Health Issues/Policy Analysis Paper
Guidelines and Grading Criteria

This purpose of the assignment is to explore health needs or problems within communities and to explore what health problems are for that particular community. Discussions with community leaders and experts provide what health problems priorities they perceive exist for that particular community and the plans and policies in place to improve the health disparities. The student relates the health determinants and the epidemiological concepts to the identified health disparities in their communities to provide leadership in the development of policy to affect health outcomes.

After reviewing information provided in course content about Healthy People 2020 and the list of national concerns, the student consults with three (3) to five (5) local authorities and experts in his/her home community to discern the individuals perceptions about their own community problems. Students need to obtain the national list from Healthy People 2020 web site and ask authorities in their communities to describe how community problems compare to national top three health problems.

Interview a variety of individuals in positions of leadership who have knowledge of the communitys health problems and challenges. Conduct the interviews with public health officials, community leaders, school officials, local council members, state representatives, etc. but include a cross section of the community, one nurse leader, or other health care providers.

Write a paper that details each community authoritys perceptions of the top three health concerns. The paper specifies the individual interviewed, the credentials, his/her perspectives of community needs, and why the individual feels these conditions are problematic. The use of first person in this assignment is acceptable. Many community leaders indicate common health concerns, but list in a separate section each individuals concerns. The student identifies at least nine (9) problems. The problems may certainly be the same or similar, but these must be listed according to the community leader who identified the issues as problematic. Differentiate each of the leaders policies for improving the health disparities, and then examine the effects of legal and regulatory processes on nursing practice, healthcare delivery, and outcomes

Investigate and report on the epidemiological information associated with the top three (3) problems identified including a list of resources and statistics from an epidemiology web site. The student needs to tie the community health concerns with the concepts of epidemiology in order to develop a cogent plan of action for the Advanced Practice Nurse to use when developing strategies to address the identified problems.

Then assess specific ways an Advanced Practice Nurse could make an impact on one of the problems. These impacts are specific to the chosen area of practice, i.e. FNP, CNS, ACNP, Management & Leadership, and Education and should include information about how the nurse might make a difference in addressing one of these problems.

Papers should be 6-8 pages in length, excluding title and reference pages using APA format. Points will be deducted for papers that either exceed or do not include 6-8 pages of text. The file containing the paper should be submitted in the assignment section and named with the STUDENTS last name and assignment name.

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I need you to answer 5 health questions in essay form( double space, 12point font) which makes two page. Ineed it by sunday 10-17-2010 morning. I need for you to answer 5 questions in essay form with in the two pages that you are writing for me.

1.The Growing Inequalities. During the second half of the twentieth century, a striking redistribution of earnings occurred in America, as the nation shifted from the rising tides of the postwar quarter-century after World War II into the growing inequalities of the millennial quarter-century after 1975. (a) What would you say is the most compelling explanation for this remarkable change in the economic structure of American society? (b) Describe one specific policy intervention that you would recommend as a way to restore a modicum of equity and fairness to the U.S. economy.

2.Describe the relationship among health disparities, disasters and environmental health hazards in the Gulf of Mexico region.

3.What framework can be used to guide the transformation of public and safety net institutions to reposition them to thrive as health care reform is implemented.

4.When a health care professional encounters an Asian patient in their practice, what are at least three characteristics he/she should consider in order to improve communication and cultural competence in delivering services to this patient and tell why those characteristics are important to consider.

5.Define, differentiate, and demonstrate the interrelationship between values, and culture. Next, provide insight as to how cultural factors in your life may affect your perception(s) regarding the health and well-being of the individuals that you consider part of your "university" culture.

Discuss the issues related to health disparities in the U.S.including cost, quality, access, and equity. Identify the ethical implications.
Discuss the impact of culture on health status.
S&L talks about the importance of "cultural competence," a concept promoted by Madeline Leininger and others. Another concept promoted by Goldberg and Goldberg (2000) proposes that "maintaining an awareness of one's lack of (cultural) competence" should be our goal rather than the establishment of competence. Given that we live in a culturally pluralistic country and a global society, which approach do you think will help us to most effectively care for and promote the health of individuals and groups from different cultures?

In essay format, answer the question: "Was the US Department of Health and Human Services' Healthy People 2010 a success or a failure? Support your answer by discussing whether or not it accomplished the stated goals and objectives for Americans in the US. Indentify the critical issues, challenges or problems. Did certain key health factors, health disparities, social justice precepts play a role in the success or failure of Health People 2010? Are ther comparisons between Health People 2010 and Healthy People 2020: if so what are they? I will fax the pages from my textbook that can be used.Several websites suggested by the professor are www.apha.org, www.phf.org, www.dhhs.gov. Must be typed (MS Office Word)

Case Assignment
An important goal of Healthy People 2020 is to reduce health disparities in the United States. Formulate a discussion on this issue. Your paper should
address:
1. The definition of ?Health Disparities.?
2. Differences in health indicators of various ethnic and racial groups in the
United States.
3. Potential causes for these observed differences.
4. List possible ways to improve the health of underserved populations


Please include academic sources. These are peer-reviewed/scholarly sources. Ensure to include a short conclusion at the end of your papers. Ensure to include in-text citations for all numbers/stats.

From a writing perspective, rather than using numbered lists for your sub-sections, include headings. Here is a great link with information on how to format headings differently depending on their level: https://owl.english.purdue.edu/owl/resource/560/16/

There is one area that needed more precision: In regards to policy development, you don't include any specific policies that have been developed. You talk about the topic in a more general way.
Rather than using numbered bullets, use short headings to organize your paper and include an introduction.

Analyze the health status of a specific minority group. Select a minority group that is represented in the United States (examples include: American Indian/Alaskan Native, Asian American, Black or African American, Hispanic or Latino, Native Hawaiian, or Pacific Islander.) (YOU CAN CHOOSE ANY MINORITY GROUP)

In an essay of 750 -1,000 words, compare and contrast the health status of the minority group you have selected to the national average. Consider the cultural, socioeconomic, and sociopolitical barriers to health. How do race, ethnicity, socioeconomic status, and education influence health for the minority group you have selected? Address the following in your essay:
1.What is the current health status of this minority group?
2.How is health promotion defined by the group?
3.What health disparities exist for this group?

Describe at least one approach using the three levels of health promotion prevention (primary, secondary, and tertiary) that is likely to be the most effective given the unique needs of the minority group you have selected. Provide an explanation of why it might be the most effective choice. Cite a minimum of three references in the paper.

You will find important health information regarding minority groups by exploring the following Centers for Disease Control and Prevention (CDC) links:
1.Minority Health: http://www.cdc.gov/minorityhealth/index.html
2.Racial and Ethnic Minority Populations: http://www.cdc.gov/minorityhealth/populations/remp.html

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.



NAME OF PAPER : Health Promotion Among Diverse Populations

Answer the following question with no less than 300 words each. Please do not quote and make sure the references are in APA format and located under the 300 words it goes with. Please do not combine all the references together at the end. There need to be at least 3 reference for each question. The following questions are listed below.

1. Discuss informatics in Public Health.

2. Ethics and Public Health Model Curriculum - Module 2: The Legacy of the Tuskegee
Syphilis Study. http://www.asph.org/UserFiles/Module2.pdf.
Answer the questions for either Case Study 1, 2, or 3 (pg. 67- 68).

3. Find a site within one of the governmental health agencies devoted to health disparities. Discuss the research or interventions it contains.

Based on your specialty tracks elected role option (Nurse Practitioner), identify a potential problem (topic) that you would like to investigate through nursing research. Begin by reading the American Association of Colleges of Nursings (AACN) position statement on nursing research (http://www.aacn.nche.edu/publications/position/nursing-research).

Use a minimum of three nursing research articles that have addressed the problem you have identified. The literature may not be older than 5 years. After reading the literature respond to the following:

1. Note your role option and briefly describe the problem you are interested in researching and why this is of interest to you. (Health disparities, racial and ethnic minorities tend to receive lower quality healthcare)
2. Briefly summarize the literature you reviewed. Focus your discussion on the problem and how the literature you identified provides evidence of the existence of the problem.
3. Include in your discussion a potential innovation that you might consider as a solution to the problem.
Include citations/references in APA style format, using citations where appropriate.

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Good afternoon,
please forward this articles to be written by "WRITER".
Please write a compare contrst essay based on 4 articles.

Start with a central statement. Do not include authors words,just based on 4 articles discuss the influence of race as the underlying dimension of health disparities in public health.Please write 10 facts, make 10 short paragraphs.

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Week 9 discussion
HITECH Legislation
In order for organizations to receive the incentives offered through the HITECH legislation, they must be able to demonstrate that they are using the technology in meaningful ways. The following criteria for meaningful use must be evident to qualify for EHR incentives (U.S. Department of Health & Human Services, 2012). The technology must:
? Improve quality, safety, and efficiency, and reduce health disparities
? Engage patients and families
? Improve care coordination
? Improve population and public health
? Ensure adequate privacy and security protections for personal health information
For this Discussion you consider the impact of the meaningful use criteria of the HITECH legislation on the adoption of health information technology.
To prepare:
? Review the Learning Resources on the HITECH legislation and its primary goals.
? Reflect on the positive and negative impact this legislation has had on your organization or one with which you are familiar.
? Consider the incentives to encourage the use of EHRs. Focus on the definition of meaningful use and how it is measured.
? Reflect on how the incentives and meaningful use impact the quality of patient care.
? Find an article in the Walden Library dealing with one of the criteria to qualify for meaningful use and how it has been successfully met.
Post on or before Day 3 a description of how HITECH legislation has positively or negatively impacted your organization. Address how its related incentives influence the adoption of health information technology in health care and impact the quality of patient care. Provide a summary of the article you identified and explain how it demonstrates the ability of health information technology to meet the requirements of meaningful use.
? Arlotto, P. (2010). 7 strategies for improving HITECH readiness. hfm(Healthcare Financial Management), 64(11), 90?96. ?Retrieved from the Walden Library databases.??This article reviews seven strategies to help prepare for the implementation of the Health Information Technology for Economic and Clinical Health Act (HITECH). The central point of the article focuses on demonstrating meaningful use of electronic health records.
? Brown, B. (2010). The final rules for meaningful use of EHRs. Journal of Health Care Compliance, 12(5), 49?50. ?Retrieved from the Walden Library databases. ??In this article, the author poses four questions pertaining to the EHR system in the United States. In particular, the article examines Medicare and Medicaid incentive payments and the ways the meaningful use of certified EHRs will be verified.

Discuss the issues related to health disparities in the U.S. including cost, quality, access, and equity. Identify the ethical implications.
Discuss the impact of culture on health status.
S&L talks about the importance of "cultural competence," a concept promoted by Madeline Leininger and others. Another concept promoted by Goldberg and Goldberg (2000) proposes that "maintaining an awareness of one's lack of (cultural) competence" should be our goal rather than the establishment of competence. Given that we live in a culturally pluralistic country and a global society, which approach do you think will help us to most effectively care for and promote the health of individuals and groups from different cultures?

Describe two positive societal implications of enhancing the cultural competence of health care providers and narrowing or eliminating health disparities among racial and ethnic minorities.

General Subject : Understanding Race, Ethnicity and Cultural Diversity in Health and Illness

Culture and Health Disparities Paper

The paper is a reflection of your personal culture (Filipino) on health disparities health related practices, and healthcare outcomes. The paper will follow APA format, 4 pages excluding figures, tables and reference pages.
1. Use the 19 social categories in the Journal of Transcultural Nursing (vol.21) to assist you in defining your social status.
2. Describe and assess your personal culture of origin, and analyze your cultural habits and its effect on health.
3. What are the traditional beliefs and values that are beneficial or not beneficial to generations influenced under the culture; describe the aspects of health care practice and systems related to this culture.
4. Examine health care disparities in this culture in a chosen topic and populations.

Discuss and analyze healthcare in FRANCE, specifically:

1)Country's health disparity issues

2)Country?s health care financing mechanisms (e.g., fee for service, free, supported by taxation)

The topic for my project is Reducing Health Disparities among African American Women (ages 35-50 with metabolic syndrome).

My research project will explore unique intervention that incorporate technology in decision making related to health promotion. I am interested in showing what has been done around shared-decision making with underserved women and what still needs to be done to health reduce health disparities. I would also like to incorporate how to use technology to promote physical activity for this population. The project will focus on women in Montgomery County, Maryland.

Background information must include:

Defining health disparities (briefly) and why they exist in African American women.

Specific data on health disparities in Montgomery County, Maryland (e.g., women affected by diabetes, hypertension, etc. ? physical activity levels, etc.) Also, state-wide national would be helpful.

In depth section on why applying shared-decision making will make a difference in health disparities among African American women.

In depth section on the use of technology to address health disparities.

Conclusion and future research questions.

*All research sited must be on the most current literature in the field.

*Please do not use parenthetical cititations

This paper looks at health disparities among African-american and Latino men compared to that of whites. The first part of the paper should look at the numbers and the reasons behind the disparities. Please also look at the stigma attached to prostate cancer screenings (test) and how they may affect certain populations from obtaining proper preventive care.

The second should look at how a clinical social work can help clients address issues in order to improve treatment and outcomes.

More detail below:

1. A description of prostate cancer and details of Incidence/prevalence data based on ethnicity (african-american, latino, white) for each condition.
2. A description of psychosocial/environmental factors that may contribute to differences in outcomes.
3. A discussion of the impact of socioeconomic status on prostate cancer outcomes.
4. A discussion of issues related to access to care by ethnicity and socioeconomic status.
5. A thorough review of implications for Social Work practice. What can you as new social workers do to intervene to make positive changes in outcomes? Discuss this question from the vantage point of the method you have chosen in SSW (clinical practice with individuals). What do you think you will be able to do to intervene, to improve health outcomes?

I sent this paper in to my teacher , the first part has her instruction, the second part is what I wrote, there are side comments stating what she didn't like. I received a 59%. Everything I have turned into this teacher is completely wrong. I would Like someone to look at her comments, what I wrote, and fix it if possible in a way that might please her.

This part is what she wanted: Identify means of applying social justice for vulnerable populations that eliminate health disparities. (paper)Audience: Policy makers in government or an organization1.Describe your audience. 2.Describe the method of communication.3.Describe the goals of the communication of what you want to accomplish.4.Present the communication in a format that fits the audience- email, letter, letter to the editor of the newspaper or a response to a blog posting, etc.5.Evaluate how you would know if the communication was effective.6.Include documentation to support the action that you are requesting.7.APA format and spelling, grammar, writing scholarly. This part is what I wroteHerbert Humphrey said, ?The moral test of the government is how that government treats those who are in the dawn of their life, the children; those who are in the twilight of life, the elderly; and those who are in the shadow of life the sick, the needy, and the handicapped? (Harkness & DeMarco, 2012, p. 431). How we treat others reflects how much we value life.What is the value of human life? I ask you to take a moment from the comfort of your warm, velvet seats in Congress, inside your secure life, with white, gleaming marble walls and floors, and with rooms filled with refreshing central air. Take a moment from the place where your family has the security of clean water, nutrition, and access to healthcare, far from the life of the impoverished and dying. See my world of injustice and inequity, where a young woman lies dying, with her youngest child lying in her arms. I watch him play with his truck so quietly and softly so his mommy can sleep. She is my patient, as well as her family, because they are all in crisis at this time. I grab the sweet little boy a milk and some crackers because I know he often goes without breakfast. His father, a Guatemalan refugee who speaks little English, tries to hide his despair when I enter the room. Sometimes I see him praying quietly at her side, then I pray silently, asking God to help them.They have no insurance and inadequate knowledge to make informed decisions. Because of her condition, she could no longer speak, and due to the medications, my young mother had developed an odor permeating from her skin. I was told people had difficulty keeping the interpreter to stay long enough to have a needed in-depth conversation with him. As her advocate, I felt it was my duty to make sure her husband was informed because she could no longer speak. I could get angry at this whole situation of cultural barriers, limited knowledge of health conditions, and inadequate access to healthcare. I have seen numerous patients in this same position, one which could have been avoided if there were better prevention and education strategies. Whatever the reasons, many people, mostly the poor, wait until he damage is irreversible. This lack of access to healthcare had worsened her condition, but I knew my frustration would not serve my patient, so I took the young husband out into the hall, to a room where the interpreter and husband could sit, and we talked. I felt my patient was going to fall through the cracks in this system despite my efforts. How could I help this from happening repeatedly? How can this be prevented? How can we, as citizens of humanity, change the structure of healthcare so that it does not forget our impoverished families? In a time where civilization has the ability to care for every human soul, I ask you, what is the value of human life?I am writing to Congress to give you a better understanding of the healthcare system today, in the hope that my words may reach people and open a few doors of thought leading to action. I would like people to understand my plight as a nurse working within the healthcare system, who cares about humanity and the suffering of others.There is a framework design theory that incorporates health and social justice called the ?health capability paradigm.? This theory states ?all people should have access to the means to avoid premature death and preventable morbidity?. (Rugar, 2010, p. 224).This theory ?incorporates the philosophical, economic and political, that all societies (through public?private partnerships) can design and build effective organizations and systems to achieve health capabilities? (Rugar, 2010, p. 224).What is the concept you ask? Health capability ?enables us to understand the conditions that facilitate barriers that impede health and the ability to make health decisions? (Rugar, 2010, p. 2). Rugar analyzes these fundamental "why" problems: Why is it so difficult for some populations or individuals to translate health resources into health outcomes? Why have health literacy efforts been only moderately successful? Why do some individuals have such difficulty adhering to specific treatment regimens? Why are some individuals harmed or helped by cultural norms about health behaviors? (Rugar, 2010, p. 1).Health capability measures how well people can act as agents of their own health by assessing their abilities, skills, habits, and beliefs. ?It does not just measure individual health; it also factors in situations and conditions that determine a person?s health? (Rugar, 2010).Have you ever wondered what a person could become, given the most ideal environment? I have wondered what would become of this quiet little boy who gave his mommy silent wet kisses and played with his truck if he were given the knowledge and resources to make healthy choices for himself. He might even become a doctor because he remembered the care his mother received. Alternatively, would he be forgotten and die at a very young age from conditions beyond his control?How healthy a person is encompasses his or her personal beliefs, values, and health related goals as well as the ability to recognize damaging behaviors and the external factors that form the framework of a person.There are also internal factors at work within a person; for example, health conditions like HIV or diabetes, along with how the person states they feel and their emotional and mental wellbeing. A person?s general information about health, diet, preventative care, and disease processes, as well as their knowledge base on where to receive information about their disease processes or modes of transmission all affect wellbeing. A child that is growing up with intolerance, poverty, and hunger can develop unhealthy views. This model can help develop strategies that may foster socioeconomic policies that will focus on prevention and motivation to improve health and break through barriers.To be most effective, it should begin when a child is very young. The focus should be on maternal and child health, clean drinking water and nutrition, and continuing education through life (Fukuda, 2001).What would the world look like if we saw every person as a true brother and sister? What would the world look like if we loved thy neighbor as thyself? Mark 12:31 (King James Version). One day, global citizenship that incorporates justice and fairness will be formed, eliminating poverty and equity.People need the ability to choose a healthy lifestyle, as well as information about why it is important in ways they can understand. All people deserve to have a healthy lifestyle and access to healthy foods and safe drinking water. A person cannot make healthy choices when they are physically, mentally, and spiritually malnourished.I believe I will see that little boy again someday, this time as a man, and I believe that, in some way, we had helped him where we could not help his mother. He will be walking down the hallway with a stethoscope, remembering the excellent care his mother was given, and in turn, he will give back to the next patient he sees, with a little boy lying on his mother?s lap, giving her little wet kisses.?ReferencesFukuda, S. P. (2001). The human development paradigm: Operationalizing Sen?s ideas on capabilities. Feminist economics, 9(2?3), 301-317. Abstract retrieved from http://www.ibero.edu.mx/humanismocristiano/seminario_capability/pdf/11.pdfHarkness, G. A., & Demarco, R. F. (2012). Community and public health nursing evidence for practice. Philadelphia, PA: Lippincott Williams & Wilkins.Rugar, J. P. (2010). WHO

Vulnerable Population in the Workplace Project

The goal of your project is to identify barriers in the workplace to understanding vulnerable populations and affecting the disparity in promoting health care delivery. This project presents the opportunity to take course concepts and knowledge to your workplace to affect change and create new awareness to the realities of health disparities and barriers to health care that challenge wellness interventions.

Identify a barrier to decreasing a health disparity in a vulnerable population.

Evaluate your workplace for the presence of barriers in understanding vulnerability.

Use the action plan approved by your facilitator to complete this project.

Develop your action plan with the objective of increasing awareness of vulnerability based on culture, illness or disease, or a goal of Healthy People 2020.

Design the materials for your action plan for your workplace. You can teach a class, create a poster for display in your unit, design a brochure for staff, or use another creative approach. Include the following elements:

? An audio or visual aid as a tool to your action plan
? Three integrated course concepts
? Other applicable materials such as the teaching aid, digital photos, a copy of the brochure, and an outline of the teaching plan, as appropriate

Write a 700- to 1,500-word report describing experience in the workplace. Describe the concepts that were the project?s focus, results, and possibilities for future change.

Include citations for at least four references

Format your paper consistent with APA guidelines.

1.Identify the specific goal you have chosen, describe it in detail, and discuss why you chose to focus on this goal and how it related to population health, both locally and globally.
2.What strategies have been identified to address this goal, and what progress has been made? (General Overview)
3.How do some of the "Indices of Health Disparities" listed on page 11 of your text relate to the MDG you have chosen?
4.Give an example of a key index or indices relevant to the assessment of progress towards meetings this goal.
5.How does the goal you have chosen relate to the "predictions of global health pattens" and the "predictions of the leading causes of diseases or injury worldwide" as discussed on page 9-10 of your text?

**REMEMBER** using APA format. Provide the full reference for each citation that you use at the end of your posting. Demonstrate critical thinking, application of textbook readings, and integration of relevant module content whenever possible. No plagerism.






?Center for Disease Control and Prevention (CDC) (n.d). Principles of epidemiology in public health practice (3rd ed.). Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services.

Note: Review Lesson 1, p 1-93 to review basic concepts of epidemiology. Check the downloads I sent you for this document.




http://books.nap.edu/openbook.php?record_id=12758&page=1
Click on the title link above to navigate to the website to review the following article:
?Institute of Medicine (2010) Infectious Disease Movement in a Borderless World: Workshop Summary, Washington, DC: National Academies of Health Press

Electronic Health Records
Electronic health records (EHRs) are at the center stage of the effort to improve health care quality and control costs. In addition to allowing medical practitioners to access and record clinical documentation at much faster rates, EHRs are also positively influencing care delivery and nurse-patient interaction. Yet despite the potential benefits of EHRs, their implementation can be a formidable task that has broad-reaching implications for an entire health care organization.
In this Discussion, you appraise strategies for obtaining the benefits and overcoming the challenges of implementing and using electronic health records.
To Prepare:
Review the Learning Resources focusing on the implementation of EHRs in an organization. Reflect on the various approaches used.
If applicable, consider your own experiences with implementing EHRs. What were some positive aspects of the implementation? What suggestions would you make to improve the process?
Reflect on the reactions of others during the implementation process. Were concerns handled effectively?
If you have not had any experiences with an EHR implementation, talk to someone who has and get his or her feedback on the experience.
Search the Walden Library for examples of effective and poor implementation of EHRs.
Post on or before Day 3 an overview of at least three challenges in the implementation of electronic health records and provide an example of each challenge. Develop strategies for addressing each challenge based on what has been demonstrated to be successful. Cite your resources.


KEY WORDS: chronic diseases; meaningful use; health care policy; health information technology.?J Gen Intern Med 25(3):174??"6?DOI: 10.1007/s11606-010-1252-x
Society of General Internal Medicine 2010
T he U.S. is making a historic investment in federal support for health information technology, which will likely ap- proach $50 billion.1 Most of this investment will go out in the form of incentives to providers who adopt electronic health records (EHRs) both outside the hospital and inside it. The rationale for this policy change is the belief that EHR use will
reduce the costs of care, and improve quality and safety. While there is widespread belief this will occur, the evidence with respect to the impact of EHRs on costs and quality has been mixed.2 Much of the trial data come from home-grown electronic records. Models show that in these settings costs can be reduced substantially with EHRs across a range of assumptions,3 but real-world results are less certain especially with vendor-developed records. Regarding quality, while there is clear evidence that in specific circumstances EHRs do improve performance for some domains such as preventive care and use of medications when decision support is deliv- ered,4 the evidence is much more mixed for other domains, and many commercial applications include relatively little if any decision support. Cross-sectional studies that have asked whether or not EHR use has been associated with improved quality performance in the ambulatory setting have mostly found that it does not??"in one study, Linder found no systematic association between EHR use and better quality performance.5 In another, Zhou asked whether length of EHR use was associated with better performance on quality mea- sures, and again found that it was not.6 A more hopeful result came from Friedberg et al. who found that frequently used multifunctional EHRs were associated with better performance on 5 of 13 HEDIS measures in Massachusetts.7 The key themes are that for care to improve, the electronic record
needs to be reasonably robust, and it has to be used well.?If the costs of care are to be addressed, it will be absolutely essential to address the care of patients with chronic diseases, who account for approximately three quarters of all healthcare expenditures.8,9 However, it has been a challenge to use EHRs to improve care for this group. Most work has focused on the impact of clinical decision support and registries to improve
Published online February 2, 2010
care for these groups, and while there have been some modest successes for example for diabetes and coronary disease,10 the results have been decidedly mixed overall.4 In patients with chronic conditions, care coordination is especially pivotal, because it can reduce readmissions, and ensure that needed follow-up occurs.
The main care redesign approach??"which is potentially transformative and is justifiably getting a lot of attention??"is the patient-centered medical home. Although this concept was developed many years ago,11 it has not been widely implemen- ted, largely because of the way we pay for care in this country. To improve quality, all practices need good care coordination, regardless of whether or not they are medical homes.
In this issue of JGIM, OMalley et al. present arguably the most comprehensive assessment to date of the ability of the current iteration of vendor-developed EHRs to assist providers with care coordination.12 To do their assessment, the research- ers used qualitative techniques, and performed 60 interviews in a national sample of practices using 17 different commercial EHRs.
They identified six key themes: 1) that EHRs needed to help with in-office communications??"which they generally did adequately; 2) that they also needed to help with communi- cation between clinicians and settings which was much less satisfactory; 3) that clinicians found information overflow a challenge; 4) that current records dont support care coordi- nation planning; 5) that care coordination processes need to evolve; and 6) not surprisingly, that fee-for-service pay- ment encourages billable event documentation, but not care coordination.
These issues have different solutions. The problem of between-clinician and between settings communication is being addressed by the development of clinical data exchanges between entities, and this is squarely within the sights of policy-makers.13 Even when such exchanges are developed, however, considerable challenges remain, for example how to make it easy for a provider to see immediately that a key piece of information like a cardiac catheterization from another site is present, or even more important that a result available from a discharge elsewhere needs early follow-up.
The problem of information overflow represents a fundamen- tal informatics problem, and will require some redesign of current clinical systems.14 It should be possible to strain out much of the extraneous information, while highlighting the few items that are truly need to be addressed soon.
However, the themes around the observation that current EHRs do not support care coordination well, and that the
JGIM


EDITORIALS
Getting in Step: Electronic Health Records and their Role in Care Coordination
David W. Bates, MD, MSc1,2,3
1Division of General Internal Medicine and Center of Excellence for Patient Safety Research and Practice Brigham and Womens Hospital, Boston, MA, USA; 2 Harvard Medical School, Boston, MA, USA; 3Department of Health Policy and Management Harvard School of Public Health, Boston, MA, USA.



174
JGIM Bates: Electronic Health Records and their Role in Care Coordination 175

overall process needs to be redesigned represent the central and most important part of the results, with the most profound implications. No EHR in this study could claim exemplary performance in this area, and there will be a tight linkage between performing good care coordination, imple- menting the patient-centered medical home, and actually delivering the results with respect to improvement that everyone wants to see. To move to team care, which is a central feature of the medical home, will require tools that enable the various members of the team to document progress for patients, agree on goals, and stay on the same page with respect to progress and who is responsible for specific items. Many have made the assumption that this documentation needs to be in the notes of the record, but this doesnt have to e the case. Another approach would be to place much of this information in a new location in the record. Regardless, it will need to be linked with clinical decision support and registry functions that make it easier for care coordinators and providers alike to readily track patients.
But as OMalley et al. found, these tools simply do not exist today in most EHRs, which means they will need to be developed. Even the underlying processes in practices in these areas are likely to evolve substantially in the coming years. This should be a key area of attention for SGIM members in the next several years, since it is especially important that this work well in primary care.
This work also illustrates the enormous value of qualitative research in evaluating healthcare information technology. In- creasingly, mixed-model approaches should be used in informat- ics, even when the main outcomes are quantitative, because they can help elucidate what did and did not work. When addressing an area like this one which has received little previous attention, qualitative approaches are especially useful.
These findings have a number of implications. Todays commercially available EHRs do not come close to meeting provider needs with respect to care coordination, even though this is one of the most important domains for managing patients with chronic diseases. But practices themselves do not have well-developed processes for this area so this does not represent functionality the vendors can simply add on. This implies that it is too early from the policy perspective to require tools such as this for certification of records, except at a very basic level. Instead the key approach in the near term should be to support research to develop and refine the needed tools.
In addition, there are some issues that can be readily addressed by vendors in the near term. For example, vendors should be representing data in standard ways to enable data exchange among users of different systems, and developing interfaces and tools that help address the data overload issue. A simple example of this latter issue is a tool that takes all the test results for a provider, puts them in a queue, and prioritizes them according to how abnormal they are.15 Some vendor applications do include tools like this today, but most do not. The current policy agenda in these areas should result in improvement.
The meaningful use definitions being developed should take the findings of this study into account, as should the Office of the National Coordinator. The current proposed meaningful use definitions around care coordination would require outpatient providers to participate in clinical data exchange and perform medication reconciliation at relevant encounters by 2011, and require providers to be able to
receive electronic prescription fill data by 2013, while in 2015 providers would be asked to demonstrate a 10% decrease in the 30-day readmission rate and improvement on NQF-endorsed measures of care coordination. These criteria say nothing about care coordination within practices where most of it will take place, and thus it is not at all clear that meeting the 2011 and 2013 criteria will be sufficient to put practices in the position to be successful in 2015. The 2015 criteria appear to be relatively distant goalposts, and lots will need to change in the practices themselves and the EHRs they use if the 2015 criteria are to be met. While it may be reasonable for the criteria to be ends not means, there is a great deal to be done to address the issues of how to better coordinate care within practices. The Office of the National Coordinator and the Agency for Healthcare Re- search and Quality should begin supporting research in these areas immediately.
Ultimately, for improving care coordination to rise to the top of the list, payment reform will be essential. In the short run, this appears likely to take the form of accountable care organizations and bundling, which would be helpful with respect to aligning incentives, although more fundamental payment reform will likely eventually be necessary.
The current work by OMalley et al. represents some of the best to date on how EHRs support care coordination, which again is a crucial function. Moving ahead will require more research in this area, as todays processes are immature and all of this will need to be interfaced with the medical home concept. Improving this could hardly be more important, as the patients who get the most benefit from care coordination account for a huge proportion of the costs in our healthcare system.
Acknowledgements: I thank Jennifer Love for her assistance with the preparation of this manuscript.
Corresponding Author: David W. Bates, MD, MSc; Division of General Internal Medicine and Center of Excellence for Patient Safety Research and Practice Brigham and Womens Hospital, Brigham Circle, 1620 Tremont St., 3rd Floor, Boston, MA 02120- 1613, USA (e-mail: [email protected]).
REFERENCES
1. American Recovery and Reinvestment Act of 2009; 2009.?2. Chaudhry B, Wang J, Wu S, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care.
Ann Intern Med. 2006;144(10):742??"52.?3. Wang SJ, Middleton B, Prosser LA, et al. A cost-benefit analysis of
electronic medical records in primary care. Am J Med. 2003;114(5):397??"
403.?4. Garg AX, Adhikari NK, McDonald H, et al. Effects of computerized
clinical decision support systems on practitioner performance and
patient outcomes: a systematic review. JAMA. 2005;293(10):1223??"38. 5. Linder JA, Ma J, Bates DW, Middleton B, Stafford RS. Electronic health record use and the quality of ambulatory care in the United
States. Arch Intern Med. 2007;167(13):1400??"5.?6. Zhou L, Soran CS, Jenter CA, et al. The relationship between electronic
health record use and quality of care over time. J Am Med Inform Assoc.
2009;16(4):457??"64.?7. Friedberg MW, Coltin KL, Safran DG, Dresser M, Zaslavsky AM,
Schneider EC. Associations between structural capabilities of primary care practices and performance on selected quality measures. Ann Intern Med. 2009;151(7):456??"63.


176 Bates: Electronic Health Records and their Role in Care Coordination JGIM

8. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288(14):1775??"9.
9. Hoffman C, Rice D, Sung HY. Persons with chronic conditions. Their prevalence and costs. JAMA. 1996;276(18):1473??"9.
10. Sequist TD, Gandhi TK, Karson AS, et al. A randomized trial of electronic clinical reminders to improve quality of care for diabetes and coronary artery disease. J Am Med Inform Assoc. 2005;12(4): 431??"7.
11. Homer CJ, Klatka K, Romm D, et al. A review of the evidence for the medical home for children with special health care needs. Pediatrics. 2008;122(4):e922??"37.
12. OMalley AS, Grossman JM, Cohen GR, Kemper NM, Pham HH. Are electronic medical records helpful for care coordination? Experiences of physician practices. J Gen Intern Med. XXXXXX 2010.
13. Adler-Milstein J, Bates DW, Jha AK. U.S. Regional health information organizations: progress and challenges. Health Aff (Millwood). 2009;28 (2):483??"92.
14. Sittig DF, Wright A, Osheroff JA, et al. Grand challenges in clinical decision support. J Biomed Inform. 2008;41(2):387??"92.
15. Poon EG, Wang SJ, Gandhi TK, Bates DW, Kuperman GJ. Design and implementation of a comprehensive outpatient results manager. J Biomed Inform. 2003;36(1??"2):80??"91.
Copyright of JGIM: Journal of General Internal Medicine is the property of Springer Science & Business Media B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.




Nursing Informatics
Judy Murphy
The Journey to Meaningful Use of Electronic Health Records







EXECUTIVE SUMMARY


The American Recovery and Reinvestment Act and its important Health Information Technology Act provision becme law on February 17, 2009.
Commonly referred to as The Stimulus Bill or The Recovery Act, the landmark legislation allocated $787 billion to stimulate the economy, including $147 billion to rescue and reform the nations seriously ailing health care industry.
Of these funds, $19 billion in financial incentives were earmarked for the relatively short period of 5 years to drive reform through the use of advanced health infor- mation technology (HIT) and the adoption of electronic health records (EHRs).
The incentives were intended to help health care providers purchase and implement HIT and EHR sys- tems, and the HITECH Act also stipulated clear penal- ties would be imposed beyond 2015 for both hospitals and physician providers who failed to adopt use of EHRs in a meaningful way.
Nurses will be integral to achieving a vision that will require a nationwide effort to adopt and implement EHR systems in a meaningful way.







Judy Murphy
IN 2004, THOSE OF US IN nurs- ing informatics or who fol- low health information tech- nology (HIT) trends were thrilled when President George W. Bush said in his 2004 State of the Union address ...an Electronic Health Record for every American by the year 2014...by computerizing health records, we can avoid dangerous medical mistakes, reduce costs,
and improve care (Bush, 2004). This was the first time a president formally recognized the value of HIT and set a deadline to do something about it! President Bush went on to establish the Office of the National
Coordinator for HIT (ONC), and Dr. David Brailer was appointed as the first coordinator by Tommy Thompson, then Secretary of the Department of Health and Human Services (HHS).
The support continued. In 2005, funding from HHS was earmarked to establish organizations for standards harmonization (HIT Standards Panel) and for certification of electronic health record (EHR) sys- tems (Certification Commission for HIT). In 2006, the Agency for Healthcare Research and Quality (AHRQ) launched its National Resource Center for HIT. Government attention persisted in 2007 with the funding of National Health Information Network pro- totypes. Momentum was building and there was much attention on HIT from the federal government.
Fast forward to 2009. President-Elect Barack Obama says he wants the federal government to invest in EHRs so all medical records are digitized within 5 years and vows to continue to push for the 2014 deadline established by Bush. This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests, he said, adding that the switch also will save lives by reducing the num- ber of errors in medicine (Obama, 2009).
President Obama then does more than talk about HIT. He works with Congress to pass the American Recovery and Reinvestment Act (ARRA), providing unprecedented funding to promote health care reform through the use of HIT. Incentives totaling $19 billion are allocated for meaningful use of EHRs in hospi- tals and ambulatory settings beginning in 2011. This sets the stage for todays focus on the use of HIT, and the proliferation of EHR implementation projects in our clinical settings. Lets explore the legislative back- ground and details surrounding the federal incen- tives.
Legislative Background
On March 23, 2010, President Obama signed into law the landmark Patient Protection and Affordable Care Act (PPACA), a federal statute that represents the most recent legislation in a sweeping health care reform agenda driven into law by the Democratic 111th Congress and the Obama Administration. The new law is dedicated to replacing a broken system with one that ensures all Americans have access to health care that is both affordable and driven by qual- ity standards. It includes broad provisions for improv- ing health care delivery that will take affect from the moment of enactment through 2018.
For the Obama Administration, the hard-fought legislative success of PPACA turns the spotlight on


JUDY MURPHY, RN, FACMI, FHIMSS, is Vice President, Information Services, Aurora Health Care in Milwaukee, WI; a HIMSS Board Member; and a member of the federal HIT Standards Committee. Comments and suggestions can be sent to [email protected]
NOTE: Hear Judy speak on The Economic$ for Meaningful Use of Health Information Technology at the 4th Annual Nurse Faculty/Nurse Executive Summit, December 13-15, 2010, in Scottsdale, AZ. Visit www.nursingeconomics.net for Summit program and registration information.


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the growing recognition advanced HIT is and will be essential to support the massive amounts of electron- ic information exchange foundational to reform. In fact, the universal agreement that meaningful health care reform cannot be separated from the national, and arguably global, integration of HIT based on accepted, standardized, and interoperable methods of data exchange provided the linchpin for other criti- cally important legislation that created the glide path for PPACA.
This consensus resulted in the broad support and passage into law of the ARRA and its key Health Information Technology Act (HITECH) provision in the early weeks of Mr. Obamas presidency in 2009. Backed with an allocation of over $19 billion, this leg- islation authorized the Centers for Medicare and Medicaid Services (CMS) to provide reimbursement incentives for hospitals and eligible providers that take steps to become meaningful users of certified EHR technology to improve care quality and better manage care costs.
At the core of the new reform initiatives, the incentivized adoption of EHRs will improve care quality and better manage care costs, meeting clinical and business needs by capturing, storing, and dis- playing clinical information when and where it is needed to improve individual patient care and to pro- vide aggregated, cross-patient data analysis.
EHRs will manage health care data and informa- tion in ways that are patient centered and information rich. Improved information access and availability will increasingly enable both the provider and the patient to better manage each patients health by using capabilities provided by enhanced clinical decision support and customized education materi- als.
ARRA and its HITECH Act Provision
ARRA and its important HITECH Act provision were passed into law on February 17, 2009. Commonly referred to as The Stimulus Bill or The Recovery Act, the landmark legislation allocated $787 billion to stimulate the economy, including $147 billion to rescue and reform the nations seriously ail- ing health care industry. Of these funds, $19 billion in financial incentives were earmarked for the relatively short period of 5 years to drive reform through the use of advanced HIT and the adoption of EHRs. The incentives were intended to help health care providers purchase and implement HIT and EHR sys- tems, and the HITECH Act also stipulated clear penal- ties would be imposed beyond 2015 for both hospitals and physician providers who failed to adopt use of EHRs in a meaningful way. Here are some of the key components of ARRA (Murphy, 2010) and HITECH (Blumenthal, 2010; HITFHC, 2009a).
Meaningful use. The majority of the HITECH funding will be used to reward hospitals and eligible
providers for meaningful use of certified EHRs by meaningful users with increased Medicare and Medicaid payments (HITFHC, 2009b; Murphy, 2009). Both programs have start dates of fiscal year 2011 (October 1, 2010) for hospitals and calendar year 2011 (January 1, 2011) for eligible providers. On December 31, 2009, the Centers for Medicare and Medicaid Services (CMS), with input from ONC and the HIT Policy and Standards Committees, published a Proposed Rule on Meaningful Use of EHRs and began a 60-day public comment period. After reviewing more than 2,000 comments, HHS issued the final rule on July 13, 2010. The final criteria for meeting mean- ingful use are divided into five initiatives:
1. Improve quality, safety, and efficiency, and reduce health disparities.
2. Engage patiets and families.?3. Improve care coordination.?4. Improve population and public health.?5. Ensure adequate privacy and security protections
for personal health information.?Specific objectives were written to demonstrate
that EHR use has a meaningful impact on one of the five initiatives. Under the final rule, there are 14 core (required) objectives for hospitals and 15 for providers. Both hospitals and providers have 10 other objectives in a menu set from which they must choose and comply with five. If the objectives are met during the specified year and the hospital or provider submits the appropriate measurements, then the hos- pitals or providers will receive the incentive pay- ment. The hospital incentive amount is based on the Medicare and Medicaid patient volumes; the provider incentives are fixed per provider. The incentives are paid over 5 years, and the hospital or provider must submit measurement results annually during each of the years to continue to qualify. The objectives will mature every other year, with new criteria and stan- dards being published in 2011, 2013, and 2015.
Quality measures. One of the meaningful use criteria for both hospitals and providers is the require- ment to report quality measures to either CMS (for Medicare) or to the state (for Medicaid). For providers, the final rule lists 44 measures, with a requirement to comply with six. For hospitals, the rule lists 15 measures, with a requirement to comply with them all.
Because HHS will not be ready to electronically accept quality measure reporting in 2011, the Proposed Rule specifies that hospitals and eligible providers will submit summary information on clini- cal quality measures to CMS through attestation in 2011. HHS expects to be ready to electronically accept quality measure reporting in 2012, so hospitals and providers will be expected to submit their results on the clinical quality measures electronically begin- ning in 2012.


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The quality measurement?is considered one of the most?important components of the?incentive program under?ARRA/HITECH, since the pur-?pose of the HIT incentives is?to promote reform in the?delivery, cost, and quality of?health care in the United?States. Dr. David Blumenthal,?current national coordinator?of HIT, emphasized this point when he said HIT is the means, but not the end. Getting an EHR up and running in health care is not the main objective behind the incentives provided by the federal government under ARRA. Improving health is. Promoting health care reform is (Blumenthal, 2009; Manos, 2009).
Research support. ARRA and HITECH increased funding by more than $1 billion for comparative effectiveness research through AHRQ and the National Institutes of Health (NIH). In addition, NIH designated over $200 million for a new initiative called the NIH Challenge Grants in Health and Science Research. NIH anticipates funding 200 or more grants, each up to $1 million, addressing specif- ic scientific and health research challenges in bio- medical and behavioral research.
In addition, the National Library of Medicine (NLM) offers applied informatics grants to health- related and scientific organizations that wish to opti- mize use of clinical and research information. These grants help organizations exploit the capabilities of HIT to bring usable, useful biomedical knowledge to end users by translating the findings of informatics and information science research into practice through novel or enhanced systems, incorporating them into real-life systems and service settings.
SHARP grants. Alongside the NIH and NLM focus on incentivizing research, ONC also made available $60 million to support the development of Strategic Health IT Advanced Research Projects (SHARP). The SHARP Program funds research focused on achieving breakthrough advances to address well-documented problems that have impeded adoption of HIT and accelerating progress toward achieving nationwide meaningful use of HIT in support of a high-perform- ing, continuously learning health care system.
Beacon communities. Also funded by HITECH, the Beacon Community Program includes $250 mil- lion in grants to build and strengthen the HIT infra- structure and HIT capabilities within 17 communi- ties. These communities will demonstrate the future where hospitals, clinicians, and patients are meaning- ful users of HIT, and together the community achieves measurable improvements in health care quality, safe- ty, efficiency, and population health. The funding was awarded to communities already at the cutting edge of EHR adoption and health information exchange to
push them to a new level of sustainable health care quality and efficiency. The communi- ties are expected to generate lessons learned on how other communities can achieve sim- ilar goals enabled by HIT.
Workforce training. Finally, ARRA funding has also been designated to educate the work- force required to modernize the promoting and expanding the
health care system by?adoption of HIT by 2014. Four grant programs support the training and development of the necessary skilled workforce:? $32 million to establish nine university-based cer-
tificate and advanced degree HIT training pro- grams, including one sponsored by the University of Colorado-Denver School of Nursing.
$360 million to create five regional community college consortia of more than 80 member com- munity colleges in all 50 states to help address the demand for skilled HIT specialists.
$10 million to support HIT education curriculum development.
$6 million to develop an HIT competency exami- nation program.
Nursing Informatics Empowering Meaningful Use
In this massive transformation from disconnect- ed, inefficient, paper-based islands of care delivery to a nationwide, interconnected, and interoperable sys- tem driven by EHRs and advancing HIT innovation, the importance of nurses and nursing informatics will be difficult to overstate. For decades, nurses have proactively contributed resources to the develop- ment, use, and evaluation of information systems. Today, they constitute the largest single group of health care professionals, including experts who serve on national committees and participate in inter- operability initiatives focused on policy, standards and terminology development, standards harmoniza- tion, and EHR adoption. In their front-line roles, nurs- es continue to have a profound impact on the quality and cost of health care and are emerging as leaders in the effective use of HIT to improve the safety, quality, and efficiency of health care services.
Informatics nurses are key contributors to a work- ing knowledge about how evidence-based practices designed in information systems can support and enhance clinical processes and decision making to improve patient safety and outcomes. In addition, as drivers in organizational planning and process re- engineering to improve the health care delivery sys- tem, informatics nurses are increasingly sought out by nurses and nurse managers for leadership as their profession works to bring IT applications into the mainstream health care environment.


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evidence-based practices designed in information systems can support and enhance clinical processes and decision making to improve patient safety and outcomes.

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Therefore, it will be increasingly essential to the success of todays health care reform movement that informatics nurses are involved in every aspect of selecting, designing, testing, implementing, and developing health information systems. Further, the growing adoption of EHRs must incorporate nursings unique body of knowledge with the nursing process at its core.
The Future
Many nursing and health care leaders agree that the future of nursing depends on a profession that will continue to innovate using HIT and informatics to play an instrumental role in patient safety, change management, and quality improvement, as evidenced b quality outcomes, enhanced workflow, and user acceptance. In an environment where the roles of all health care providers are diversifying, nurses will guide the profession from their positions as HIT proj- ect managers, consultants, educators, researchers, product developers, decision support and outcomes managers, chief clinical information officers, chief information officers, advocates, policy developers, entrepreneurs, and business owners. To achieve our nations health care reform goals, health care leaders must leverage the patient care technologies and infor- mation management competencies that informatics nurses provide to insure their investment in HIT and EHRs is implemented properly and effectively over coming years.
In fact, in its October 2009 recommendations to the Robert Wood Johnson Foundation on the future of nursing, the Alliance for Nursing Informatics (ANI) argued nurses will be integral to achieving a vision that will require a nationwide effort to adopt and implement EHR systems in a meaningful way. This is an incredible opportunity to build upon our under- standing of effectiveness research, evidence-based practice, innovation and technology to optimize patient care and health outcomes. The future of nurs- ing will rely on this transformation, as well as on the important role of nurses in enabling this digital revo- lution (ANI, 2009, p. 9).
For no professional group does the future hold more excitement and promise from so many perspec- tives than it does for nursing. $
REFERENCES
Alliance for Nursing Informatics (ANI). (2009). Statement to the Robert Wood Johnson Foundation Initiative Future of Nursing: Acute care, focusing on the area of technology. Retrieved from http://www.himss.org/handouts/ANI ResponsetoRWJ_IOMonTheFutureofNursing.pdf?src=winew s20091014
Blumenthal, D. (2009). National HIPAA Summit in Washington, DC. Retrieved from http://www.healthcareitnews.com/news/ healthcare-it-means-not-end-says-blumenthal
Blumenthal, D. (2010). Launching HITECH. New England Journal of Medicine, 362(5), 382-385.
Bush, G.W. (2004). State of the Union Address. (2004, January 20). Retrieved from http://whitehouse.georgebush.org/news/ 2004/012004-SOTU.asp
Health Information Technology for the Future of Health and Care (HITFHC). (2009a). HITECH programs. Retrieved from http://healthit.hhs.gov/portal/server.pt?open=512&objID=14 87&parentname=CommunityPage&parentid=1&mode=2&in_ hi_userid=10741&cached=true
Health Information Technology for the Future of Health and Care (HITFHC). (2009b). Meaningful use. Retrieved from http://healthit.hhs.gov/portal/server.pt?open=512&objID= 1325&mode=2
Obama, B. (2009). President-elect speaks on the need for urgent action on an American Recovery and Reinvestment Plan. Speech at George Mason University in Fairfax, Virginia, January 8, 2009. Retrieved from http://change.gov/news- room/entry/presidentelect_obama_speaks_on_the_need_for_ urgent_action_on_an_american_r
Manos, D. (2009). Healthcare IT is the means, but not the end, says Blumenthal. Healthcare IT News. Retrieved from http://www.healthcareitnews.com/news/healthcare-it- means-not-end-says-blumenthal
Murphy, J. (2010). This is our time: How ARRA changed the face of health IT. Journal of Healthcare Information Management, 24(1), 8-9.
Murphy, J. (2009). Meaningful use for nursing: Six themes regard- ing the definition for meaningful use. Journal of Healthcare Information Management, 23(4), 9-11.


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HITECH Legislation
In order for organizations to receive the incentives offered through the HITECH legislation, they must be able to demonstrate that they are using the technology in meaningful ways. The following criteria for meaningful use must be evident to qualify for EHR incentives (U.S. Department of Health & Human Services, 2012). The technology must:
Improve quality, safety, and efficiency, and reduce health disparities
Engage patients and families
Improve care coordination
Improve population and public health
Ensure adequate privacy and security protections for personal health information
For this Discussion you consider the impact of the meaningful use criteria of the HITECH legislation on the adoption of health information technology.
To prepare:
Review the Learning Resources on the HITECH legislation and its primary goals.
Reflect on the positive and negative impact this legislation has had on your organization or one with which you are familiar.
Consider the incentives to encourage the use of EHRs. Focus on the definition of meaningful use and how it is measured.
Reflect on how the incentives and meaningful use impact the quality of patient car

This is a GRANT PROPOSAL TERM PAPER on Public Health issues. I do not have a specific topic, but I am looking at something related to minority health or health disparity. I will be sending you a word document consists of the components of the proposal. I will also include a list of some grant supporters, I hope that would be helpful.
The organization that I will be representing is Saint Anselm's Cross Cultural Community Center (please refer to the word document for the website). You will need this for the organziation information part of the proposal.
There are faxes for this order.

Design a program or strategy to reduce morbidity and mortality for that focus area for Baltimore, a Maryland County of the state of Maryland that addresses the key content areas of the course. Structure your paper as follows:
Abstract: Summary of the paper

Part 1
Discuss the epidemiological basis for the program you are designing. Include demographic data on the National, State and Local level if appropriate. Address cultural diversity, health disparities and develop a social justice platform for your program.

Part 2
Identify how you, in a leadership position, would plan, organize, finance, regulate and assure quality in the program. Using the policy process and political strategies, indicate how you would work with existing public policies or advocate for new policies and deal with stakeholder opposition, to assure the success of the program.


I would like to provide you with some guidelines for your upcoming paper. You need to have at your disposal the 6th edition of the APA manual. This is required and is the only format that the School of Nursing accepts for your papers and any other formal writing

1. Please include a cover sheet that is to conform exactly to the sample cover sheet provided in the 6th Edition of the APA manual (pgs. 23-24; 41).

2. The paper must have the proper page numbers, section names (i.e. References instead of Bibliography), and page headers, and running head, as provided in the sample cover sheet and manuscript provided in the 5th Edition of the APA manual (pg. 41-53).

3. Please consult your APA 6th edition book to format your citations and references

- Use correct APA spacing among and between references
- References must begin on a separate page behind your paper
- References use italics in certain areas, so you must review this in your APA Manual

4. Please do not use contractions- such as dont and shouldnt -- write the words out (do not, should not, etc).

5. Please do not use slang- this is a professional paper. Do not write as you speak, but write in a professional manner.

6. Length of paper is 10 pages, excluding cover sheet and references. Points will be deducted for additional pages. You are to use 12 point font, Times New Roman, with 1 inch margins on the top, bottom, left, and right margins. Please check your default settings as the default is normally 1.25 margins, and this is incorrect. The paper is to be double spaced as you type (i.e. do not write the paper single spaced and then change the format to double spaced).

7. Organize your paper following the requirements listed under Assignments in your course on Blackboard. Please use the bolded headings below in your paper and your information will fall under these categories.

Sections should be:

Abstract- Summary of your paper (Place on its own page)

Introduction (introduce the reader to the topic)

Epidemiological Basis (for program you are designing)

Cultural Diversity (how your program will address different cultures)

Health Disparities (what the problems and issues are of people being asked to participate in your program and how can they be addressed)

Social Justice (how you will handle social justice issues in your program)

Plan and Organization of Plan (Describe your plan in detail using a list or bullet format, but in a very specific and detailed manner. This section is your main focus of the paper. Do not copy another programs you have found in the literature. You may adapt it but you need to make it unique to your population.)

Plan finances (how you are going to finance the plan- be specific) Do not assume that money can be taken from other plans to make your plan work. Also, legislating more money is difficult and many times impossible. How can you make this work with little or no money to support the program? What in-kind donations can you solicit, in-kind services, and in-kind help? Need to think about using volunteers as much as possible in this economy.

Regulations (how you will work with existing public polices or advocate for new policies)

Stakeholder Information (who might be your supporters and who may not)
Stakeholders and partnerships are essential to any plan in health care especially in the community.

Quality Assurance of Plan (How will you assure quality and also evaluate your plan?)

Conclusion (Summary of paper)

References in APA 6th edition format. References begin on a new page. Please make sure they are all APA format as points will be deducted for improper use of APA.

8. Grammar, Sentence Structure, and Spelling will all be graded. No name on the paper is an automatic 5 point deduction.

9. You must have a minimum of 8-10 scholarly references. This means articles from nursing and/or professional journals that are peer reviewed within the past five years (since 2005), unless they are a classic article and are the basis for what you are doing. Current websites can be used, but the website must be reputable (i.e. government, association, public health, professional organization, or university websites). Wikipedia is not to be used or cited. Please refer to the APA manual (starting on pg. 187) for information on Electronic Media and how to reference any online information.


There are faxes for this order.

Dear Researcher
Prepare a community assessment.
Address at least the following six topics in the paper (APA):
1. Describe the community
2. Describe the characteristics of the people who live in the community.
3. Describe any health disparities and any strategies that are being implemented to address them.
4. State the major sources of income and the ranges of average income.
5. Describe occupational safety and other health risks.
6. Describe the communities health care system.
Discuss the concept of availability, accessibility, affordability, appropriateness and acceptability of health services.

The quality of participation will be graded by the use of at least two in-text citations on each original posting (with references at the end of your posting), the frequency and quality of blog postings (both original and peer responses), the application of course content and concepts to current events reflecting global health issues, and by demonstrating the use of the textbook content in the student?s postings. The use of at least one in-text citation is highly recommended in peer responses as well.The use of current media events and other grey literature is acceptable in the blog.

The purpose of the blog is to explore how the human experience of the physical environment across diverse geographic locations shapes the health of individuals and populations. Students will explore how individuals and community level responses to the physical environment become embedded in biopyschosocial structures in populations. The topic focus or the Blog is to explore how the place experience "inhabits" (Sundstrom, 2003) and influences the health of communities and populations.
Explore the following main themes and create a Blog for each one, no plargerism, and sources no older then 5 years.
1. How individual and community social behaviors and responses to the physical environment alter, disrupt, impair and/or damage the ability of human physiology to fight infectious diseases. The following concepts will be explored: drug resistant microorganisms, herd immunity, and re-emergence of vaccine preventable diseases, genetic susceptibility of some populations.
2. How the practice decisions of health care providers, health educators, health organizations, policy nation and globally. Consider the leadership and management roles of nurses in recognizing the global health implications of patient education, screening and care delivery management.

3. The global health implications of the dramatic movement of people, goods and ideas related to increased access to a means of travel and the technologic explosion of the Internet.
Causes and contributors to the numerous global health disparities, predictions of global health patterns, predictions of the leading causes of diseases or injury worldwide, and the relationship of these to the Millennium Development Goals (MDGs).