Strategic Planning, Mintzberg

Strategic Planning, Mintzberg Roll of strategic planning and implementation Introduction According to Mintzberg et al (2003, p.10) ‘A strategy is the pattern or plan that integrates an organisations major goals, policies, and action sequences into a cohesive whole. A well formulated strategy helps to marshal and allocate an organisations resources into a unique and viable posture based on its relative internal competencies and shortcomings, anticipated changes in the environment, and contingent moves by intelligent opponents. Likewise Haberburg and Rieple (2008, p.6) defined strategy as ‘ a strategy is the set of actions through which an organisation , by accident or design, develops resources and uses them to deliver services or products in a way which its users find valuable, while meeting the financial and other objectives and constraints imposed by key stakeholders. In contrast White (2004, p.5) defined strategy as ‘a coordinated series of actions which involve the deployment of resources to which one has access for the achievement of a given purpose. Furthermore strategy ‘is a process of translating perceived opportunity into successful outcomes, by means of purposive action sustained over a significant period of time. Lynch (2000, p.8) defined corporate strategy as ‘ it is the pattern of major objectives, purposes or goals and essential policies or plans for achieving those goals, stated in such a way as to define what business the company is in or is to be in and the kind of company it is or is to be. Morden (2007, p.14) revealed, Strategic Management is concerned with the character and direction of the enterprise as a whole. It is concerned with basic decisions about what the enterprise is now, and what it is to be in the future. It determines the purpose of the enterprise. It provide the framework for decisions about people, leadership, customers or clients , risk, finance, resources, products, systems, technologies, location, competition, and time. It determines what enterprise should be capable of achieving, and what it will not choose to do. It will determine whether and how the organisation will add value, and what form that added value should take. Strategic management is also concerned with management planning and decision making for the decision making for the medium and long-term future. It is considered with the anticipation of that future and with the establishment of a vision or view of how the enterprise should develop into the future that it must face. Strategic Planning According to Marios I.Katsioloudes (2006) â€Å"Strategic planning is the process by which a system maintains its competitiveness within its work environment by determining where the organization is, where it wants to go, and how it wishes to get there. In other words, strategic planning involves examining what strategies will enable to corporation or association to prosper in future† Strategic planning is a process where you determine the strengths and weakness of your business. You also can set your companys goals, objective and mission statement during this process. We can say this that strategic planning is a management tool for organizing. Its also lead an organizing from where is now to future. A good definition is strategic planning is â€Å"the process of determining a companys long-term goals and than indentifying the best approach for achieving those goals.† Without a strategic planning an organization will never know where it going. Importance Strategic planning is a very important for an organization. And its help to achieve An organizations goals and its also helps to provide direction and focus for all employees. It points to specific results that are to be achieved and establishes a course of action for achieving them. A strategic plan also helps the various work units within an organization to align themselves with common goals. Strategic planning Process In the earlier 1970s, various large firms adopted an official top-down strategic planning model. With this model, strategic planning became a planned process in which top executives from time to time would prepare the firms strategy, and then communicate it down the organization for implementation. The following strategic planning process model discuses below. Mission | V Objectives | V Situation Analysis | V Strategy Formulation | V Implementation | V Control This process is most appropriate for strategic management at the business unit level in organization. For large corporations, strategy at the corporate level is more concerned with managing a selection of businesses. In the process outlined here, company or firm will be used to signify a single-business firm or a single business unit of a diversified firm. Mission A mission is important key factor of any organization. The mission often expressed in the form of a mission statement of any organization, which conveys a sense of purpose to employees and projects a company image to customers. In the strategy formulation process, the mission statement sets the mood of where the company should go. Objectives Objectives are actual goals that the organization will achieve, for example, an earnings growth target. The objectives should be challenging but achievable. They also should be considerable so that the company can monitor its progress and make corrections as needed. Situation Analysis Once the firm has specified its objectives, it starts with its current situation to set up a strategic plan to fulfil those objectives. Changes in the external environment and make new opportunities and new ways to achieve their objectives. An environmental scan is performing to find out the available opportunities. The situation analysis therefore involves an analysis of both the external and internal environment. The external environment has two dimensions: the macro-environment affects all firms and a micro-environment that affects only the firms in a particular industry. The macro-environmental analysis includes political, economic, social, and technological factors and sometimes is called PEST analysis. An important part of the micro-environmental analysis is the industry in which the firm operates or is considering operating. Michael Porter devised a five forces framework that is useful for industry analysis. We also can use SWOT Model to Analysis Companys internal and external situation. Strength and weakness use for internal analysis and opportunity and threats use for external analysis of any organisations as show in the diagram below. Strategy Formulation Once we get a clear image of the organization and its environment in hands, exact strategic alternatives can be applied. Infect different firms has different alternatives depending on their situation, there also exist generic strategies that can be applied across a wide range of firms. Control Once we applied the strategy, the results of the strategy need to be calculated and evaluated, with changes need to be required to keep the idea on path. Strategy implementation De Wit and Meyer (2005, p.278) revealed, the implementation of the strategy comprises a series of sub activities that are primarily administrative. If purpose is determined then the resources of a company can be mobilized to accomplish it. An organisational structure appropriate for the efficient performance of the required tasks must be made effective by information systems and relationships permitting coordination of subdivided activities. Furthermore the role of personal leadership is important and sometimes decisive in the accomplishment of strategy. Although we know that organisational structure and processes of compensation, incentives, control and management development influence and constraint the formulation of strategy, we should look first at the logical proposition that structure should follow strategy on order to cope later with the organisational reality that strategy also follows structure. When we have examined both tendencies, we will understand and to some extent be prepared to deal with the interdependence of the formulation and implementation of corporate purpose. According to Henry (2008, p.10) ‘effective implementations of strategies require the organisation to be sufficiently flexible in its organisational culture and design. Strategies need to be communicated, understood, and properly coordinated with the stakeholders inside and outside the organisation. In an age of collaboration, this may involve discussions with suppliers and partners. Although the leader of the organisation will ultimately be responsible for a strategys success or failure, their role should be to encourage and create an organisational culture which empowers managers to respond to opportunities. In this way each employee will be confident to try out new ideas and innovate without fear of reprisals. White (2004, p.618), the implementation of a successful strategy is to focus on the five Cs as the basic requirement needed to keep the separate units in any organisation to achieve the objectives of strategy. The five Cs are: Coordination, Communication, Command, Control and Conflict/consensus. Coordination: There should be coordination at every step of strategy making, certainly in the process of formulation and implementation between the stakeholders, different cooperating enterprises and organisational levels, and between different internal units within the enterprise itself. Communication: Coordination is only possible with the help of proper communication of information concerning objectives and threats, capabilities and threats, risks and threats. The accurate information must be communicated. Command: â€Å"It is passed downward, reflecting the hierarchy of authority which characterizes every organisation. It should be rarely given and only when absolutely necessary, in crises or to resolve a particular conflict. It is held in reserve for when is needed. Everyone should be aware of possibility of command but it does not have to be used. There are some occasions when decisive action is necessary, but most the time staff should be aware of what they need to do without being prompted. Control: It is often exercised indirectly and discretely, through incentive structures and globalization of a corporate culture. There are direct control systems in certain areas such as finance. It is better that all become committed to following the broad directions of the strategy without explicit instructions. The outlines of strategy provide the guidelines are internalized and do not require endless repetition. Each decision maker has their own domain or is of control, all well understood, and obtains from intervention on other domains unless invited or if there is a crisis. Conflict / Consensus: Honest disagreements are certain in any organisation. It is a vital aspect of any creative activity, since creative thinking means thinking outside the normal boundaries. If a new idea is to change behaviour, it needs to be argued out in the forum of enterprise where there will inevitably by those who cannot agree. Any proposal for change for change almost always invites conflict of kind, hostility from those opposed to a new way of thinking or to change.† Strategic Management Process Thompson and Strickland (2003, p.6) defined term strategic management â€Å"it refers to the managerial process of forming a strategic vision, setting objectives, crafting a strategy, implementation and executing the strategy, and then over time initiating whatever corrective adjustment in the vision, objectives, strategy, and execution are deemed appropriate. Strategic Vision: A strategic vision of a company reflects managements aspirations for the organisation and its business, providing a panoramic view of ‘what we are doing and giving specifics about its future business plans and giving specifics about its future business plans. It brings out long-term business purpose and shape the organisational identity. A strategic vision helps an organisation in a particular direction and in a strategic path for it to follow. Setting Objectives: ‘The purpose of setting objectives is to convert managerial statements of strategic vision and business mission into specific performance targets, i.e. results and outcomes the organisation wants to achieve. Crafting a Strategy: Strategy making brings into the critical managerial issue of how to achieve the targeted results in light of the organisations situation and prospects. Objectives are ends and the strategy is the means of achieving them. Implementing and Executing the strategy: Strategy implementation concerns the managerial exercise of putting a freshly chosen strategy into place. Likewise ‘strategy execution deals with the managerial exercise of supervising the ongoing pursuit of strategy, making it work, improving the competence with which it is executed, and showing measurable progress in achieving the target results.† Case: British Airways Airline industries and carriers are facing very hard time, because recession has affected the business and the industries have to reduce their prices and are not making well profit as compared to the past. As it is a worldwide fast growing industry making airlines more complex and challenging. Because of recession and increased number of unemployments in airline industries. British Airways is the UKs largest international airline, flying to 6 domestic destinations over 148 international destinations at multiple times, to the all best located airports. The major place of business is Heathrow, one of the worlds premier airport locations. BA also operates a worldwide air cargo business. But still British Airways had to restructured and make some serious strategic changes to avoid the bankruptcy or the closure. BA had his vision to achieve their goal and took effective and reasonable steps to compete in the market with its performance and operation under the last couple of years. Market fell from more than 30 per cent in 1998 to about 20 per cent in 2005. This year, BA announced the worst half-year losses in its history. During the six months to September 2009, the company face a  £292m ($485m) loss, compared with  £52m profits during the same period a year earlier. In order to survive and to make an easy recovery in this competitive environment and to attain a leadership in the industry BA has taken strong steps to upgrade the systems and technology, In order to increased the fleet size British Airways ordered 36 new long haul Aircraft on 27th September 2007 which includes 12 A380s,and 24 Boeing 787s. British Airways also ordered on 1st February 2008 Airbus A318s to run a premium services out from London City Airport to New York. This fitted luxury 32 lie flat beds in business class cabin. The increase in technology like online ticketing, online checking also enhances the BA business. Because customer has no need to stand in queue. Innovative flight service such as sleeper service will attract more customers. Introduction of the terminal 5 on the HEATHROW AIRPORT will help increasing of the flig hts of the BA and able to provide more relaxed environment to its customers. Possible merger of the BRITISH AIRWAYS and QANTAS AIRLINE could be the great opportunity to become absolute market leader of the world. Willie Walsh stated that British Airways had reduced 1,450 staff members since March 2009. They also reduced the overtime and 500 redundancies were made. Twenty percent of future capital expenditure is reduced this year from 725 million pounds to 580 million pounds and it will be the same through out this year. Mr. Willie Walsh also admitted that this structural change of British Airways is necessary for survival and long term success. British Airways managed with its comprehensive and proactive strategy to accelerate its return to profitability and economic welfare well in advance of its rivals. The airline announced that it is planning to raise  £680 million of liquidity through a  £350 million convertible bond issue and by gaining access to bank facilities which are currently used to provide guarantees to its pension funds. This will increase liquidity to approximately  £2 billion. Conclusion A successful and well-organized strategic plan can recognize the organisations strength, and related weaknesses, determining the new opportunity and with useful action resolve the problems. These can be either from the capabilities and expertise of an organisation or from the actual market demand. Successful strategy plan is when there is a continues perfection and effective use of time and resources. The role of manager is very important to make organisation profit-making or non- profit making with taking right decisions. He should think strategically rather than operationally. The main factor of strategic planning is that how the information gained, implement and used. References Mintzberg, H., Lampel, L., Quinn, J. Ghoshal, S. (2003) The Strategic Process, 4th edition, Prentice Hall publishing, New Jersey. White, C. 2004, Strategic Management, 1st edition, Palgrave Macmillan, New York Lynch, R., 2000, Corporate Strategy, 2nd edition, Prentice Hall, Harlow Morden, T. 2007, Principles of Strategic Management, 3rd edition, Ashgate Publishing, Aldershot. Haberberg, A. Rieple, A. 2008, Strategic Management: theory and application, 1st edition, Oxford University Press, New York. De Wit, B. Meyer, R. 2005, Strategic Synthesis: Resolving strategy paradox to create competitive advantage, 2nd edition, Thompson, London. Henry, A. 2008, Understanding Strategic Management, 1st edition, Oxford University Press, New York. Thompson, A., Strickland A.J., 2003, Strategic Management: concepts and cases, 13th edition, McGraw-Hill, New York. Marios I.Katsioloudes Ph. D, (2006) Strategic Management, Global Cultural perspectives for profit and non-profit organisation, p 2, 6 Lynch, R., 2003, Corporate Strategy, 3rd edition, Prentice Hall, Harlow URL Source: www.investorwords.com/4774/strategic_planning.html Date of Access: 25th February 2010 URL Source: http://www.onlinebusadv.com/index.php?PAGE=14 Date of Access: 25th February 2010 URL Source: http://www.netmba.com/strategy/process/ Date of Access: 25th February 2010 URL Source: http://hrmadvice.com/assets/images/swotanalysis.jpg Date of Access: 25th February 2010 URL Source: http://www.britishairways.com/travel/about-british-airways/public/en_gb Date of Access 25th February 2010

Alcohol And Brine Shrimps

Abstract Alcohol catches the interest of many scientists because of its different effects on human, especially during pregnancy. These effects can also be seen in lower forms of organisms, such as that of the crustacean brine shrimp. By studying these, the scientists can get a better understanding on the mechanisms underlying the alcohol’s effects. When other conditions are held constant, a very high amount of alcohol should inhibit the growth or hatching of these brine shrimp eggs.By growing brine shrimp eggs exposed to different concentrations of alcohol and observing the larvae afterwards, the effects of alcohol on these organisms can be revealed in a quantified manner. To do so, volumes of 0. 0 mL. 0. 1 mL, 0. 25 mL and 0. 5 mL of a 100% alcohol were placed in different Petri dishes containing 10 mL of brine solution each. Brine shrimp eggs were then placed and left for a week before the eggs and larvae were obtained and counted. Results show that there are more eggs hatch ed on the system with no alcohol in it.Though the plate with higher alcohol content showed a relatively large number of hatched eggs, it has a higher amount of dead larvae compared to the dishes having lower alcohol content. This shows that alcohol works in two ways, preventing the hatching of brine shrimp eggs and causing deaths to the larvae. I. Introduction Brine shrimps (Artemia) are small crustaceans, and not closely related to the common shrimp. They are usually termed as â€Å"sea-monkeys† and sold in pet stores as fish food.They are very resistant in adverse conditions, and their eggs are able to stay dormant until the right environment induces their birth. Many of these are seen in large bodies of water, for they serve as food for the larger fish and other organisms present in the ecosystem. One interesting fact of these crustaceans is the ability of their eggs to undergo cryptobiosis, a characteristic where they exhibit a â€Å"hidden life† by maintaining a m etabolically inactive state. This happens during adverse conditions that inhibit the growth of the organism.In this case, brine shrimp eggs stay dormant as long as there are large fluctuations in the environment caused by factors such as temperature, oxygen content, and acidity. Because of this, brine shrimps are excellent to be test subjects for this experiment regarding the effects of alcohol on early development. Brine shrimp eggs can also hatch at a short span of time, and grow into larvae capable of swimming by themselves in just a matter of days. Furthermore, there are no known ethical issues regarding the use of these organisms. In fact, a number of studies using this genus have been performed throughout history.One of these is the research of Antonio Marquez’s group, where they tested the effects of bacteria on Artemia franciscana. They cultivated the organism in 10 different strains of bacteria together with some major feeds. The treatment resulted to the Artemis sur vivors having a longer length. The bacteria added played an important role in providing direct feed for the Artemia. They provided essential proteins, vitamins, amino acids, and inorganic nutrients (Marques, 2005). These results can be taken into consideration when designing this experiment.Since the experiment aims to determine the effects of alcohol only, the medium on which the brine shrimp are to be grown must be free of other substances, especially bacteria that might contribute additional nutrients for the organism to grow. The experiment by Marquez also shows the versatility of these brine shrimps in data gathering experiments done on the lab. They are easy to cultivate and grow. Another research, which can complement the purpose of this experiment, is the one tackling about the toxicity of the chemical diisopropyl fluorophosphate (DFP) when exposed to Aremtia salina The group of S.Sanchez-Fortun and M. V. Barahona found out that on high concentrations of DFP, a longer develo pment time is evident on Artemia larvae. A more concentrated solution even showed death on some of the larvae. Several treatments were tested, including addition of the compounds atropine, physostigmine pyridostignime. But only the compound 2-pyridine aldoxime methoiodide (2-PAM) proved to be effective in preventing intoxication due to DFP (Sanchez-Fortum, 2007). These results show the lethal effects of some chemicals to the larvae of some organisms.Aside from DFP, alcohol is another substance that is believed to have bad effects on organisms during their pre-birth stage. In higher animals, such as humans, alcohol is usually blamed for miscarriages, prematurity, and many other defects on birth. This alarming substance caught the attention of many, and efforts have been made to make the public aware of the dangers posed by alcohol. Such effects of alcohol are made notice by Brimacombre and his team. Sometime before the year 2007 ended, they conducted a study to asses the knowledge of health professionals regarding fetal alcohol spectrum disorders or FASD.They conducted several presentations, lectures and demos to health professionals across New Jersey over a four-month period. The groups were then asked to answer a series of 20 questions to determine the depth of their understanding regarding FASD. The results showed that though they are well versed with the basics of FASD, these health group professionals reveal weaknesses in some important areas. One of these is the lack of knowledge on some core diagnosis and treatment of FASD. It was then concluded that more efforts must be done to further increase the awareness of the public to the facts of alcoholism (Brimacombe, 2008).If alcohol has a severe effect on humans, then it is safe to assume that it would also have a devastating impact on lower creatures such as the brine shrimps. This experiment is designed to illustrate the possible threats of varying concentration of alcohol to Artemia. The alcohol’s effects will be determined by adding varying amounts of it to the culture of unhatched brine shrimp eggs. The eggs and possible young hatchlings from the different treatments will then be manually counted and compared with each other.Taking into consideration prior knowledge and previous studies made, high alcohol content would not be optimum for the brine shrimps to live. The treatment containing the most alcohol would then probably have less or no brine shrimp larvae present compared to those cultures with little or no alcohol in it. II. Methodology Prior to the experiment, the solutions and equipments to be used were prepared. Four Petri dishes, brine solution, 100% alcohol, some toothpicks and a brine shrimp egg solution were placed close by for easy access.The Petri dishes were then marked with numbers â€Å"1†, â€Å"2†, â€Å"3† and â€Å"4†. A volume of 10 mL of brine solution was then added to each Petri dish. In the Petri dish labeled â€Å"1â € , 0. 1 mL of alcohol was added and mixed. In the same manner, 0. 25 mL of alcohol was added to Petri dish â€Å"2† and 0. 5 mL of it to Petri dish â€Å"3†. No alcohol was added to Petri dish â€Å"4†, as this is be used as the control system. A clean toothpick was then taken, wetting it by dipping it in a brine solution first, and then in the container with brine shrimp eggs.The eggs were then transferred to Petri dish â€Å"1† by slowly stirring the toothpick in the brine solution contained in the Petri dish until all eggs are dislodged from the toothpick. A new toothpick is then used to transfer eggs in the same manner to Petri dishes â€Å"2†, â€Å"3† and â€Å"4†, using a fresh toothpick for each Petri dish. The eggs were allowed to sit for a week and then they were observed. The eggs and larvae were counted using a toothpick and viewed with a microscope. The data were then recorded and compared.

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

Anabolism and Catabolism Definition and Examples

Anabolism and catabolism are the two broad types of biochemical reactions that make up metabolism. Anabolism builds complex molecules from simpler ones, while catabolism breaks large molecules into smaller ones. Most people think of metabolism in the context of weight loss and bodybuilding, but metabolic pathways are important for every cell and tissue in an organism. Metabolism is how a cell gets energy and removes waste. Vitamins, minerals, and cofactors aid the reactions. Key Takeaways: Anabolism and Catabolism Anabolism and catabolism are the two broad classes of biochemical reactions that make up metabolism.Anabolism is the synthesis of complex molecules from simpler ones. These chemical reactions require energy.Catabolism is the breakdown of complex molecules into simpler ones. These reactions release energy.Anabolic and catabolic pathways typically work together, with the energy from catabolism providing the energy for anabolism. Anabolism Definition Anabolism or biosynthesis is the set of biochemical reactions that construct molecules from smaller components. Anabolic reactions are endergonic, meaning they require an input of energy to progress and are not spontaneous. Typically, anabolic and catabolic reactions are coupled, with catabolism providing the activation energy for anabolism. The hydrolysis of adenosine triphosphate (ATP) powers many anabolic processes. In general, condensation and reduction reactions are the mechanism behind anabolism. Anabolism Examples Anabolic reactions are those which build complex molecules from simple ones. Cells used these processes to make polymers, grow tissues, and repair damage. For example: Glycerol reacts with fatty acids to make lipids:CH2OHCH(OH)CH2OH C17H35COOH  Ã‚  Ã¢â€ â€™Ã‚  Ã‚  CH2OHCH(OH)CH2OOCC17H35  Simple sugars combine to form disaccharides and water:C6H12O6   C6H12O6  Ã‚  Ã‚  Ã¢â€ â€™Ã‚  Ã‚  C12H22O11   H2OAmino acids join together to form dipeptides:NH2CHRCOOH NH2CHRCOOH  Ã¢â€ â€™Ã‚  Ã‚  NH2CHRCONHCHRCOOH H2O  Carbon dioxide and water react to form glucose and oxygen in photosynthesis:6CO2   6H2O  Ã‚  Ã¢â€ â€™Ã‚  Ã‚  C6H12O6   6O2 Anabolic hormones stimulate anabolic processes. Examples of anabolic hormones include insulin, which promotes glucose absorption, and anabolic steroids, which stimulate muscle growth. Anabolic exercise is anaerobic exercise, such as weightlifting, which also builds muscle strength and mass. Catabolism Definition Catabolism is the set of biochemical reactions that break down complex molecules into simpler ones. Catabolic processes are thermodynamically favorable and spontaneous, so cells use them to generate energy or to fuel anabolism. Catabolism is exergonic, meaning it releases heat and works via hydrolysis and oxidation. Cells can store useful raw materials in complex molecules, use catabolism to break them down, and recover the smaller molecules to build new products. For example, catabolism of proteins, lipids, nucleic acids, and polysaccharides generates amino acids, fatty acids, nucleotides, and monosaccharides, respectively. Sometimes waste products are generated, including carbon dioxide, urea, ammonia, acetic acid, and lactic acid. Catabolism Examples Catabolic processes are the reverse of anabolic processes. They are used to generate energy for anabolism, release small molecules for other purposes, detoxify chemicals, and regulate metabolic pathways. For example: During cellular respiration, glucose and oxygen react to yield carbon dioxide and waterC6H12O6   6O2  Ã‚  Ã¢â€ â€™Ã‚  Ã‚  6CO2   6H2OIn cells, hydroxide peroxide decomposes into water and oxygen:2H2O2  Ã‚  Ã¢â€ â€™Ã‚  Ã‚  2H2O O2 Many hormones act as signals to control catabolism. The catabolic hormones include adrenaline, glucagon, cortisol, melatonin, hypocretin, and cytokines. Catabolic exercise is aerobic exercise, such as a cardio workout, which burns calories as fat (or muscle) is broken down. Amphibolic Pathways A metabolic pathway that can be either catabolic or anabolic, depending on energy availability, is called an amphibolic pathway. The glyoxylate cycle and the citric acid cycle are examples of amphibolic pathways. These cycles can either produce energy or use it, depending on cellular needs. Sources Alberts, Bruce; Johnson, Alexander; Julian, Lewis; Raff, Martin; Roberts, Keith; Walter, Peter (2002). Molecular Biology of the Cell (5th ed.). CRC Press.de Bolster, M. W. G. (1997). Glossary of Terms Used in Bioinorganic Chemistry. International Union of Pure and Applied Chemistry.Berg, Jeremy M.; Tymoczko, John L.; Stryer, Lubert; Gatto, Gregory J. (2012). Biochemistry (7th ed.). New York: W.H. Freeman. ISBN 9781429229364.Nicholls D. G. and Ferguson S. J. (2002) Bioenergetics (3rd Ed.). Academic Press. ISBN 0-12-518121-3.Ramsey K. M., Marcheva B., Kohsaka A., Bass J. (2007). The clockwork of metabolism. Annu. Rev. Nutr. 27: 219–40. doi:10.1146/annurev.nutr.27.061406.093546