Activity Among Youth, the national law passing of requiring restaurants with 20 or more chains to provide calorie information on menus and menu boards, and lastly, the enhancement of PE requirements for school aged children. The distribution of said guidelines is reported to be important by reviewing â€Å"the evidence on strategies to increase youth physical activity and make recommendations and to communicate findings to the public.† (Rodgers, 2012, p.10) This report focuses on five settings, but in reality only offers strategies for 3 of them. Two settings (Home and Family, and Primary Care settings) received no proposed strategies to increase physical activity among youth, and focused only on areas requiring further research (p.7). Those settings which did receive proposed strategies were quite obvious suggestions which doubtfully would have any significant impact on physical activity among youth. One such suggestion is to â€Å"provide teachers with appropriate training† (p.5). Although it must be noted that this is not a report distributed solely to decrease obesity among youth, it is distributed to increase physical activity among youth, which is not the same, though admittedly similar. On the webpage this guide is provided, a number of other arbitrary tools can also be found. Webinars on online nutrition information, fact sheets, blogs, access to printable posters, and more. Educating the public, educating the parents of youth, and the youth themselves of course is important. At what point however will it be supplemented by restrictions on marketing of food and beverages to youth, which this guideline reports is estimated at a whopping $10 billion per year, but shows no indication of wanting to reduce or restrict this, and can only suggest counterbalancing with media campaigns directed to offset these unhealthy images (Rodgers, 2012, p. 3). One article is more forward in summarizing â€Å"Despite this widespread recognition of negative impact of marketing unhealthy foods, the practice continues unabated.† (Harvard School of Public Health, 2012) Mandated menu labelling of calories in some American jurisdictions was passed in 2008, requiring restaurant chains with 20 or more facilities to post calorie information next to each item on their menus and menu board (Kuo, Jarosz, Simon and Fielding, 2009, p.1680). This new law was backed by evidence that â€Å"eating fast food has been shown to increase caloric intake and the risk of becoming obese† (Harvard School of Public Health, 2012). As an alternative to restricting what is sold in these fast food chains, restricting advertising of these products, or perhaps even zoning restrictions on how many fast food restaurants were permitted to be within a certain range of schools, this new law appears to be the most liberal of solutions, and the most beneficial for the companies selling these high calorie foods. Findings from a health impact assessment are as follows: â€Å"mandated menu labelling at fast food and other large chain restaurants could reduce population weight gain, even with only modest changes in consumer behaviour.† (Kuo, Jarosz, Simon and Fielding, 2009, p.1683) As promising as this is, it is followed by a stronger and more realistic assessment stating â€Å" if nonobese restaurant patrons were more likely to order reduced calorie meals than were obese patrons, the impact on the obesity rate could be less than what we reported†. Because there was no study conducted on the weight of those opting for calorie reduced items, it is difficult to say if this solution is beneficial to the target audience, obese people in these jurisdictions. If changes are being made that is great, but there is no evidence to date to support this influencing the rising issue of obesity. It is just another means of essentially saying that the government is willing to educate on the food being provided and it is the choice of the individual, to consume or not consume. One solution offered by government recognizes that with the majority of youth enrolled in schools, school is an ideal place to provide much needed physical activity to students (Rodgers, 2012). In implementation, many state policies require schools to â€Å"have a PE unit requirement that constrains students to spend a minimum amount of time in PE class† (Cawley, Meyerhoefer, and Newhouse, 2007, p. 508). A study evaluating the effectiveness of such policies revealed that, naturally, a required PE unit is correlated with a higher probability that the student participates in PE (Cawley, Meyerhoefer, and Newhouse, 2007, p. 511). Although this is clearly a positive outcome of enforcing requirements among youth to enroll in PE classes, this same study goes on to say that â€Å"a requirement is correlated with students reporting fewer minutes spent active in PE†(p.511). Yes, you read that correctly, specifically 15.1 fewer minutes active in PE for boys, and 3.1 fewer in PE for girls (p.511-512). In conclusion, this report sums up the opposing information by stating that â€Å"curriculum development is not significantly associated with the amount of time spent active in PE†. As such, the implementation of these programs sounds a lot more effective in theory then it is in practice. All three of these solutions offered by government are certainly steps in recognizing that childhood obesity is in fact prevalent in our society. These solutions also claim that something can be done to reduce the level of harm to children’s health, and that actions should be implemented in correcting this epidemic. Essentially childhood obesity is a recognized social problem in our society. Unfortunately because the victims, (obese children), are politically powerless individuals, proposals to decrease the harm attributed to them have been, and will continue to be symbolic. Sadly, effort from interest groups with good intentions can be overshadowed by the social problems game of politics. This concept is not lost in an article posted in The New York Academy of Medicine which reads as follows: â€Å"private interests generally have more resources and skills than public health reformers to achieve their policy goals, and are more successful in resisting changes than advocates are in implementing them. These structural barriers are a powerful deterrent to reducing childhood obesity. Creating cities where health rather than business concerns take precedence will require new approaches to governance and democracy.† (Freudenberg, Libman, and O’Keefe, 2010, p.761) It appears as though, for now, the social problems game of proposing symbolic solutions for childhood obesity is being accepted by audiences. Since Loseke claims that â€Å"the goal of social problems game is persuading audience members† (p.51), government officials, the players, are succeeding. References Cawley, J., Meyerhoefer, C. and Newhouse, D. (2007), The correlation of youth physical activity with state policies. Contemporary Economic Policy, 25: 506–517. doi: 10.1111/j.1465-7287.2007.00070.x Fredenberg, N., Libman, K., O’Keefe, E. (2010), A tale of two obescities: The role of municipal governance in reducing childhood obesity in New York city and London. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 87:5 doi:10.1007/s11524-101-943-x Harvard School of Public Health, (2012), The obesity prevention source toxic food environment. Retrieved from: http://www.hsph.harvard.edu/ Kuo, T., Jarosz, C., Simon,P., Fielding, J. (2009), Menu labelling as a potential strategy for combating obesity epidemic: A health impact assessment. American Journal of Public Health, 99:9 doi: 10.2105/AJPH.2008.153023 Loseke, D. (2003), Thinking about social problems. New York: Walter de Gruyter, Inc. Robert, J., Wilson, D., (2012, April 27), Special report: How Washington went soft on childhood obesity. Reuters. Retrieved from: http://www.reuters.com/ Rodgers, A., (2012), Physical activity guidelines for Americans mid-course report: strategies to increase physical activities among youth. US Department of Health and Human Services. Retrieved from: http://health.gov/paguidelines/default.aspx

Fascism - Alternative Approach Essay -- essays research papers

Fascism. The name of this movement alone provokes thoughts of hate, racism and evil throughout all modern western civilizations. Never before has one word created such a cultural taboo for nearly two generations. As a people, we immediately think of Fascism as Hitler’s methodical destruction of nearly six million Jews during World War II, but as a movement, there is so much more to be learned. It is the aim of this paper to accurately and without judgement look at Fascism from its creation to modern day applications. Benito Mussolini was catapulted into power in 1919 after helping create and naming his movement Fascism. Italian Fascism began on the left but stressed the dire need for strong nationalism with an urgency to industrialize. His style prized violence, idealism and anti-materialism, bonding him with the plight of the socialists of the time. As time went on in Italy, Mussolini merged with many modern corporations, luring him further and further to the right. Benito’s vision of Fascism facilitated national liberation, and racism was never his political nor personal goal. Many of Mussolini’s top aids and elite were Jews prior to his alliance with Hitler in 1937. In 1932 Mussolini wrote a lengthy definition of Fascism for the Italian Encyclopedia. This work shows exactly what it was Mussolini believed he was doing, creating a new wave of change. The definition is lengthy and often repetitive, however it is absolutely essential to the understanding of fundamental fascism t hat some of its points be explained and discussed herein. "Fascism, the more it considers and observes the future and the development of humanity quite apart from political considerations of the moment, believes neither in the possibility nor the utility of perpetual peace. War alone brings up to its highest tension all human energy and puts the stamp of nobility upon the peoples who have courage to meet it. All other trials are substitutes, which never really put men into the position where they have to make the great decision -- the alternative of life or death.... " This paragraph alone explains the reasons for nearly all modern wars in this century. Mussolini’s founding ideal was that of struggle. He believed war to be the climax of human emotion, believing that peace was not, an... ...bsp;In France, the primarily Fascist party led by Jean-Marie Le Pen gained 29% of the vote. This excerpt not only applies to France, but to conditions that will continue to rise throughout the world. Whenever a group of people go unheard, unrest immediately occurs. What follows unrest is the willingness to be apart of something that will lead you somewhere great. The rising popularity of Fascism is not due to a change in man’s thinking, but due to nations not listening to their people. Thousands of "skinheads" march through the streets of Germany waiting for a time when they will once again stake their claim for the world. It is only a matter of time before the comfort and discipline Fascism offers becomes a reality in the world. Benito Mussolini believed in the power of state and corporate becoming one to best represent the needs of the people. The time has come for the ordinary people of the world to declare what they desire to be known as next, before the choi ce is made for them. Whoever fights monsters should see to it that in the process he does not become a monster. And when you look long into an abyss, the abyss also looks into you." — Friedrich Nietzsche

Jack Fruit Seed Spread

Historical BackgroundA spread is a food that is spread with a knife onto bread, crackers, or other bread products. Spreads are added to bread products to provide flavor and texture, and are an integral part of the dish; they should be distinguished from condiments, which are optional additions. Spreads should also be distinguished from dips, which do not employ a knife in applying it to crackers or chips. (en. wikipedia. org) Butter is a dairy product made by churning fresh or fermented cream or milk.It is generally used as a spread and a condiment, as well as in cooking applications, such as baking, sauce making, and pan frying. Butter consists of butterfat, water and milk proteins. Most frequently made from cows' milk, butter can also be manufactured from the milk of other mammals, including sheep, goats, buffalo, and yaks. Salt, flavorings and preservatives are sometimes added to butter. Rendering butter produces clarified butter or ghee, which is almost entirely butterfat. (en. w ikipedia. org) The proponents’ focuses on making Jackfruit seed butter that will be profitable and demandable by the consumers in the mere future.This study will prove and give new ideas to the industry that we can use different ingredients or raw materials in producing new products. The jackfruit has played a significant role in Indian agriculture for centuries. Archeological findings in India have revealed that jackfruit was cultivated in India 3000 to 6000 years ago. Findings also indicate that Indian Emperor Ashoka the Great (274–237  BC) encouraged arbori-horticulture of various fruits including jackfruit. Varahamihira, the Indian astronomer, mathematician, and astrologer, wrote a chapter on the treatment of trees in his Brhat Samhita.His treatise includes a specific reference on grafting to be performed on trees such as jackfruit. Jack fruit trees are seen in almost all areas of Kerala except sandy areas. Maturing in 35-40 years, their wood can be used for furn iture. The gum from this tree and jack fruit is used as a stopper for small holes of pots. No one knows the jackfruit's place of origin but it is believed indigenous to the rainforests of the Western Ghats. It is cultivated at low elevations throughout India, Burma, Ceylon, southern China, Malaya, and the East Indies. It is common in the Philippines, both cultivated and naturalized.It is grown to a limited extent in Queensland and Mauritius. In Africa, it is often planted in Kenya, Uganda and former Zanzibar. Though planted in Hawaii prior to 1888, it is still rare there and in other Pacific islands, as it is in most of tropical America and the West Indies. It was introduced into northern Brazil in the mid-19th Century and is more popular there and in Surinam than elsewhere in the New World. In Asia, jackfruits ripen principally from March to June, April to September, or June to August, depending on the climatic region, with some off-season crops from September to December, or a few fruits at other times of the year.In the West Indies, I have seen many ripening in June; in Florida, the season is late summer and fall. The seeds, which appeal to all tastes, may be boiled or roasted and eaten, or boiled and preserved in syrup like chestnuts. They have also been successfully canned in brine, in curry, and, like baked beans, in tomato sauce. They are often included in curried dishes. Roasted, dried seeds are ground to make flour which is blended with wheat flour for baking. (http://www. hort. purdue. du) The researchers thought that instead of throwing the seeds and making it a waste, they decide to make this spread using the seeds of a jack fruit as a main ingredient to produce this product. Aside from that these seeds contain and give the essential nutrients that our body needs. In preparing this product different utensils and materials are needed. Make sure your utensils are washed properly. It is best to use hot soapy water to clean the food processor, and the pan where peanuts are in contact with. Do the same with the mixing cups and, storage containers.The demand of sandwich spread in the market is gradually increasing because of the continuous increase in population, that’s why this product will certainly fulfill the demand of the consumers. Even there are a lot of competitors in the sector the proponents believe that the consumers will buy these goods because it is nutritious and affordable. The proponents believe that producing this product will benefit many people and will help the food industry. One of its major beneficiaries is the consumers, the government, competitors, and other investors that are more focused in the food industry.Statement of the Problems . Marketing Aspect1. 1 What are the promotional strategies should be implemented to attract customers?1. 2 Is there a demand for the product?2. Management Aspect2. 1 What is the organizational form of the business?2. 2 How many employees needed in putting up this busine ss?3. Technical Aspect3. 1 Where is the appropriate location in putting up the business?3. 2 Who are the possible suppliers of the materials needed for the business?4. Financial Aspect4. 1 How much would be the total capital needed to establish the business?4. 2 How long will the business recover its investment?5. Socio Economic Aspect5.1 What are the possible contributions of the business in the national and local economy?5.2 What are the changes that may occur in the economy?Objective of the Study1. Marketing Aspect1. 1 To determine the promotional strategies to be used to attract customers.1. 2 To evaluate the status of supply and demand.2. Management Aspect2. 1 To be able to know the form of business or type of ownership to be applied in this study.2. 2 To identify how many employees to be needed.3. Technical Aspect3. 1 To determine the ideal location of the business.3. 2 To identify the suppliers of the business.4. Financial Aspect4. 1 To know how much will be the starting capi tal.4. 2 To know how long the investment to be recover.5. Socio Economic Aspect5. 1 To determine the contribution of these study in national and local economy.5. 2 To know the changes in the economy.Significance of the StudyThe project will give a great benefit to the followingTo the customer, by providing a new product, that gives a variety of choices.To other competitors, it gives them new thoughts and ideas in the food industry.To the local government, a new provider of income through paying taxes.To the students, it gives them idea in making their own products in their study. Scope and Limitation This study focuses mainly to produce jack fruit seed butter and would not be extent to concern about the other spread products. This study only includes market, technical, management, financial, and other socio-economic aspects of the project. The study will only focus on using jack fruit seed because the proponents have decided to make jack fruit seed butter as its initial product. The study covers a relevant range of exploration about the viability of the product.To gather the needed information, the target respondents, who are the selected customers, and the distributors of the jack fruit seed butter, were asked through survey questioners. Due prudence in making assumption and decision are observed so that the study will represent the real capacity of the prospected business. With all these merits, still this study will be affected by unforeseen and uncontrollable circumstances and changes occurring in the near future. Government taxes, inflation, peso devaluation, and the condition of the country’s economy will likely change the result of the study.Though it is geared with efficiencies, its effectiveness depends also in those that are expected to arise in the environment. Theoretical definition of Terms Jackfruit. is a species of tree in the mulberry family (Moraceae), which is native to parts of Southern and Southeast Asia. (www. wikipedia. org) A trop ical tree with large oval fruit, the yellow flesh and seeds of which is edible. (Dictionary) Jackfruit Seeds. which appeal to all tastes, may be boiled or roasted and eaten, or boiled and preserved in syrup like chestnuts. (www. hort. purdue. edu) Spread. is a food that is spread with a knife onto bread, crackers, or other bread products. www. wikipedia. org) Grinding mill. is a unit operation designed to break a solid material into smaller pieces. (www. wikipedia. org) Is a tool used to crush solid material unto powder or small pieces. (Dictionary) Mixer. is a kitchen appliance intended for mixing, folding, beating, and whipping food ingredients. (www. wikipedia. org) Machine or device used for mixing. (Dictionary) Plastic bottle. is a bottle constructed of plastic, with a neck that is narrower than its body and an opening at the top. (www. wikipedia. org) Plastic hollow necked container use for holding liquids. (Dictionary) Cooking oil. s purified fat of plant origin, which is usu ally liquid at room temperature. (www. wikipedia. org) Use in cooking.It is usually thick liquid that will not mix with water. (Dictionary) Operation definition of terms Jackfruit. this is where the researchers get their main ingredients. Jackfruit Seeds. this is the main ingredients of the product. Spread. this is the product of the researchers Grinding mill. this is used by the researchers to grind the raw ingredients Mixer. this is where the researchers mixed the ingredients. Plastic bottle. this is where the researchers put the product. Cooking oil. his is used by the proponents on roasting the product.Chapter II MARKETING ASPECTMarket StudyThis chapter of the study tackles and discusses the different aspects that must be considered in entering and taking up business. The computation and analysis of demand, supply, demand gap, supply gap, and projected sales that will help to determine the viability of the study. Implementing effective marketing strategies and programs are also included in this chapter to penetrate the target consumers that are patronizing the product. The research method of gathering data and information is also discussed in this chapter.ObjectivesThe purpose of this study is to identify the market feasibility of the said business. This section has the following objectives:1. To determine the demand for the product.2. To identify the price of the product to be sold.3. To determine the promotional strategies and programs to attract consumer.4. To identify the market gap.Research Methodology Survey questionnaires for gathering information are distributed to respondents located in Tanauan City, Batangas majorly in Barangay Sambat and Poblacion areas where the factory is nearly located. Taste test was also used by the researchers to gain some information and feedbacks.Subject of the Study The proponents conducted this study to provide additional selection and taste to the increasing needs of spread in the market. JFS Spread is made available in the potential market of Tanauan City, Batangas to have a new flavor in the spread industry that will surely benefit the consumers. Data Gathering Instrument The descriptive method of research is being employed in this study. It is also used in order to answer questions concerning the current status of the subject of the study and the collection of data to formulate and test hypothesis.Descriptive method is the most appropriate method to meet the purpose of the researchers. The use of questionnaires as a research instrument for gathering information from the respondents and interview guide are used for competitors’ information and data. Data Gathering Procedures The set of questionnaire was distributed by the researcher to gather some information that will help the researchers to have a guide for the product. 15 questions are given to the respondents of the study. The percentage of question no. 1 answers the question on how many consumers are taking sandwich spread.The foll owing questions are to determine on what kind of product that is most likely by the consumer. The projection of the demand and supply are based on question no. 3 and 15. Through taste test, the researchers gain some feedback and commented regarding the product and its appeals to them. Statistical Treatment of Data Statistical Data In order to compute for the sample size and have a reliable results in gathering data, Solvin’s Formula was used. n=N / (1 + Ne? ) 23469 n= 1 + 23469 (. 05) ? n=393. 30 Table 1 Population of the Study Year |Population | |2011 |24098 | |2012 |24744 | |2013 |25407 | |2014 |26088 | |2015 |26787 | The proponents will provide the demand for the product in Tanauan City, Batangas majorly in Barangay Sambat and Poblasyon areas that have a growth rate of 2. 68% annually. Demand Demand refers to a consumers’ desire of a product or service with the consumers’ availability to purchase.Quantity demand is the total amount of such effectual desire in a given market with reference to a given commodity at a certain price. Historical Demand Historical Demand is the number of people that consumes spread during the past years. This is based to the researchers gathered information using the question â€Å"Do you take sandwich spread? † which was 90. 84% positively answered by the respondents. Table 2 Historical Demand (nearest to 220g bottles) |Year |Historical Demand | |2005 |18876 |2006 |19395 | |2007 |19930 | |2008 |20478 | |2009 |20799 | Major Consumers of the Product JFS Spread will provide thedemand for the product in Tanauan City, Batangas majorly in Barangay Sambat and Poblacion areas. These areas became the major consumers of the researchers due to its location which is near the factory.Knowing the culture of the people in the said location and having a low product cost, purchasing power of consumers would not be a factor in availing the product. Products will be distributed through retail during the first few years o f its operation. Projected Demand Table 3 Projected Demand (nearest to 220g bottles) Year |Total Projected Demand |of Projected Demand | |2011 |1598736 | | |2012 |1641588 | | |2013 |1685580 | | |2014 |1730748 | | |2015 |1777128 | | Table 4 Relationship of Historical Demand and Supply Year |Population of the Study |Historical Demand |Historical Supply | |2005 |24098 |18876 |6336 | |2006 |24744 |19395 |9792 | |2007 |25407 |19930 |10368 | |2008 |26088 |20478 |13824 | |2009 |26787 |20799 |14688 | Table 5 Relationship of Projected Demand and Projected Supply Year |Population of the Study | | | | |2011 |24098 | | | | |2012 |24744 | | | | |2013 |25407 | | | | |2014 |26088 | | | | |2015 |26787 | | | | Supply Supply refers to the total number of good or services that are available in the market place. Historical Supply Historical Supply is the total quantity of products that are sold during the past few years. The researchers gather this data through interviewing and asking the different sup per markets, bakeshops, and other leading suppliers located in Tanauan City, Batangas. Table 6 Historical Supply (nearest 220ml bottles) Year |Supply | |2005 |6336 | |2006 |9792 | |2007 |10368 | |2008 |13824 | |2009 |14688 | Competitors JFS Spread is categorized under spread products and there might be a lot of indirect competitors like Mayonnaise, Cheezwiz, and Leaver Spread, JFS Spread is have its confidence to compete having its own benefits and uniqueness.One of its major competitors is the Peanut Butter which is highly demandable by the consumers. Projected Supply Table 7 Projected Supply (nearest 220g bottles) |Year | | | |2011 | | | |2012 | | |2013 | | | |2014 | | | |2015 | | | Projected Supply and Demand Analysis Market Share Table 8 Projected Market Share | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Marketing Analysis Gross market acceptability rate Gross market acceptability share is the number or percentage of c onsumers that will accept our market product. Total Market Acceptability Gross market acceptability rate= Total sample size 279 =x 100 393 = 71% To compute for the net market acceptability: = GMAR – Conservatism = 71% – 20% = 51% Marketing MixThe marketing mix also known as the 4 P's of Marketing, is the combination of product, price, place, and promotion. Product JFS Spread is categorized as healthy spreads that will provide new taste in the spread industry. Product brand name is derived from the name of main ingredient which is Jackfruit Seed. It is rich in protein, vitamin C and A which are good for our health and for eye sight. The need for the product is to satisfy the basic need of the consumer. The consumers are becoming conscious with what are the benefits that they can get from the product. It is expected to change the conventional spread. The product weight is 220g per bottle. The product addresses to the need of alternative for peanut butter that have many b eneficial.The Jackfruit seeds help lower blood pressure because of its high potassium content. This will give a great competitive opportunity to the sandwich spreads industry. [pic] Figure 1 JFS Spread Label Place The researchers choose to establish the business at Barangay Sambat Tanauan City, Batangas. It is located along the highway going to Calabarzon and the supplier of raw materials are said to be near the said location. Shellane, Shell, and Vispo plastic store which serve as the primary supplier of 220g bottle located in Tanauan City Public Market. There is also an easy access to the road and Calabarzon going to Lipa where the supplier of Jackfruit seed is located. PromotionJFS spread, having a unique characteristics and unique ingredients; it triggers the consumers to easily recognize the product these advantages was noted and perform different marketing strategies to highly compete with other competitors.1. Product Demonstration Product demonstration will be done in public markets, super markets, and selected bakeshops where the products will be distributed and available.2. Sampling and Taste Test The researchers implemented this strategy at the beginning of the operation to be introduced to the consumers. It may also help the product to be known.3. Posters, Banners and Leaflets Poster and banners will be posted around the target areas. This strategy is done to inform those consumers who doesn’t go to supper markets.4. Word of Mouth Word of mouth is said to be a way of passing information from one person to another that will be a big help in promoting a product. Having a product with good reputation will easily be known around the target area. Price Having a low cost of raw materials used, the price of the finished product would not be costly. Having this kind of advantage, the product will have a great advantage on its competitors.Chapter III TECHNICAL ASPECTThe Technical aspect is the discussion of the basic and operational flow of the projec t. The technical aspect is one of the essentials of this tudy because this factor responds to the technicalities and basic structure of the proposed study. This includes the list of equipments, materials, structure plan and also the source of the supplies use in the proposed project. Business plans, promotion strategies, utilities, facilities, layout designs and location are included in this chapter. The Product JFS Spread is categorized as healthy spreads that will provide new taste in the spread industry. Product brand name is derived from the name of main ingredient which is Jackfruit Seed. It is rich in protein, vitamin C and A which are good for our health and for eye sight. The need for the product is to satisfy the basic need of the consumer.The consumers are becoming conscious with what are the benefits that they can get from the product. It is expected to change the conventional spread. The product weight is 220g per bottle. The product addresses to the need of alternative for peanut butter that have many beneficial. The Jackfruit seeds help lower blood pressure because of its high potassium content. This will give a great competitive opportunity to the sandwich spreads industry.†¢ It is an excellent energy food that helps to prevent constipation, obesity and contains a small amount of fats.†¢ This may also help to prevent and treat tension and nervousness†¢ It can also help cure ulcer and indigestion.Figure 2 Manufacturing Process Table 9 Raw Materials Ingredients |220g | |Jackfruit Seed |105g | |Sugar |84g | |Salt |1g | |Vegetable oil |30g |Description of the ProcessA. Boil and roast the Jackfruit seed1. Boil the Jackfruit seed2. Roast the Jackfruit seed3. Allow the peanuts to cool after roasting.4. Remove seed coveringB. Add brown sugar, salt, and vegetable oil to form a mixture Jackfruit seed then is added with sugar, salt, and vegetable oil for the taste and form a mixture.C. Put all the mixed ingredients to a food processor1. Mixt ure is put to a food processor that will grind the Jackfruit seed.2. Mix it well to make the mixture smoother.D. Quality Control Output is brought to the quality control department for checking for validation.E. Bottle filling 220g bottle are filled with 220g of the mixture.F. Packaging and Labeling Bottle being field are passed to processing and finishing department for the packaging and labeling of the product.G. Quality control The last and final is checking of the finished product. Table 10 Raw Materials Requirement Materials |Unit |Requirements per batch |Price per batch | |Jackfruit seed |105g | | | |Brown sugar |84g | | | |Vegetable oil |30g | | | |Salt |1g | | | |220g bottle |1pc. | | | Production Schedule Total number of weeks in a year 52 Number of working days in a week 6 (Mon. – Sat. ) Total number of working days in a year 312 (52Ãâ€"6) Number of Legal Holidays 23 Total number of Production Days237 Production ConsumptionAverage production per day 200 (220 g bott le) Number of production days 237 Factory Equipment The researchers decided to use the following equipments like heavy duty stove, refrigerator, saute pan, generator, stainless containers, weighing scale, electric blender, trolleys, pallet, mini truck, company vehicle, and fire extinguisher, to be used and needed in this manufacturing business. The equipment to be purchased as follow: Table 11 Production Equipment |Items |Description |Quality |Unit price |Total price |Life span | |Heavy duty stove |Used for brewing of the ingredients |2 pcs. 1,800 |3,600 |5 yrs | |Saute pan |Used for boiling and roasting of raw |6 pcs. |500 |3,000 |5 yrs | | |materials | | | | | |Refrigerator |For preservation of inventory |2 pcs. |5,000 |10,000 |56 yrs | |electric blender |Used for food processing |4 pcs. |1,000 |4,000 |5 yrs | |Generator |For emergency power supply |1 pc. |15,000 |15,000 |10 yrs | |Fire extinguisher |Used to secure safety in case of fire |4 pcs. 1,250 |5,000 |10 yrs | |Stainless c ontainer |Containers during production |8 pcs. |500 |4,000 |5 yrs | |Weighing scale |For accurate measure of the materials |2 pcs. |2,000 |4,000 |1 yr. | |Trolley |For easy transfer of objects |2 pcs. |600 |1,200 |5 yrs | |Pallet |Product holder |10 pcs. |100 |1,000 |2 yrs | |Company vehicle |For company service |1 pcs. |80,000 |80,000 |10 yrs | |Mini-truck |For the purpose of delivery and getting of|1 pc. 100,000 |100,000 |10 yrs | | |raw materials | | | | | Furniture and Fixtures For making the workplace organized and well presented. The following furniture and fixtures will be needed. Table 12 Furniture and Fixtures |Item |Quality |Unit price |Total amount |Life span | |Tables/ desk |3 pcs. |500 |1,500 |5 yrs | |Chairs |12 pcs. |75 |900 |5 yrs | |Filling cabinet |2 pcs. |1,000 |2,000 |10 yrs | Office EquipmentIn order for the business to operate with better facilities, the following office equipments are required. Table 13 Office Equipment |Item |Quality |Unit price |Total amount |Life span | |Computer (desktop) |1 pc. |15,000 |15,000 |5 yrs. | |Telefax |1 pc. |3,000 |3,000 |10 yrs. | |Air Con |1 pc. |10,000 |10,000 |5 yrs | Manufacturing Supplies Day to day operations of the business requires the following supplies: Table 14 Production Supplies Item |Quality |Unit price |Total amount | |Laboratory gown |6 pcs. |100 |600 | |Gloves |6 pcs. |100 |600 | |Rugs |12 pcs. |5 |60 | |Hand soap |2 pcs. |200 |400 | |Hair net |6 pcs. 30 |180 | Table 15 Office Supplies |Item |Quality |Unit price |Total amount | |Bond paper |1 ream |150 |150 | |Computer ink |1 cartridge |120 |120 | |Receipts |2 ream |100 |200 | |Ball pen |8 pcs. 30 |240 | |Folder |1 box |150 |150 | |Staple wires |5 box |10 |50 | |Paper fasteners |1 box |30 |30 |Utilities The business firm will need utilities in order to run and operate the business.These include the following:†¢ Electricity which is needed in manufacturing process witch is estimated a worth of Php 2000 in monthly consumptions which will be provided by Batangas Electric Cooperative II (BATELEC).†¢ Water which is needed in sanitizing the equipments, working place, and for food processing which is estimated a worth of Php 1000 in monthly consumptions which will be provided by Tanauan Water District. Telecommunication that is needed in dealing with inquiries, additional information, product orders, communicating to suppliers, and internet connection for online advertisements which is estimated a worth of Php 2000 in monthly consumptions which will be provided by Philippine Long Distance Telephone Company (PLDTco. ).†¢ Liquefied Petroleum Gas (LPG) in elation with the heavy duty stove which is estimated a worth of Php 3000 in monthly consumption which will be provided by Shellane.†¢ Fuel or Diesel for vehicle purposes which is estimated a worth of Php 8000, which will be provided by Shell. Waste Disposal As an environment – friendly business entity, zero – waste management is made by se paration of biodegradable from non-biodegradable waste.Waste collection will be held based on the garbage collector’s schedule for collecting. Cleaning program is also implemented which cuts the production period an hour earlier for cleaning purposes. Plant Location In putting up a business entity we need to consider the following factors such as nearness to market, accessibility, water, and business supply, transportation and leasing cost in choosing location is the important thing that we need to study. After knowing those things, the researchers choose to establish the business at Brgy. Sambat Tanauan City. The availability of manpower is present and the location is applicable for the business. The transportation also plays a significant role that makes the location accessible.Because it is near at the market, Gasoline Station, Shellaine, Water Station and also to the CALABARZON. [pic] Figure 3 Plant Location [pic] Figure 4 Factory LayoutBoiling and roasting of the Jackfru it seed Add brown sugar, salt, and vegetable oil to form a mixture Put all the mixed ingredients to a food processor NO Quality Control YES Bottle filling Packaging and Labeling Quality control Caltex Plant Location Mini stop Shellane Shell Mc Donalds Jollibee Market 7 eleven Tanauan Crossing GOING TO CALABARZON Inventory area Entrance 300 sq. meters Cashier Mixing Packaging Quality Control Grinding Boiling ; Roasting STORE PARKING AREA

Electronic Medical Records

Electronic Medical Records Essay Cynthia Jones Grand Canyon University: HCA 450 November 11, 2012 Electronic Medical Records Essay Medical record keeping has change in the last couple of decades. In the past patients records were kept in a file on paper taking up excessive room. In the past, paper charts were the only means of keeping a patient’s medical diagnoses documented. Some of these charts are still used today in healthcare facilities, however they are slowly being replaced with a more advance method; electronic medical records (EMR’s).This virtual data–information center can serve as a vehicle to promote and to disseminate standardized data definitions and best practices to providers, consumers, and others interested in quality improvement efforts nationally and internationally (Varkey, 2010). The Electronic Medical Records is an advance computerizes medical record system that delivers medical data for physician’s office and hospitals within a matt er of seconds while offering care. This system allows the healthcare staff and physicians to modified, store and retrieves patient’s medical records.Electronic medical records are legible and organized. The Electronic Medical Record (EMR) has been around since the late 1960‘s, when Larry Weed introduced the concept of the Problem Oriented Medical Record into medical practice (NASBHC, 2012). Weeds innovation introduces the concept of the Problem Oriented Medical Record into the medical practice, which verifies the diagnosis (NASBHC, 2012). However, it wasn’t until 1972 when the Regenstreif Institute developed the first medical records system. Although it was a great invention, physicians didn’t seek to use it right away.This new system would help physicians improve patients care. Although, $19 billion in stimulus funds have been invested into the Electronic health record (EHRs) another name for EMRs; the Obama administration highly suggested that health car e and hospitals facilities start to digitize patient data and start making better use of the advance technology(Greenemeier, 2010). The health care industry has been slow to adapt to this new system. Although the EMR system is intended to make patients records more accessible for the physicians and staff, still many have not implemented it yet.Given the lack of EMR adoption throughout the health care industry, less than 10 percent of U. S. hospitals have adopted electronic medical records. Cost is the primary reason many have resisted or are unwilling to adopt the EMR system and shortage on staff as well. In a recent interview on November 9, Jessica in human resource at Vineville Internal Medicine, with Dr. Mary Bell Vaughn presiding as the physician over the practice. The practice has been using electronic medical records systems since the practice open in 2002. Dr.Vaughn thought patients and staff needed easy access to their records when needed. Some of her other reasons are as fo llow: †¢ Paperless, Less storage †¢ No physician running around ( Patient info available at finger tips) †¢ Saves time spent with patient †¢ Good for tracking information †¢ Financial Good This system is web based and uses an E-Clinical program through a portal. This system also allows prescriptions to be sent to the local pharmacy as well. Blood work results are also put into the patients charts as well.Recently, the practice took on new patients with paper charts, because their physician retired. In this cause their most recent charts were converted over to EMRs. However those paper charts still exist in a small storage area if further information is needed on the patient. Though the practice implements the EMRs system from the very beginning, the physician and staff are very happy with the system. Most patient information is put into the system via computer on the spot while the patient is telling the nurse or physician what is ailing them.Although there system is a web based system, it has two backup systems in two different locations just in case the systems go down or power outage. The EMR system has had great quality impact on the practice. The patients care has been improve by the system. It allows the physician to track and effectively treat the patient. In some cases if the patient is located at another healthcare facility this system allows them to send information to multiply people for care, no matter where they are. Dr.Vaughn’s practice is already looking into the future to implement sending out text message to patients to inform them of appointments. Patients have access to their care anytime. EMR adoption is slow to be implemented into some practices. Although there is some disapproval of the electronic medical records today, it is merely a digitized version of paper chart. This system will reduce medical errors and help put information in front of researchers This new form of technology is here to stay and the s ooner healthcare facilities start using it the more efficient results they will receive.References Prathibha Varkey (2010). Medical Quality Management, Sudbury, Massachusetts: Jones and Bartlett Publishers. History of the Electronic Medical Record system (2012) Retrieved November 8, 2012 www. nasbhc. org Will Electronic Medical Records Improve Health Care? (2009) Retrieved November 8 2012 http://www. scientificamerican. com/article. cfm? id=electronic-health-records Electronic Medical Records Engineering Management Field Project Electronic Medical Records: A Case Study to Improve Patient Safety at Royal Victoria Teaching Hospital By Annie Bittaye Spring Semester, 2009 An EMGT Field Project report submitted to the Engineering Management Program and the Faculty of the Graduate School of The University ofK. ansas in partial fulfillment of the requirements for the degree of Master's of Science )= †¢ , , Tom Bowlin Cotntnittee Member ‘~k Committee Member Date accepted: _ _&-4–_':'†/~,,,,,,†1_-. -Q:;,,.. r5c—-_ _ Table of ContentsTable of Contents †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 2 List of Figures †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 3 List of Tables †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 3 Acknowledgments†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ Executive Summary †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 5 1. 1. 1. 2. 3. 3. 1. 3. 2. 3. 3. 3. 4. 4. 4. 1. 4. 2. 5. 6. 7. Introduction†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 6 Background of Royal Victoria Teaching Hospital †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 7 Literature Review †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 0 Procedure and Methodology †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 17 Exp erimental Design †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 17 Survey Procedure †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 18 Data Analysis †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 9 Limitations of the study †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 19 Resultsâ⠂¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 20 Reasons why EMR is not being used at RVTH †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 23 Benefits and challenges of EMR†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 24 Summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 0 Conclusion †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã ¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 30 Suggestions for Additional Work †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 32 References †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 34 Glossary †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 5 Appendix †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 36 2 List of Figures Figure 1: Sources of funding, RVTH 2008 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 22 Figure 2: Averages ofEMR functions in order of relevance to work at RVTH †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 29 List of Tables Table 1: Number of patients seen at RVTH in 2008 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 7 Table 2: List of Professionals, RVTH 2009 †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 0 Table 3: Computer ownership and previous computer training received by the respondents at RVTH †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 28 Acknowledgments My journey towards my Master's degree was a long and fruitful one. The Engineering Management (EMGT) program has not just exposed me to much information and ideas but also opened a way towards my career path. Thank you to my parents, Ebrima and Lucy who have always been a source of great inspiration and strength to me. They taught me the value ofeducation and their prayers has always been with me.Thanks to my brother, Baboucar who encouraged me to pursue my Master's degree and the never ending support I receive from him. Special thanks to my six year old son, Ebrima for his understanding that I'm at school when I'm not home to read him a bedtime story. I also want to thank all my EMGT instructors especially Professor Herb Tuttle, Dr Tom Bowlin and Ray Dick who worked with me recently, for the wonderful information and feedback they provided on this project. Thanks to Parveen Mozaffar for her extreme support and encouragement during the course of my studies.Thanks to the staff at Royal Victoria Teaching hospital for providing me with all the needed information for this project. Last but not least, my gratitude goes out to Dr Don Anthony Woods. It is because of his influence that brought me where I am today. He always had my best interest at heart and I want to thank him for that. May God bless you! Executive Summary Most countries in Europe and the USA are increasingly using an electronic medical record (EMR) system to help improve healthcare quality. Unfortunately, The Gambia government faces a series of health crises including but not limited to HIVIAIDS, malaria, diabetes and tuberculosis.These diseases threaten the lives of thousands of people. Lack of infrastructure and trained, experienced staff are considered important barriers to scaling up treatment for these diseases. The contribution of this field proj ect outlines the benefits of an EMR system at Royal Victoria Teaching Hospital (RVTH) and how it will improve patient safety. This is a descriptive study using interview questionnaires from officials at the Royal Victoria Teaching Hospital. The study also looks into other facilities in similar developing countries with advanced systems, but not so advanced as to be at the level of state-of-the ­ art facilities in the U.S. Results from this study indicates the importance of an EMR system at RVTH to facilitate effective and efficient data collection, data entry, information retrieval and report generation. As a catalyst for development, the implementation of an EMR system at RVTH may make it one on the best hospitals in the West African region. 5 1. Introduction According to Dick and Steen, Electronic Medical Record (EMR) is the compilation of patient medical information in a computer-based format that allows the collection, storage, retrieval, and communication of this data.An electronic medical record replicates a paper chart and contains both clinical information (diagnoses, allergies, drug resistance and treatments) and demographic information about a patient; it provides a comprehensive medical picture and can be used by clinicians as a tool to determine appropriate treatment for patients. EMR is not only being welcomed by healthcare providers as a way to improve care delivery but also serves as a catalyst and gold standard for development (porter, Kohane, & Goldman; Reifsteck, Swanson, & Dallas).Unfortunately, Africa, a continent faced with many challenges ranging from epidemics, civil wars, and disasters, lacks robust healthcare infrastructure in the form of computerized h ealth care systems. For instance, Ghana has one the best health institutions in the region, Korle-Bu Teaching Hospital. This Hospital, for example, is currently the only institution in the West African sub-region which performs surgery. Due to the quality of outcome, it now receives referrals from most parts of the continent namely the Gambia, Sierra Leone, Liberia, Togo Benin, Tanzania, Nigeria, Cameroon, Cote d' Ivoire, and Ethiopia.Despite its exemplary performance, the hospital has no computerized information system which can help improve care delivery in the region. Therefore, the purpose of this study is to examine the potential benefits of EMR and its ultimate contribution to improving healthcare delivery development in less developed countries like The Gambia. 6 1. 1. Background of Royal Victoria Teaching Hospital The Gambia is a small country in West Africa, with a population of approximately 1. 5 million. RVTH has been in existence for over 100 years in The Gambia's capita l, Banjul.It used to be called Royal Victoria Hospital until in the late 1990s, when its name was changed to RVTH. The Gambian Government decided that it had to reduce its dependency on foreign doctors by establishing a medical school in the University of The Gambia (UTG). The UTG now uses RVTH to teach its clinical students. In recent years, The Gambia has been doing much on its own initiative to take to improve the healthcare of the nation. There are 540 beds in the hospital and the two largest Departments are Pediatrics and Maternity.The biggest â€Å"killer† disease in The Gambia is malaria, with young children and pregnant women being particularly vulnerable to this disease. Diabetes, high blood pressure, pneumonia and eye problems such as trachoma and cataracts are also major health problems. The following table provides an estimation of how many patients were seen at RVTH in the year 2008. Procedure Inpatient Admissions Children admitted to Pediatrics Patients treated in the Eye Center Out-Patient Appointments Out-Patients in the ER Number of Patients 25,281 9,352 986 over 184,365 24,334 Table 1: Number of patients seen at RVTH in 2008 7Unfortunately, RVTH does not have any EMR system in place to facilitate patient safety. As noted by participants, â€Å"EMR software is not used at RVTH because administration keeps complaining of money. It looks expensive to them and also they are more used to the paper folder†. Currently, information is very fragmented and therefore does very little to help patient safety and consistency in care. Another important issue here is that a large number of these patients are illiterates. To ensure they receive the appropriate treatment, they will have to explain to the physician current medications they are taking etc.This can be a very challenging and fatal to the patient sometimes. The typical paper medical record contains sections including information on demographics, admissions, discharge summaries, progre ss notes, protocols, laboratory results, radiology results, surgical and pathology reports, orders for, treatment and nursing notes. Most documentation regarding treatment of a patient is written directly in the patient's medical chart. On a given day a patient arrives at the hospital for care, sign in his name and waits anywhere from 30 minutes to six hours o get their records pulled depending on the day. Physicians, nurses, medical residents who need access the information in the medical record must wait till it's available. Typically, medical records are transported to the outpatient clinic where the patient would be seen, and then returned to storage center to be filed again. It is necessary for the medical record to follow the patient throughout their visit. If the patient was seen in one clinic where orders were written, it was necessary to physically transport the record when the patient moved to the medicine room for treatment. The purpose of this field project is to examine the potential benefits of an EMR system and its ultimate contribution to improving patient safety at the Royal Victoria Teaching Hospital in The Gambia. 9 2. Literature Review The first generation of EMRs was extensions of medical billing systems in large US hospitals. Over the last four decades, they have been used as tools to organize and store medical data. EMRs are widely accepted as important tools to support high quality health care in the US, Europe and other developed countries.Evidence shows that using EMRs that include decision support systems improves quality of care and both reduce medical errors and unnecessary medical investigations (Partners in Health), Experience with the use of EMRs in developing countries, if available, is much more limited than it is in the US and Europe. Now there is considerable interest in using medical information systems to support the treatment of HIV and TB in Africa, Latin America, and Asia. In most African countries, healthcare informati on systems have been driven mainly by the need to report aggregate statistics for government or funding agencies.Such data collection can be performed with simple paper forms at the clinic level, with all electronic data entry done centrally, but that approach tends to be difficult and time ­ consuming and may provide little or no feedback to the staff collecting data. Individual patient data that are collected and accessible at the point of care can support clinical management. Clinicians can easily access previous records, and simple tools can be incorporated to warn of potential problems such as incompatible drugs.Physicians or nurses can check on the outcomes of individuals or groups of patients and perform research studies. Many of these functions will work well on paper or with simple spreadsheets for up to 100 patients but become very time-consuming and potentially unreliable with more than 1,000 records, and virtually impossible with 10,000 or more. 10 Experience with the use ofEMRs in developing countries is much more limited than it is in the US and Europe, but there is now considerable interest in using medical information systems to support the treatment of HIV and TB in Africa.Some examples of EMR use in Africa include: †¢ The Regenstrief Institute in collaboration with Moi University in Kenya developed an EMR for general patient visits to clinics in western Kenya. This system was subsequently modified to support the care of several thousand HIV patients. †¢ Baobab Health Partnership in Malawi has developed an EMR system using innovative, low-power touch-screen PCs for data entry and display. This system is now used to support the care of more than 7,000 HIV patients in the Lighthouse clinic in Lilongwe and has been chosen by the national HIV program for use throughout the country. [email  protected], an HIV medical information system developed for US patients, has now been deployed in Uganda and is planned for use in other African c ountries and in Latin America. (Partners In Health) A wide-ranging literature review of electronic medical record implementation over the past decade reveals that clinical, workflow, administrative, and revenue enhancement benefits of the EMR outweigh barriers and challenges. Among other key efforts, organizations must train and motivate users to navigate EMR systems, as well as develop a common structured language.Clinicians who used CPRs found that electronic 11 access to clinical infonnation saves time and provides a thorough and efficient way to manage patient information To reap the full benefits of an EMR, organizations must redesign current workflows and practices to evolve into efficient providers of care. EMR systems are developed to meet the following goals: improve quality of care, reduce organizational expense, and produce a data stream for electronic billing. (Dassenko and Slowinski).The EMR meets these goals through workflow automation, connectivity, and data mining. ( Gaillour) The Computer-based Patient Record Institute's (CPRI) definition concurred with the other researchers, but added that the EMR provides protection of patient and provider confidentiality, has a defined vocabulary and standardized coding, produces documentation as a by-product of patient care, connects local and remote systems and provides electronic support for secondary users (payers, policymakers, researchers). Fromberg and Arnatayakul) Unfortunately, most EMR systems are unable to offer all of the components defined by the CPRI because †the technology is too complex and too expensive, doctors won't use computers, and standards don't exist. â€Å"(Gaillour) The advantages associated with implementing EMRs are well documented and are straightforward. The difficulty comes with placing a dollar figure to these advantages; consequently, few organizations have published studies describing the actual costs and benefits attained from implementing EMRs. Bingham) The benefit s associated with CPRs are organized into four categories: clinical, workflow, administrative, and revenue enhancement. Renner, states that measuring all the benefits associated with EMRs is 12 virtually impossible, and that it is probably safe to select those that can make the greatest financial difference, and incorporate them into a financial model.Clinical benefits seen after implementing an EMR include: better access to the chart, improved clinical decision making and disease management, enhanced documentation, simplified patient education, and increased free time to spend with patients, accompanied by improved perception of care and quality of work life. These benefits ultimately result in better delivery ofpatient care and safety. Despite all of these benefits, EMRs are not a standard in today's healthcare systems. It is evident that EMR technology is still a hot topic for discussion when browsing through current healthcare technology and management journals.The following bar riers have kept healthcare leaders discussing EMR technology instead of adopting it: cost, leadership, ROI, vendors keeping up with users' needs, and deficits in the following categories: public policy, standards, security, and a true definition. First of all, cost has kept organizations from implementing EMR systems. These costs can be organized into the following categories: software, hardware, infrastructure development and maintenance, implementation, education, planning, and administration.Software costs include development or purchase, maintenance, and upgrades over time, while hardware costs include purchase of workstations. (Mohr) Infrastructure development and maintenance costs include servers, interfaces, workstations, network cables, network maintenance, and help desk operations. Planning costs include development of an implementation plan, identifying measurable outcomes, and choosing meaningful metrics and goals, while implementation costs include training, overtime 13 ssociated with entering patient data, business disruption during transition, employee resistance to change, and lost productivity. Drazen, suggested that leadership was probably a more significant barrier than cost because, in the past, healthcare leaders have raised capital for essential business initiatives such as major building programs, acquiring a physician network, or starting up a managed care organization. This amount of capital is on the same scale as an EMR. Next, Drazen stated that a lack of government support is a major issue holding up EMR implementation.Unfortunately, the federal government does not contribute fmancially to EMR implementation projects. Without standards and structured data definitions, computer systems are not guaranteed to interface easily with each other, and databases are not easily developed. Most individual departments within a healthcare system have already invested in computerized patient information systems; however, these systems are isolated and do not communicate well with one another. Getting these systems to interface is one challenge facing EMRs. Data security continues to be an ongoing challenge.Bergman, found that politicians, consumer advocates, and the general public have voiced concerns about risks to the privacy and confidentiality of patient information. However, when compared with the security of the paper chart, the EMR's electronic audit trails and passwords actually improves internal security. The EMR may be more secure for internal breeches of confidentiality, but must also be protected from external breeches such as hackers, who could potentially enter the EMR from an off-site location and download volumes of 4 confidential information. Firewalls and encryption software are methods used to protect patient data from these violators. Clinicians who use EMRs recognize two benefits: First, electronic access to clinical information saves time. Second, electronic access provides a thorough and efficient way to manage patient information. With EMR systems, comprehensive information can be located and presented in a way that is relevant to the task at hand. Dassengko and Slowinski) The obstacles identified have thus far been insurmountable, but the considerable achievements identified in the benefits section of this discussion suggest that the advantages are well worth the effort. As Lenhart et al state, â€Å"Success comes at the price of considerable effort, persistence and optimism, as well as dedicated leadership. † (p. 114) some organizations that invested in early EMR systems are struggling to show the qualitative benefits promised by vendors because an electronic version of current work processes is not cost effective. Sandrick) â€Å"If the ROI were a function of the information tool itself, the financial benefits would be experienced universally. † (ROI: The White Paper. A Business Case for Electronic Medical Records) To get the most value out of an EMR, healthcare organizations must reengineer the following work processes to make full use of the system: Healthcare organizations must first train and motivate their users on how to navigate and operate the EMR tools. To optimally use the EMR, it must be implemented from registration through billing, thus allowing the organization to realize full potential benefits across the delivery system.These benefits include clear, concise, and comprehensive documentation, greater efficiency, care consistent with best practice guidelines and improved claims processing. 15 It is difficult to measure the economic value associated with less tangible benefits such as higher quality of care, patient service, provider and employee satisfaction, and competitive advantage. It is even more difficult to allocate necessary resources and commit to institutional change when the paper chart is â€Å"getting the job done,† even if it is not in the most efficient style.However, Carlon, suggests that all providers s hould embmce the EMR to deliver safe medical care. The information in the EMR can reduce medical errors to avoid dangerous, sometimes lethal, mistakes. If organizations can't show that EMRs have a positive ROI, they may decide that the EMR is just another expense of running a business. The expense is to improve patient safety and reduce medical errors. This review of literature emphasizes that the use of EMR systems contributes to the ultimate goal of delivering effective care while improving patient safety. 16 3.Procedure and Methodology The study is an exploratory study conducted in Banjul, The Gambia, to examine the potential benefits ofEMR and its contribution to improving patient safety. For the most part, this study is descriptive and categorized as a non-experimental qualitative study. Initial contacts were made with the Chief Medical Director, Development Officer and the Head of Medical Records at the RVTH to solicit participants for the study. 3. 1. Experimental Design Surv ey approach was used to gather data from healthcare professionals who are considered potential users of EMR.Copies of the questionnaires were sent through e-mail to participants. A total of 50 surveys containing 15 questions were sent out and 30 of them were returned. The content of the survey designed was open-ended questions based on the following areas: knowledge of EMR, benefits and challenges of EMR, transition from paper-based system to EMR, security issues associated with EMR use and assistance given to developing countries by developed nations to implement or use EMR. Other areas include, demographic details of respondents based on profession, length of practice, age and sex.The survey questions can be found in the Appendix. Participants were selected based on their level of healthcare training. The population set for the study was healthcare professionals from the RVTH, which includes physician consultants, surgeons, pharmacists, nurses, midwives, pathologists, radiologists , and laboratory technicians. Study participants were limited to these previously mentioned health professionals, since they would be the principle users of an EMRsystem. 17 RVTH has a total population of about 500 professionals and a sample size of 50 was chosen for the study.Since this was the first time such a study was being conducted in the country, there was limited knowledge of professionals on the subject as well as difficulty in getting volunteers to participate. 3. 2. Survey Procedure Survey questionnaires were converted into a PDF file and mailed electronically to all 50 participants on February 2, 2009. Unfortunately, five medical professionals who were initially contacted to participate in the study later declined to take part due to lack of understanding of the survey questions. As a result, different participants were contacted to replace the five individuals to make up the sample size.Since the researcher could not travel to Gambia to facilitate the survey, one of th e administrative officers at the hospital was contacted and helped to distribute hard copies of the questionnaire to all participants. Participants were requested to fill out the attached survey and return it in a sealed envelope to this person or the chief administrator. After three weeks, on February 23, 2009, a first reminder was mailed asking for their cooperation and the importance of returning the survey. A final reminder was sent out on March 9, 2009, to those who might have forgotten to return the survey. 8 3. 3. Data Analysis The 30 completed surveys were coded, sorted, and organized into themes. A spreadsheet was created in MS-Excel to enter all data for analysis. All responses were placed into themes and summarized. The survey responses and themes generated were used to determine result interpretation, recommendation, and future research direction. Despite initial difficulties to get volunteers to participate in the study, 30 out of the 50 surveys mailed were returned on March 16,2009, thus representing 60% response rate. 3. 4. Limitations of the studyDue to the difficulty of getting other hospitals in the area involved, the study was limited to RVTH only_ The findings represent views ofthat hospital alone. However, the research would have been more interesting and challenging if more professionals from other hospitals were involved in the study. Secondly, due to cost of air travel between the United States and Gambia, the researcher was not able to travel to Gambia to collect the necessary data for the study. The inability of participants to respond to some important questions on the survey skewed the data.Finally, due to the six hour time difference between Kansas and Gambia, it was hard to reach the participants at during business hours. Lack of high speed internet or sometimes no connection at all caused the delay in receiving all the responses on time. It was also really difficult to get people to cooperate because the survey was not on their l ist of priorities. 19 4. Results Based on the methodology, surveys were mailed to 50 participants at the RVTH in Banjul, The Gambia. Thirty completed surveys were received which included 15 questions.The results from all participants are as follows: The 30 respondents consisted of 17 males, 11 females and two people who did not indicate their gender. The age range of the group was 25-56. Table 2 presents the professional distribution of participants. No Response represents people who did not include their profession. The five students, however, included final year medical and dentistry students, as well as nursing, and medical laboratory students. Professional experience ranged between 1 and 20 years.Profession Surgeon Pharmacist Physician Radiologist Midwife Nurse Laboratory Technician Student No Response Total Table 2: List of Professiona is, RVTH 2009 Number 3 2 3 2 5 6 2 5 2 30 20 To analyze this result, key words such as computerized, storage and retrieval, were used to determi ne respondents' understanding of the concept of an EMR system. Subsequently, one-third of respondents (33. 3%) who included these three key words were marked as right. While nine people representing 20% who said it is a mechanism for storing patient medical record on a computer were classified as partially right and approximately half respondents (46. %) who just said the use of machine to keep patient medical data were classified as having an idea or understanding of the system. In addition, implementing and running a successful EMR system requires a number of key elements. Accordingly, 15 people identified technical elements such as (electricity, hardware, software, etc. ), 10 stated patient data, while four said adequate trained personnel, and one person indicated the need for money to train staff on EMR. Also availability of adequate infrastructure such as experts to support and train care providers on EMR is very crucial when implementing EMR system.However, more than half resp ondents agreed that enough infrastructures are not available in Gambia to support EMR implementation. On the other hand, 10 people believed that infrastructures are available, while four said available infrastructures are only few. Despite unavailability of infrastructures, 16 respondents reported there are enough computer experts in Gambia to train healthcare providers to use EMR. Seven reported experts are not available; six stated experts are available but too few to meet the demand and needed training requirement of the healthcare sector.Lastly, one person indicated he has no idea of the subject. Responses concerning how much developed nations are assisting less developed countries like Gambia with Health Information Management (HIM) system infrastructure 21 implementation showed diverse opinions. Nine people said developed countries are helping, 15 responded no. However, six indicated that â€Å"the help given from developed nations are not enough and sometimes electronic devi ces sent to less developed countries like the Gambia are inferior and lack quality†.Still others think â€Å"some form of assistance comes in to support the country on information management systems but not much is channeled towards the health sector†. Lastly, seven people reported they have no idea â€Å"if developed nations are helping† and one person did not respond to this question at all. This pie chart below shows the sources of funding and the amounts received for the year 2008. Sources of Funding 2% †¢ Gambia Government †¢ Patient User Charges †¢ Donation Fund †¢ Internally Generated Fund †¢ Global Fund Severe Malaria in African Children FundFigure 1: Sources of funding, RVTH 2008 22 The majority of funds come from the Gambia Government in the fonn of subvention received monthly or quarterly in advance. However, about 70% of the amount goes towards payment of salaries and allowances to approximately 1,200 staff. Other donations re ceived are in the fonn of drugs, equipment, supplies and services which made considerable contribution to the hospital. (RVTH) 4. 1. Reasons why EMR is not being used at RVTH Paper records are bulky and can take up costly space.Filing, retrieval of files, and the re-filing of paper records are very labor-intensive methods with which to store patient infonnation. Plus if a record is checked out for one department, another department cannot access the chart. The impact of not having immediate access to key infonnation in emergency situations can be serious. Paper medical charts also cannot be effectively searched and used to track, analyze, and/or chart voluminous clinical medical infonnation and processes. They cannot be easily copied or saved off-site.Also physician's orders and the corresponding results such as medications and labs can be issued and saved in a comprehensive EMR system. Our literature review and results have proven that paper records are costly, cumbersome, misinter preted, easily misplaced and cannot be used for any meaningful decision analysis. Unfortunately, RVTH does not have any EMR system in place to improve patient safety. As noted-by participants, â€Å"EMR software is not used at RVTH because administration keeps complaining of the lack of money. It looks expensive to them and also they are more used to the paper folder†.Nevertheless, four key issues were identified by participants as the main reasons why RVTH does not have an EMR system in use. 23 Overall, 36% of respondents attributed the problem to lack of resources in terms of personnel and infrastructure, 29% blamed it on lack ofleadership initiative and priority. While 18% reported cost in terms of equipment and training personnel, 15%, however, stated lack ofEMR importance or awareness and fear to change. Lastly, 2% respondents did not give any reason. 4. 2. Benefits and challenges of EMR There are both benefits and challenges to EMRs.Many argue that positive aspects of u sing an EMR system outweigh the challenges. Even though the investments in EMR systems are costly, most argue that over time this outset cost will result in greater savmgs. As well as cost saving, many agree that one advantage of EMR system is that they save space. Instead of keeping huge paper files on patients, all records are kept on computer files. Though someone must store these records in computers, this still represents a small percentage ofthe space required to store physical records. Along with saved space is reduction of paper used by hospitals.Although EMR systems do not render paper obsolete, but they certainly do reduce needed paper significantly. Another advantage of electronic medical records is the ability for all in a health care team to coordinate care in terms of monitoring and treating diseases. This helps avoid duplication of testing, prescribing medicines that in combination might be dangerous and the ability for anyone on the medical team to understand the app roaches taken to a condition. A person with complex health issues may see several specialists, and can easily become confused by overlapping or contrary advice.When specialists and primary care doctors use the same system for electronic medical records, then everyone on the team would be aware of all the other team members' actions and recommendations. Electronic medical records may save time as well. Though faxing and email may assist one doctor to get information from another doctor or a laboratory, there is generally a wait time to receive this information. When a doctor has instant access to all of a patient's information, including things like x-rays, lab tests, and information about prescriptions or allergies, he or she is ready to act right away, thus saving time.This may be particularly helpful in emergency situations where a patient cannot answer questions about medical history or allergies due to extreme illness or injury. Generally, doctors are often considered to have th e worst handwriting, though this is just a generalization, unclear writing can lead to misinterpretations and mistakes. Typed notes and prescriptions are more legible and less likely to create misunderstandings. However, electronic medical records do not rule out the occasional typo. One of the main disadvantages to EMR system is that start up costs is enormous.Not only must you buy equipment to record and store patient charts (much more expensive than paper and file cabinets), but efforts must be taken to convert all charts to electronic form. Patients may be in the transitional stage where old records haven't yet been converted and doctors don't always know this. Further, training on EMR software adds additional expense in paying people to take training, and in paying trainers to teach practitioners. In fact, one concern about the use of electronic medical records is that doctors may have a significant learning curve when these programs are first implemented.A poor 25 typist may a ctually take a long time to input information. Doctors often have to be their own medical clerks especially during an office visit, and a doctor distracted by confusing technology may not be as alert to a patient's symptoms or needs. There is no single electronic medical records source or system, so different hospitals and individual clinicians may not all be using the same program. This negates the possibility of instant information for all on the medical team, since one program may not communicate with another.Another concern is that electronic medical record systems might be hacked and exploited by others. Since one of the first considerations of medical treatment is confidentiality, it may remain a concern about how many people may have access to other medical records which they are not authorized to do so. Misuse of private medical information could create problems for people who have conditions they wish to keep private. Despite these concerns, it appears many hospitals are no w attempting to use EMR systems.It remains unclear how long it will take for hospitals to transition completely from the traditional paper-based systems to a complete paperless environment. As shown from the survey results, it is clear that many participants believe that implementation ofEMR will tremendously improve upon patient in the country. For instance, as noted by one respondent, â€Å"availability of patient past history in electronic format will enable health care workers have information about patients in seconds and with ease which will facilitate quick diagnosis and treatment hence reducing the rate of mortality. 26There is always some level of fear and resistance to change, especially in the healthcare industry. A question concerning the level of acceptability from the traditional paper-based system to EMR system shows that such change will be met with some difficulties. More than half of respondents said the process would be challenging initially, but eventually care providers will accept the system because it will improve patient safety and work performance. Although the majority may still prefer the paper-based system, â€Å"they will change when they see the importance or need for EMR† stated a participant.Others also believe it would be a â€Å"welcome idea†. The adequate protection of patient health record requires limitations at all levels, such as: collection, use, access, and disclosure. Therefore, development of privacy, confidentiality, and security principles is necessary to protect patients' interests against inappropriate access to their health data. Unfortunately, 14 respondents (47%) did not respond to this important question regarding measures necessary to maintain patients' privacy, security, and confidentiality at RVTH.However, 16 people representing (53%), did state that all health records must be securely protected by use of password, data encryption, and access restrictions to users. It is obvious from the surv ey results that effective implementation and utilization ofEMR can improve patient safety in developing countries. Considering training as one of the key elements to EMR success, a question was asked to determine length of time required to train care providers in Gambia on EMR.Almost 50% of respondents indicated it might take 6-18 months depending on â€Å"practitioners' ability to understand the concepts ofEMR as well as the user friendliness of the software†. Others believe â€Å"for 27 current medical students who are already computer literate may take about two weeks, but the older practitioners will take longer time (approximately over a year)†. Table 3, below shows the number of respondents that own a computer or has had some form of computer training in the past. Computer Training Profession Own a Computer 1 1 1 0 1 2 1 2 I Yes 1 1 1 0 2 3 1 7 16