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

The Nuiances of Reflection Essay for English Class

The Nuiances of Reflection Essay for English Class Reflection Essay for English Class Ideas Sometimes you try to do your best and even then you're not able to score well in your home tasks. You're working because you've got zero selection. A good deal of the moment, it will help to break down each process into subsections. When you own a purpose, nobody can take that from you. What's Really Happening with Reflection Essay for English Class The introduction portion of the essay is followed by the body section, that is the major part of the paper. Everyone has the capacity to compose the ideal essay. The ideal thing about us is that each time you can buy original essay papers for sale. Then the ideal approach is place a request I want to acquire essay papers written. The research paper ought to be interesting to read from the start to the end. The duration of the essay is usually dependent on the difficulty and number of steps it takes. This sample is just meant to help you write your own process essay. English essay samples require in order to be thoroughly analyzed and understood for the youthful student before trying to compose his magnum opus. Things You Won't Like About Reflection Essay for English Class and Things You Will Provided that the aim is reached, the assessment does not need to be fixed. In the span of time you will enhance your classes, and when you compose it for the very first time, you will learn to quickly remove it. There are a couple things I do feel I lack the confidence and skill to do, and that is precisely what I aspire to gain from participating in Capstone. A good example of my personal meditative growth has arrived from everyday living for a freshman. Choosing Reflection Essay for English Class As the last paragraph is represents your very last opportunity to create your case and, being such, should stick to an extremely rigid format. Moreover, a couple of hours of class time will want to get allocated so as to present the collages. View our site provides a completely free scrawl after which they could use their redaction to create the acceptable amendments that delivers dependable and comprehensive feedback. Some can take a couple minutes while some take months or perhaps even years to finish. When you talk to a client do not assume they understand much of what you need to offer you. You're the master of your domain and you're ultimately in charge of your happiness. With the introduction of digital tools, an array of media options are readily available to utilize for learning. Software English writing software will stop you when you're redaction your documents. Our writers always create unique content that is totally free from all grammatical error. Her idea proved to be a financial literacy eLearning platform named MeVest. The reader should know this and it's your job as the writer to paint the correct picture in their opinion. He should be able to gather the vital information at one go, hence it needs to be clear and unambiguous. The Reflection Essay for English Class Game Tomorrow you'll see a couple more points to speak about and think of additional methods to say things. Your customer may opt not to go with the bigger project after counting the extra expenses. One of many reasons are environment is polluted is due to household waste. Imagine the pressure of knowing that in case you forget a day of work or whether you get sick, you might be unable to eat or pay your rent. What Does Reflection Essay for English Class Mean? Words tell a whole lot more than a story. Now proceed to compose the ending. Reverse the sequence, then e arn a poem. The Hidden Secret of Reflection Essay for English Class It's not made for learning but just for a brief reflection. People today cruise about and honk to discover the closest spot to the mall's entrance. Starting over was painful but a lot of the time it was really well worth it. Begin a poem in the manner in which you're most comfortable with. It's this very reason religion plays an important role in influencing entire families. The truth is that no matter in which you turn, religion is a significant portion of culture and influences everyone on some level. On the flip side, there is not any denying that religions still play a valued role for the majority of people on Earth. Though there are lots of religions which are still practiced in the planet, it is crucial to find out what role they play in culture and thinking. With teachings like the Four Noble Truths and the Eightfold Path, individuals can start to find out what truly matters in their very own dai ly lives. If you're likely to use words to make certain that the public will have the ability to match the kind of your paper. You may easily depend on us to find essay help as we have a tendency to assist and guide the students with the assistance of our professional experts. Some people today recommend copying out good examples by hand to have a sense of the way the language of a specific genre works. When writing, it's important to understand the perspective you're attempting to portray. This writing exercise does not need to the done this precise same way either. The introduction gives a summary of the topic accessible. Writing in French is exactly like any sort of writing.

McDonalds Ethical Responsibility - 1358 Words

McDonald’s: Ethical Responsibility Small business owners of fortune 500 companies, democrats, republicans, men and women all have ethical responsibilities that should always be considered. Mc Donald’s is a well-known restaurant around the world. Some people enjoy this fast food restaurant and also have made Mc Donald’s one of the leading fast food companies. Although, Mc Donald may have some tasty food, there are still many critics that think Mc Donald’s may have a lot of ethical issues and company violations. Some consider being ethical is simply defined as knowing the difference between what is considered good and evil. However, ethics is defined as moral principles that govern a person’s or group’s behavior, and the practices that†¦show more content†¦Seeing that Mc Donald’s operation was moving fast and effective, the soon to be franchisee, Ray Kroc, wanted in. McDonald’s met with Ray Kroc and as a salesman he sold milk shake mixers and offered him a dream of opening a McDonald’s. After agreeing to allow Mr. Kroc to open more franchises in different locations, the rest was history. The Ray Kroc Story states that, â€Å"Ray Kroc wanted to build a restaurant system that would be famous for food of consistently high quality and uniform methods of preparation. He wanted to serve burgers, buns, fries and beverages that tasted just the same in Alaska as they did in Alabama (Kroc, 2009).† Ethics Issues: McDonald’s Corporation has been growing and spreading internationally for the past three decades. Although McDonald’s seems convenient, cheap and clean, there are many negative aspects of the business. McDonald’s has a long history of terrible labor practices. Employees working for McDonalds are usually forced to work for low pay and long hours with little to no benefits, employees who work on major holidays like Thanksgiving and Christmas are not paid overtime. Unfair wages is a widespread problem for McDonald’s workers year-round. The work environment is usually unsanitary and unhealthy for employees and negatively impacting other cultures, the unethical practices of this large fast food corporation are known but do not seem to detract from theShow MoreRelatedCsr Mcdonalds1534 Words   |  7 PagesWhat are the strengths, limitations and challenges of ethical and socially responsible business practice? Discuss with reference to case studies of your choi ce (1200-1500 words). This essay will analyse the strengths, limitations and challenges of ethical and socially responsible business practice. The purpose of this essay is to identify the advantages and limitations of following business ethics and act socially responsible in business operations. In order to help me analyse those furtherRead MoreMcdonald s Strength And Weakness1280 Words   |  6 PagesAbstract McDonalds is considered to be the world’s largest and most globally known fast food restaurant, which serves approximately 69 million consumers daily. 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Globalization has internationally integrated the world with respectRead MoreThe Pyramid Of Corporate Social Responsibility1262 Words   |  6 Pages It’s the responsibility of the top managers in an organization/business to conduct the business in accordance with the intent to follow all the company guidelines. In fact, this would allow the organization to make as much money as possible while maintain the basic rules of society, both of the embodied of the law and those of the ethical custom. In today’s business world any corporations who spend shareholder’s money if they invested any money in their company would be face with penalties and chargesRead MoreCorporate Social Responsibility Group Paper1344 Words   |  6 Pages MGMT 2130 (Section 002) Corporate Social Responsibility Group Paper Brenda Lang Marisa Arnholtz, Kyla Mackie, Cassidy Makus October 19, 2015 â€Æ' Corporate Social Responsibility Group Paper In 1955, the McDonald’s franchise was established by Ray Kroc. Since then, it has been a growing success in the food and drink industry, directly and indirectly employing over 200,000 people throughout Canada. (McDonald’s, 2015, para. 2). McDonald’s is generating nearly $4.5 billion in the local annualRead MoreEthical Issues Facing McDonalds1772 Words   |  7 PagesProblem/Issue Identification Ethical Issues Facing McDonalds McDonalds puts in a lot of effort in supporting children with severe diseases. However, the diet this company offers contributes to heart diseases, asthma, obesity, and likely even mad cow disease. Adults and children are getting the wrong message in the society today. For instance, around 59 of 250 hospitals house fast food restaurants. Expenditure on fast foods from McDonalds has been on the rise as years pass by. The company has beenRead MoreInternal And External Factors Affecting Mcdonalds1468 Words   |  6 PagesII (A). 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In the following essay, some of those unethical issues of McDonald being criticized will be analyzed based on the values-oriented framework, which refers to the AMA Statement ofRead MoreStrengths And Strengths Of Mcdonald s1262 Words   |  6 PagesStrengths Strengths of McDonald’s in relation to its three motivation principles for a sustainable supply chain include the safe and high quality products without supply interruption.Safe and quality products go hand and hand with each other.Safe products include both the human and environmental safety aspects, and high quality products exceed the typical standards for products. Human safety from McDonald’s items include the USDA approved food standards, as well as each other country’s nationally

How to Prepare Performance Report of a Company

Questions: Task 11. Prepare a performance report for the two companies for consideration by the directors of Chelsea Plc indicating which of the two companies you consider to be abetter acquisition, the directors require an analysis of these ratios and explanation2. Indicate what other information is needed before a final decision can be madeTask 21) Calculate the annual cash flows for each of the five years.2) Using the investment appraisal methods calculate the ARR, Payback, NPV and IRR 3) Advise the client on whether this project should be accepted or rejected based on methods used above.Task 31. You are required to prepare a cash budget for the four months August to November 2014. The opening cash balance at 1 August 2014 is 15,400.2. Budgeting is one of the areas that the management are keen to improve on, could you provide an explanation of why budgeting is beneficial to a business and whatcan be done to enhance the budgeting process? Answers: Solution to the Required Task 1 1. Chelsea Plc is considering two companies Kensington (K) and Wimbledon (W) as the target companies which we are required to compare and advice which one is the better target for acquisition. There is certain profitability, activity and liquidity ratios are given for both the companies as well as the industry standards, we need to analyze all such ratios and conclude the decision. Let us discuss and analyze each ratios one by one (Bodie, et al, 2011). Return on Capital Employed is computed by dividing the net operating profit with the employed capital. It denotes the profit earned for each of capital employed in the company. The more the profits for the company the better it is so the higher the ROCE ratio the better it is for the company. Here the industry average given for this ratio is 20 whereas the W (28) has higher of this ratio from both industry as well as of Ks (22) (Burns and Morris, 2014). Therefore both the company is better off but W is more profitable. (Return On Capital Employed) Return on equity is a profitability ratio from the investors point of view since it is the ratio of the net income earned from the shareholders fund. It reflects the efficiency of the company to use the shareholders money and earn profit from it. In this ratio also W has higher ratio then both K and Industry thus it is in better position (Cao, 2011). Acquiring W will help Chelsea gain more confidence from investors since they will have sense of security that there fund is utilized in creating shareholders wealth and not destroying it. (Return on equity ratio) Gross profit and Net Profit ratios are the ratios computed by dividing the respective profits by the sales. This ratio reflects the percentage of profit earned on certain level of sales. Here in the given case study gross and net profit ratio of K is better than industrys average but of W is worst which denotes that profitability of W is lower when compared to that of K. It may be due to mismanagement or unnecessary expenditures which can be corrected by Chelsea after acquisition. Therefore we can say that analyzing the profitability ratios Wimbledon is better target firm. (Gross Profit Ratio) (Net Profit Ratio) Total Asset Turnover ratio indicates Net sales divided by average total assets. The higher ratio is preferable since it indicates that company is efficiently using its assets to generate sales. Here also W is better off from K as well as from the industry standards. Non-current asset ratio is similar only difference being here only the fixed assets is considered and not the total assets. This denotes how efficiently the company is utilizing its fixed asset in generating income for the financers. W has a ratio of 12 whereas Industry and K has 5.1 and 2.3 respectively (Cherneva, 2012). Thus in both the above ratios W is surpassing all other comparisons. (Asset turnover ratio) (Fixed Asset Turnover Ratio) Receivables collection period are the credit period allowed to debtors. The time period it takes to realize the sales amount in cash is known as receivable collection period. This period is preferred to be lower since the faster the collection is made the sooner the cash can be rolled back into the operating cycle. Here as per the given data W has the lowest collection period and thus it is preferable. (Accounts receivable Collection Period) Inventory holding period is the period which is required to sell the product to the consumers kept in stock. Like receivable collection period lower inventory holding period will shorten the days to complete one operating cycle and thus will allow Company grab more opportunities (Clift, 2011). Here also the holding period of W is lowest and thus it is in better position. (Average age of Inventory) In all the liquidity ratios such as current ratio, acid test ratio and debt equity ratio which is considered lower the better W is in better position thus we conclude that in almost all the ratios W is a better acquisition target. (Current Ratio) These ratios help us to analyze how the various areas are being covered under the ratios and how the decisions can be based on that ratios. Such as debt equity ratios helps us to measure the amount that the company uses as debt for financing the capital and the debt burden also for the company. The various other ratios shows how the company is liquid enough t pay off the debts and the liquidity structure of the company. The ROCE and ROE is one of the valuable measurements to measure the companys profitability ratio. By calculating the ROCE for both the companies W and K, it has been observed that the ROCE of W Company is 28 and the ROCE of K Company is 22 (Zhang et al., 2011). This shows that the profitability ratio of W Company is more than the K Company. So, acquiring W will be better for Chelsea to earn more profit from the market. The ROE of W Company is much better than K Company, so it would be better to acquire W by Chelsea Plc. So the Chelsea Plc Company should acquire the W Company to earn huge amounts of profit from market. If the company had more profitability ratio then the observation reflects that the company has more equity value as compared with the debt value of the company. It has been also found that the average borrowing rate is much less for the W Company (Glantz, 2014). So, the management of Chelsea Plc Company should merge with the W Company. 2. Final Decision cannot make only based on some ratios. Certain other aspects should be considering before deciding. These are as following in nature: Shares issued by the company Numbers of shares that are issues by the company to generate the funds for the operational activities of the company are mainly base on the final decision making strategies of the organization. Acquisition activities of the company Acquisition of a new or popular product in the company is also primary factors that are required to be considering during the final decision taken by the organization. The acquisition activities of the company are mainly base on the decision-making criteria of the particular organization. Research Activities Researches of several articles by independent analysts are also required and essential for the decision-making strategies of the organization are mainly base on the certain activities of the company is support the organization to take beneficial decision about the company. Borrowings of the company There are several debt amount which is taken by the company which is required to be settle after acquisition activity of company which is mainly based on the capabilities of the organization to fulfilled their organizational obligations which is based on the financial capabilities of the organization. Legal Obligations The legal obligations that are mainly base on the several activities of the company as per the pending legal obligations of the company. Moreover, those are required to sort out the company rules and policies measured by the company. There are certain value addition activities which are required for the decision making activities of the organization which is based on the maintaining the goodwill of the company. Human Resource Activities The decision-making activities of the company that is mainly based on the expenditures and the employees retrenchment activities that are mainly base on the certain activities of the organization as per the compatibility of the product line of the organization. Product price affordability The products price affordability of the company is base on the different purpose of the company decision-making activities of the organization. The decision-making strategies of the organization are mainly base on the several strategies follow by the organization. Mode of Payment The decision-making strategies of the company are mainly base on the several essential activities of the organization for choosing the proper mode of payment of the organization. this is the one of the most famous decision-making aspects of the organization in compare to the others aspects of the organization. Work Culture Environment The objectives behind the research on the work culture of the company are mainly base on the organizational decision and which is base on the certain activities of the company. The company is mainly depends upon the certain activities of the cultural factors of the company. Merger Activities The earnings after merger should evaluate to decide acquisition of the company is mainly support the company to take essential decisions about the organization about their financial and operational activities of the company (Gowthorpe, 2011). Task 2 1. As per the research of the Riverside Motorcycle Components Ltd. Company can provide some standard service which has been recently developed by them. For the service provision it requires special machinery which costs 100,000 with a residual value of 20,000 after 5 years. The companys cost of capital is 12% which can set as the benchmark to achieve this target at least to check the projects viability in some of the appraisal methods. We have been asked to prepare the annual cash flows each year given the data of estimated sales in units each year (Guiso and Rustichini, 2011). These cash flows are calculated by multiplying the contribution per unit amount with the units per year given. The following table shows the computation of annual cash flows each year: Annual Cash Flows Particulars Details Years 1 2 3 4 5 Units Sold - 5,000 10,000 15,000 15,000 5,000 Amount (in ) Annual Cash Inflow SP @ 12per unit 60,000 120,000 180,000 180,000 60,000 Annual Cash Outflow VC @ 8 per unit 40,000 80,000 120,000 120,000 40,000 Net Cash Flows - 20,000 40,000 60,000 60,000 20,000 2. The company requires us to compute the investment appraisal methods using different methods such as accounting rate of return, payback period, internal rate of return and net present value method. In the accounting rate of return method average accounting profit of all the years involved in the project is computed and then it is divided by the amount of initial investment resulting in a return percentage (Sagner, 2014). It is also called simple rate of return because it is easy to compute and also simple ratio. ARR is used in investment appraisal it helps in deciding whether the project is viable to adopt or not. The following steps show the computation of the ARR. Since this is rate of return therefore higher the return more viable is the project in this method. (Jan, 2013) Accounting Rate of Return (ARR) Step 1: Computing Annual Depreciation Initial Investment 100000 Salvage Value 20000 No of years 5 Annual Depreciation 16000 Step 2: Computing Average Accounting Profit Years Cash Flows Depreciation Accounting Profit 1 20,000 16,000 4,000 2 40,000 16,000 24,000 3 60,000 16,000 44,000 4 60,000 16,000 44,000 5 20,000 16,000 4,000 Total Accounting Profit 120,000 Salvage Value 20,000 Average Accounting Profit 28,000 Step 3: Computing Accounting Rate of Return Average Accounting Profit (in ) 28000 Initial Investment (in ) 100000 ARR (in %) 28 Particulars Years 0 1 2 3 4 5 Initial Investment (100,000) - - - - - Cash Flows - 20,000 40,000 60,000 60,000 20,000 Cumulative Cash Flows (100,000) (80,000) (40,000) 20,000 80,000 100,000 Fraction Calculations - n/m n/m 0.66666667 0.33333333 4 Payback Period (in yrs) 2.667 Payback period is the method which determines the time period in which the initial investment can be recovered resulting profits in further years. Here in the mentioned question the company has an initial investment of 100,000 which will be recovered in the next 5 years since the project lifetime is such. The payback period can be computed in many alternate ways but here we have calculated by using the excel formulae (Ramsden, 2011). After dividing the absolute value of the last cumulative negative cash flows with the cash flow of the first positive cumulative cash flows, we have added it to the number of years before the first positive cumulative cash flows (Harris, 2013). The following table shows the payback period computation with the help of excel formulae in the excel sheet. The worksheet has been attached. (Ajay, 2013) There are many investment appraisal methods but Net present value method is very prevalent and commonly used. It includes the effect of time value of money thus making the method more effective and appropriate for decision making. In the project the present values are computed by discounting the cash flows each year. The sum of these present values is subtracted with the initial investment to compute the net present value (Peterson, et al, 2012). If the NPV is positive then the project is viable and if it is negative it is not viable. Sometimes the salvage value is also given that gets realized at the end year of the project, in that case we add up the present value of the salvage value with the cash flows of that year and compute the NPV accordingly (Holton, 2012). The following table shows the computation of the NPV of the given problem with help of excel formulae. (NPV IRR, 2013) Particulars Discounting Rate 12% Years 0 1 2 3 4 5 Initial Investment (100,000) - - - - - Cash Flows - 20,000 40,000 60,000 60,000 20,000 Salvage Value - - - - - 20,000 Present Values (100,000) 17,857 31,888 42,707 38,131 22,697 NPV 53,280 Since the NPV is positive in the above calculation thus the project is viable for the company. Internal Rate of Return is the method which compares the inflows and the outflows making it equal. The discounting rate at which the inflow gets equal to outflow is the IRR. The project with the greater IRR should be selected since it is better to have higher IRR. The project is considered viable if the IRR is greater than the hurdle rate. The below table shows the IRR computation using the Excel formulae: (Formulae for calculating IRR in excel) Particulars Years 0 1 2 3 4 5 Cash Flows (100,000) 20,000 40,000 60,000 60,000 20,000 Internal Rate of Return (IRR) 27% Since the above IRR is greater than the companys hurdle rate of 12% we consider the project is viable. In the absence of further information we assume the companys cost o capital to be its hurdle rate for the IRR computation. (Formulae for computing NPV in Excel) From the above calculation, it has been observed that the company has invested 100,000 Pound in purchasing a new machine for their manufacturing process. In the first year, the management of the Riverside Motorcycle Components Ltd has a cash inflow around 17,857 Pounds in the first year. In the second year, the management of the firm has received a cash inflow of 31,888 Pounds from the machine installed for the production purpose. In the third year, the company has received around 42,707 Pounds and has a cash inflow of 38,131 Pounds and 22,697 Pounds in the fourth and fifth year respectively. It has been observed from the calculation that the total cash inflow from the machine is 153,280 Pounds in the last five years. The total net present value of the cash inflow is 53,280 Pounds (Media, 2012). As the net present value of the cash flow is positive, the management of the Riverside Motorcycle Components Ltd should invest in the machine to earn more profit. If we compare the NPV, IRR a nd ARR, it has been observed that the NPV is positive; IRR is more than the hurdle rate of the project (IMA., 2012). The ARR value is 28 % which is very healthy foer the investors to get back the money from the investment. It can be stated that the management of the company can invest in the machine. 3. Since as per the above calculations we get that all the methods give a positive indication towards the project thus the project is completely viable. In the ARR the rate of return earned is quite high i.e. 28%. Similarly in payback period method the years computed is 2.67 years for a five year project which is almost half the total time period which is a positive sign. The company will be able to recover its investment soon and invest in some other new project reaping only profits from this project in further years. The NPV and IRR are also giving good appraisal since the NPV is positive with the good margin and the IRR is greater than the double of the hurdle rate. Thus considering all of the above methods we advise the client to accept the project. Task 3 1. The bookkeeper of the Pedrosa Plc has fallen sick and the new staff is inexperienced. Therefore the directors of the company wishes if we can help them in anyways. It requires preparing a cash budget for the period of four months from the period Aug to Nov 14. Some information is provided to us by whom we will have to prepare the budget. There are sales and purchase value for the six months period is given. 40% of the total sales constitute cash sales which are realized immediately whereas 60% of the sales are credit sales with a one month credit period given to the debtors (Kimmel, et al, 2011). Similarly the suppliers also provide 1 month credit period which means this months purchase will be paid in the next month. The depreciation charge of 2,500 per month is non cash expenditure and thus will not be included in the cash budget. The following tables show the cash budget for four months and the appendix attached. Cash Budget For the period Aug '14 to Nov '14 Particulars Details August September October November (in ) (in ) (in ) (in ) Opening Cash balance given for Aug 15,400 37,240 43,390 48,930 Inflows Cash Sales Appendix 1 27,060 24,160 23,400 22,200 Collection from debtors Appendix 1 39,180 40,590 36,240 35,100 Rent Income Given 9,000 9,000 9,000 9,000 Total Inflows (A) 90,640 110,990 112,030 115,230 Outflows Payment to Suppliers Appendix 2 35,400 33,600 32,600 34,750 Wages Appendix 3 18,000 18,000 18,000 19,080 Dividend Given - 16000 - - Payment for Machinery Appendix 4 - - 12,500 6,250 Total Outflows (B) 53,400 67,600 63,100 60,080 Closing Balance (A-B) 37,240 43,390 48,930 55,150 Appendix 1 Sales Months Particulars Details July Aug Sept Oct Nov Dec Sales Volume given 65,300 67,650 60,400 58,500 55,500 64,600 Cash sales 40% of sales above 26,120 27,060 24,160 23,400 22,200 25,840 Credit Sales 60% of Sales 39,180 40,590 36,240 35,100 33,300 38,760 Collection From Debtors 1 month credit period - 39,180 40,590 36,240 35,100 33,300 Appendix 2 Purchases Months Particulars Details July Aug Sept Oct Nov Dec Purchase Amount given 35,400 33,600 32,600 34,750 35,650 35,600 Payment to suppliers 1 month credit period - 35,400 33,600 32,600 34,750 35,650 Appendix 3 Wages Months Particulars Details July Aug Sept Oct Nov Dec Wages 6% inc. from nov onwards 18,000 18,000 18,000 18,000 19,080 19,080 Appendix 4 Machinery Months Particulars Details July Aug Sept Oct Nov Dec Installments Payment 25% in Oct, rest in 6 months (Cost= 50,000) - - - 12,500 6,250 6,250 2. Budgeting is the process of managing and approximating the expenditure and the income. It is a plan prepared for future to keep a balance between the income and expense. Budgeting is also very vital in fulfilling the financial needs of the company as they have the plan at hand ready to work on different situations accordingly. Preparation of budgets such as cash budget, purchase budget, sales budget etc helps in proper evaluation of the companys performance. Any deviation from the budget will alert the management to take necessary actions and work accordingly. (What is Budgeting?) (Nordmeyer) There can be various ways to enhance the budgeting process. Not achieving it alerts the management and makes them pay more heed to such process. Corporate Performance Management (CPM) and Performance Based Budgeting (PBB) are the ways to enhance the budgeting process (Marney and Tarbert, 2011). The cost benefit analysis is significant in this budgeting process. Thus we conclude that for every organization preparing a budget is crucial part in its management process. (Performance Based Budgetting, 2015) Bibliography Accounts receivable Collection Period. (n.d.). Retrieved 2015, from Accounting Tools: https://www.accountingtools.com/receivables-collection-period Ajay. (2013, April 4). Calculating Payback period in Excel. Retrieved June 6, 2015, from Techtites: https://techtites.com/calculating-payback-period-in-excel/ Asset turnover ratio. (n.d.). Retrieved 2015, from my accounting course: https://www.myaccountingcourse.com/financial-ratios/asset-turnover-ratio Average age of Inventory. (n.d.). Retrieved 2015, from Investopedia: https://www.investopedia.com/terms/a/average-age-of-inventory.asp Current Ratio. (n.d.). Retrieved 2015, from My accounting course: https://www.myaccountingcourse.com/financial-ratios/current-ratio Debt-Equity Ratio. (n.d.). Retrieved 2015, from My accounting courses: https://www.myaccountingcourse.com/financial-ratios/debt-to-equity-ratio Fixed Asset Turnover Ratio. (n.d.). Retrieved 2015, from Investopedia: https://www.investopedia.com/terms/f/fixed-asset-turnover.asp Formulae for calculating IRR in excel. (n.d.). Retrieved 2015, from Investopedia: https://www.investopedia.com/ask/answers/022615/what-formula-calculating-internal-rate-return-irr-excel.asp Formulae for computing NPV in Excel. (n.d.). Retrieved 2015, from Investopedia: https://www.investopedia.com/ask/answers/021115/what-formula-calculating-net-present-value-npv-excel.asp Gross Profit Ratio. (n.d.). Retrieved 2015, from Accounting Tools: https://go.microsoft.com/fwlink/?LinkId=129791 How to analyze acquisition? (n.d.). Retrieved 2015, from WikiHow: https://www.wikihow.com/Analyze-an-Acquisition Jan, I. (2013). ARR. Retrieved 2015, from Accounting Explained: https://accountingexplained.com/managerial/capital-budgeting/arr Net Profit Ratio. (n.d.). Retrieved 2015, from Accounting Tools: https://www.accountingtools.com/net-profit-ratio Nordmeyer, B. (n.d.). Why is Cash Budgeting important for the organization? Retrieved 2015, from azcentral: https://yourbusiness.azcentral.com/cash-budgeting-important-organization-24074.html NPV IRR. (2013). Retrieved 2015, from Investopedia: https://www.investopedia.com/exam-guide/cfa-level-1/corporate-finance/npv-net-present-value-irr-internal-rate-of-return.asp Performance Based Budgetting. (2015, april 24). Retrieved june 2015, from wikipedia: https://en.wikipedia.org/wiki/Performance-based_budgeting Return On Capital Employed. (n.d.). Retrieved 2015, from My accounting courses: https://www.myaccountingcourse.com/financial-ratios/return-on-capital-employed Return on equity ratio. (n.d.). Retrieved 2015, from my accounting course: https://www.myaccountingcourse.com/financial-ratios/return-on-equity What is Budgeting? (n.d.). Retrieved 2015, from My money coach: https://www.mymoneycoach.ca/budgeting/what-is-a-budget-planning-forecasting

Prison Culture an Example by

Prison Culture by Expert Prof Nelly | 22 Dec 2016 It is commonly acknowledged that in prisons, inmates influence on one another deepens criminal behavior that is already present. Inmates begin to learn the criminal ideology of the correctional facility. Generally, they also develop new habits of dressing, sleeping, eating. They develop a new language and become dependent upon others for food, work assignments, and protection. Further on, inmates without allies can find their time difficult. In order to better ensure self-protection, then, it is only natural that an inpidual inmate turns toward a gang affiliation, even within a context of zero tolerance of gang formation by institutional policy. Need essay sample on "Prison Culture" topic? We will write a custom essay sample specifically for you Proceed Even within the restricted confines of a prison, gangs may have as much influence as they would normally have on streets. All such close-knit interactions between inmates and group dynamics inside a prison create and reinforce a distinct prison subculture. There develops a general culture of the penitentiary, in terms of folkways, mores, customs, as well as language (Hensley 2002). Language is normally very closely associated with culture. In prisons, the fact that inmates have a language to relate to the experiences of their daily life inside, with gangs communicating in a lingo interlaced with special terminologies, reflects the extent of prevalence and influence of prison culture upon inmates. A prison culture helps create a sense of identity, encourages a set of expected behaviors, and promotes distinct goals in the actions of those people who are incarcerated (Huft, Kite 2003). The prison culture, in effect, becomes a synthetic culture bringing together people from various criminal backgrounds, levels of education, cultures and ethnicities to share a new set of values and attitudes that would better suit the conditions of the prison. Any culture in normal human society consists of distinctive characteristics in regard to values and norms, beliefs and attitudes of the people that constitute it; a culture also covers such perse areas as relationships, communication and language, sense of self and space, appearance and dress, work habits and practices, and food and eating habits of the people, in short it creates a special mould for the entire lifestyle of a people making up a community. Prison cultures, even within often their highly abnormal settings, mirror cultures of normal societies in terms their wide-ranging influence on the thoughts and behavior of people. However, when compared to cultural patterns in normal societies, the cultural norms within prison societies appear highly skewed and understandably so, given the overly oppressive, dangerous and debilitating environment of a typical large-scale prison. There is a marked tendency for prison cultures to value order and obedience, power over the weak or disenfranchised, and strict adherence to policies and procedures. Such authoritative and fascist regime is almost inevitable in view of criminal psychology that understands only the language of power and not that of fairness and equality. As a consequence, many prisons are characterized by a culture of fear. Further, minorities are often over-represented in prison, and such a situation can lead to an overt manifestation of racism and sexism from the side of prison staff as well as bullies in the dominant group of a prison. Often, drugs and alcohol would have affected a very high percent of inmates in their former lives, and prisons normally encourage this tendency by making way for widespread use of drugs. Physical and mental abuse in various senses of the word would also be a common and fairly accepted practice among offenders inside a prision. Prison is a place that is concerned with the issue of security over and above anything else, in order to see that offenders do not escape or commit more atrocities within the prison; as a result, prison culture reflects this high orientation towards security, with inmates being kept excessively powerless so that they are forced to rely on correctional officers for too many number of reasons. Many adult offenders would have served considerable time in juvenile correctional facilities and thus been acculturated to the social and material conditions of prison. However, many other offenders would experience culture shock and psychological disorientation upon entering a prison community. The prison would seem a strange environment demanding considerable degree of adaptation. The new inmates would have to quickly learn to adhere to sets of formal and informal policies dictating every act of theirs from those concerning eating and sleeping to dressing and speaking and work schedules. It must be remembered that the new inmates would have hard time in adjusting to lack of privacy and isolation from family and social support systems. These freshly convicted offenders would soon grasp the peculiar vocabulary and gestures that would make them better fit in their new environment. They would quickly identify the power hierarchy within the offenders and within the staff, as well as in between the inmates and the staff. The ruthlessness and lack of mercy inside a prison must be stressed in this context. Offenders with physical or mental problems or other evident weaknesses would be extremely vulnerable for victimization. However, the common misery they experience, in terms of deprivation of goods and services, love and sexual relationships, and inpidual autonomy helps in forming a particularly strong bond among the inmates and therefore often a surprising unity characterizes prison culture. Since the 1970s, the United States has experienced the greatest increase in the number of new prisons. And it only seems to be accelerating every day. Currently the U.S. has a prison inmate rate of 724 for every 100,000 people of general population up from 505 in 1992 (Walmsley 2005). This increase basically reflects the change of emphasis of penal policy from one of rehabilitation to one of containment and incapacitation. There are several other factors such as citizens' greater fear of crime and an increase in media coverage and attention as crime has become a burning issue in our society, increased length and severity of new sentencing laws and guidelines, and war on drugs, which have aggravated the overcrowding situation inside the prisons. Overcrowding is becoming a fundamental characteristic of our prisons, and is making rehabilitation and moral upliftment of prisoners increasingly difficult; and instead is leading to deterioration of norms and values of inmates as well as the general environment inside the prison. Efforts to carry out educative and therapeutic work with offenders are often severely hindered by a range of problems associated with overcrowding excessive burdens made on prison staff, lack of oversight and lack of purposeful activity, in addition to the widespread availability and use of narcotic drugs. As it is, generally low levels of formal education, socially disadvantaged backgrounds, and a deficit in vocational skills in general characterize the prison population. Added to these, the overcrowding factor is making it difficult for prisoners to reform themselves to higher standards of culture and morality. Unfortunately, lack of any provision for effective rehabilitation in the prisons of modern day is an important cause for creating the overcrowding conditions inside the prison, and this overcrowding is in turn making it very difficult to effect rehabilitation schemes. Thus the situation is developing into a vicious circle, which is only likely to worsen in the future. Far from being conducive to the moral reform of the prisoners, our prisons have in effect become an expensive way of making bad people worse (Wilson 2006). This is a statement not just on prison culture but the general culture, or still the lack of it, in our modern civilized society. References: Hensley, C. 2002. Prison Sex: Practice and Policy. Boulder, Colarado : Lynne RiennerPublishers, Inc. Hufft, A, Winter 2003.Retrieved 2 October 2006 Walmsley, R. 2005. World Prison Population List. Sixth edition. International Centre for Prison Studies. King's College, London. Retrieved 2 October 2006 fromhttp://www.kcl.ac.uk/depsta/rel/icps/world-prison-population-list-2005.pdf. Wilson, D. 2006. Prisons and How to Get Rid of Them. Public Management and Policy Association. PMPA Review. May 2006. Vol 33. Retrieved 2 October 2006 from http://www.cipfa.org/pmpa/download/david_wilson_article_2006.pdf#search=%22penal%20policy%20incapacitation%22.