Health Care Online - Health Information - Is This Reliable?

Health Care Online : Is this information for real Many people search the internet to find information about medical problems, various health issues or to find a health care provider. However, not all the information on the world wide web is credible. How is the patient supposed to know if what they are reading is reliable? Here are some questions to consider in evaluating health information from the internet. First, ask yourself who is responsible for this content? Is it a special interest group, non-profit, for profit, professional association, government agency? Is there an attempt to sell you a cure? When reading an article are you able to tell who the author is? Can you discern the qualifications or credentials? Does the author have any professional affiliations with major health or medical institutions? Has the information been reviewed by other medical professionals? Or an advisory board? Does the article provide sources for it's information? For example if the article reads "95% survival rate related to . . . " where did this number come from? And what exactly does survival mean? Just a side note (Many times people assume that a survival rate is the same as the opposite of death. The clarifying point is that survival rate takes into account a particular amount of time (e.g. 5 year survival, 3 year survival, 1 year survival rate etc.). Without qualifying what is meant by the terms used people can be led to believe many false claims. Is there a way to contact the sponsor of the information for clarification of the material provided? How is the site offering the information financially supported? Is the health information current? Keep in mind health information seems to change very quickly. Ask yourself how recent is the information? If you are asked to register for more information is it made clear how your personal information can and will be used? Does the site ask you to send money or for credit card or social security numbers? This should be a red flag that you should look at a different web site. Of course anytime you find information online you should speak to a trusted source of health information like your primary care provider? Also, see if you can corroborate the information across multiple sites. These tips should help you evaluate health information on the internet and empower you to make better health choices. Raymond Zakhari, MS, NP http://MetroMedicalDirect.com A trusted source for all your primary care needs -- Metro Medical Direct: Free Initial Consultation. Metro Medical Direct takes the hassles out of going to the doctor, by bringing the exam room to your door. Ideal for the busy and discerning professional who does not have the time to wait around in waiting room only to rushed through their appointment. A health care professional that you can talk to like a trusted friend. Offering no judgments, and competent compassionate and discrete care you can trust in your home, office or hotel. Offices also available through out Manhattan. You will be treated with respect and your dignity will remain intact.Secure patient portal that allows you to request your appointment online, send secure messages, request refills and referrals. This ensures that you do not have to speak to a secretary about your personal problems.Metro Medical Direct offers web-based, holistic primary care and medical house calls. When you don't feel well, Metro Medical Direct offers same day and next day appointments. Our Virtual Office Web Cam appointments allow you to take your PCP with you wherever you go, even when traveling for business or vacation.

HIPAA Law Protects Against Improper Disclosure of Health Information by Health Care Providers

In June 2009, a 22-year-old Honolulu mother of three young children was sentenced to a year in prison for illegally accessing another woman's medical records and posting on a MySpace page that she had HIV. The State of Hawaii brought charges against the woman under a state statute criminalizing the unauthorized access to a computer; and which categorized the conduct of the defendant as a class B felony. According to accounts of the incidents that led to the woman's conviction, there was a feud between the victim and the victim's sister-in-law, a friend of the defendant. The defendant, who worked as a patient service representative at the hospital where the victim was a patient, accessed the computer for the victim's sister-in-law. Over the course of approximately ten months, the defendant accessed the patient's medical records three times through a computer. After she learned of the victim's medical condition, the defendant posted on her MySpace page that the victim had HIV. In a second posting, she said the victim was dying of AIDS. The victim complained to hospital officials of the unauthorized access. After an internal investigation the hospital terminated the defendant's employment. The defendant's conduct, of course, was egregious and inexcusable. The one-year jail term handed down by the Court exceeded the term recommended by the prosecutor. Nevertheless, beyond the issue of holding the defendant accountable for her actions some may question to what extent the hospital should bear responsibility for the breaches of confidentiality that occurred. Federal law imposes statutory burdens on health care providers to protect against the improper use or disclosure of private health information and to reasonably limit uses and disclosures to the minimum necessary to accomplish their intended purpose. Specifically, the Health Insurance Portability and Accountability Act of 1996's ("HIPAA") privacy regulations became effective on April 14, 2003. HIPAA is intended to protect consumers' health information, allow consumers greater access and control to such information, enhance health care, and finally to create a national framework for health privacy protection. HIPAA covers health plans, health care clearinghouses, and those health care providers that conduct certain financial and administrative transactions electronically. In addition to the privacy regulations, HIPAA's security rules became effective on April 21, 2005. Together the privacy and security regulations are the only national set of regulations that governs the use and disclosure of private, confidential and sensitive information. Under HIPAA's Security Rule, the standards for the protection of electronic information covered by HIPAA are divided into three groups: Administrative safeguards, Physical safeguards and Technical safeguards. A couple of the most significant required safeguards under HIPAA are the Administrative "Sanction Policy" and "Security Awareness Training" safeguards. The sanction policy standard requires a communication to all employees regarding the disciplinary action that will be taken by the covered entity for violations of HIPAA. The sanction policy should have a notice of civil or criminal penalties for misuses or misappropriation of health information and make employees aware that violations may result in notification to law enforcement officials and regulatory, accreditation, and licensure organizations. The security awareness training standard requires all employees, agents, and contractors to participate in information security awareness training programs. Based on job responsibilities, the covered entity should require individuals to attend customized education programs that focus on issues regarding use of health information and responsibilities regarding confidentiality and security. The HIPAA privacy and security regulations require a privacy officer and security officer to be designated by the covered entity. The privacy and security officer should continually analyze and manage risk by thoroughly assessing potential risks and vulnerabilities, and implementing related security measures. The U.S. Department of Justice ("DOJ") clarified the penalties that may be assessed and against whom for HIPAA violations. Covered entities and individuals whom "knowingly" obtain or disclose individually identifiable health information in violation of HIPAA may be fined up to $50,000, as well as imprisonment up to one year. Offenses committed under false pretenses allow penalties to be increased--a $100,000 fine, with up to five years in prison. Finally, offenses committed with the intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain or malicious harm permit fines of $250,000, and imprisonment for up to ten years. Given the security breach that led to the tragic events, including the one-year jail term for the defendant, Hawaii employers, health care providers and health plans should review their privacy and HIPAA policies and conduct an audit of their practices in order to protect against the improper use and disclosure of private health information and to reduce the risk of privacy breaches in their own organization. Roman Amaguin, Esq. is a Hawaii lawyer specializing in employment law, labor law, and civil litigation. His philosophy is to provide practical solutions to both complex and common workplace, employer/employee, and civil disputes. As a Hawaii attorney, Mr. Amaguin regularly appears before all federal and state courts in Hawaii, as well as state and federal administrative agencies such as the U.S. EEOC and Hawaii Civil Rights Commission.

How Do You Get Your Family Health Information?

Who do you turn to for family health matters? If your child wakes up in the middle of the night and isn't feeling well what do you do? If your ache or pain hasn't gone after a couple of days, do you make an appointment to see the doctor, or do you just hope it will go away by itself? Do you know the difference between your baby or small child crying for attention and crying due to illness? If you don't know where you can get relevant and accurate health information, how do you know you're not suffering unnecessarily, or ignoring serious symptoms? Has someone you know been diagnosed with an illness or condition that you don't know anything about? Perhaps it's not the sort of thing that you want others to know about, so asking around might not be possible. Where can you get the accurate and easy to understand information you need quickly? If you do know where to look for your family health information, how accurate and true is it? Are you using an old book handed down through your family for generations? Do you ask somebody with tenuous medical knowledge or experience? What about online? The internet means that information can be obtained in seconds, but it's not always accurate or relevant, especially where health is concerned. There are always scare stories sites, or sites containing the opinions of people with no medical training. Even putting your symptoms into a more trustworthy site can lead you to believe that you could have a life threatening illness. If you do use a trusted source for your medical and health information, how often is it updated? If it is not updated regularly, or you are relying on a book from several years ago, then prevention and treatments could have changed dramatically. You wouldn't expect a 20 year old map to still be accurate, so why would you rely on a 20 year old medical book? Do you know what the latest treatments are for common family conditions? Have things changed over the last few years? If you're not sure, you'll need some way of finding out, so that you can be sure that you are providing accurate health information for your family when they need it most. There may have been significant advances in drugs, surgical procedures and other technology recently that will affect you. Are there any new treatments available for any existing conditions you or your family may have. What about asthma, hay fever, or allergies? You might want to keep on top of any new treatments for conditions that you or your family may have. Nutrition and exercise advice is important for those looking to lead an active and healthy life. Perhaps you're not sure where to get advice from if you want to take up a new sport or pastime, or start an exercise regime. In order to make things easier for you and your family, you'll want to try and find a single central source of medical and health information. You'll need to make sure that it is accurate and regularly updated, and that the information provided is easy to understand and relevant. This source of family health information might not go far enough for you, but it will certainly provide you with the basics. Whatever type of family health advice you're looking for, you'll need to make sure that it is accurate, and genuine. If you need Family Health information or advice, you'll want to make sure that it is accurate and trustworthy. Let Candis Magazine provide you and your family with all your Family Health information.

Health Information at Your Fingertips

We all are familiar with the saying, "an apple a day, keeps the doctor away." But no matter how many apples you eat, bottom line is you cannot run away from ailments. If you are born healthy without any defect of design then God almighty has been incredibly kind to you. Else if you are born with a problem or flaw then life gets quite challenging henceforth. This is when health information works as gospel to us. It's not that if you have all the health information in your bag then you become a superman, but it's important because it can keep you away from health problems or will guide you to the best possible cure, as much as possible. Having the latest health information not only enlightens us towards the latest cure, but also teaches us the 123's of proper health care and health information that can prevent us from illnesses. No matter what is the case, everyone should go for a thorough physical check up at least once a year, just to know how your body feels, it's exactly like our car servicing that we never forget to oblige. And as we all know human body is the most sophisticated machine we can ever think of, so undoubtedly it requires more care than a man made machine, by having proper health information. Because if the car fails to work, it could be replaced but the human body cannot be. Doctors, websites, government health agencies sometimes have free health information and check up just to make sure we are aware of the changing health scenario. Many big non-profits like Family Care International, Global Health Council, UNICEF, and Action Against Hunger have health care programs, which serve different sections of the society. You do not have to be a doctor to spread health information amongst people. If every single person in this society vows to catch up with the latest health information and spread it, then we can save millions of people across the world. Health information is the key to the growth of the society. Proper health and hygiene comes first in the development of a any class, community or nation. So many organizations and people across the world have dedicated themselves to the cause of health care and cure. So remember, it we take this one big step, it could lead to several other big steps and serve a whole class or community.

5 Simple Search Strategies to Find Quality Health Information on the Internet

Approximately 10 million people in the USA search online for information about their health, or the health of their loved ones, every single day. 140 million Americans have already undertaken such searches. A number of recent studies have reviewed this activity and three factors stand out: 1. Searching on the Internet for health information is a remarkably common activity in America 2. While many people find health information that seems helpful, most do not really know if it is reliable. 3. People trust doctors to deliver high quality health information, and information from the internet discussed with doctors, who are the "health information experts" often leads to changes in treatment. So what are the 5 search strategies? 1. Quick and dirty. For a quick simple search there is nothing wrong with doing rapid searches at Google or Yahoo , and at least scan the first 20 or so results. Just remember that Google displays two types of results, sites ranked by a commercially secret algorithmically derived measure of popularity, which is what most people look at first, and sponsored paid links. The second quick and dirty approach to undertake routinely is to go to a couple of quality information sites as your first stop beyond the search engines. I recommend wikipedia the amazing open source encyclopedia with great breadth and depth, but still with a level of inaccuracy, and MedlinePlus which is a Government run site and is, in my opinion, the best overall consumer health site on the Internet. Many patients want to go beyond this level of search however, and I would suggest the following strategies; 2 Professional journal searching There are several free programs on the Internet which allow you to search professional peer-reviewed scientific papers from the health and medical journals. The two main professional databases are: "Medline" at the NIH and "Psycinfo" at the American Psychological Association 3 Search evaluated Internet subject gateways The beauty of Internet searches is that you can pick up useful reliable information which hasn't always been published in peer-reviewed journals, but which has been checked for accuracy by teams of medical reviewers. The gateways I use are the US National Library of Medicine or Healthfinder in the US, and Intute or NHSDirect in the UK. Other sites are devoted to collecting peer-reviewed "best practice" treatment guidelines (guideline.gov ) which you can use to compare with your own treatment regime. If you want information on evidence-based medicine you cannot go past the Cochrane Library ( cochrane.org ) and I frequently recommend eMedicine (eMedicine.com) which is emerging as the "wikipedia of healthcare". 4 General Web searches Now we move to the open areas of the Internet that you will find via search engines. Here you will have to start questioning the quality of the information you retrieve much more critically as most of it will not have been subjected to any real quality review mechanism, and much will have a commercial bias. Use the methods at Discern.org.uk to evaluate the quality of information on general sites, and in principle tend to focus on mainstream sites run by government agencies or universities. 5 Discussion lists and newsgroups This is where you can waste most time, and where information is least reliable - but it can be fun, and is sometimes helpful, particularly if you want to communicate with others who have similar needs. You may even be lucky and join a group where there is a real expert. There are many groups on the Internet - just put in a search string with the word group, as well as whatever topic you are researching. The largest number of health related ones seem to currently be at Google groups Once you have undertaken your searches the most important next step is to discuss your findings with you doctor. The role of many doctors in gradually changing, and they are increasingly becoming "information analysts" helping patients find good quality health information that will lead to good healthcare decisions. More details are available in my book.

Biomedical Internet Blog - Searching For Health Information on the Internet

In a recent study, it was discovered that 80% of individuals who search for health information make use of general search engines like Google and Yahoo. Are they going to get optimum results? The obvious answer is no. In the same survey, it was also observed that 64% of the most searched health information is about diseases or medical problems. 51% of Internet users seeking health information search for medical treatment or procedure. 9% search for information on how to quit smoking while 8% search for information on drugs and alcohol. This article reveals the right Internet tool to use when searching for health information on the Internet and what kind of resources is available in the discovered tool. It is obvious that the general search engine cannot give optimum information on health related resources on the Internet. The solution to this problem is to look for a government database on health, which is reliable and historic. Medline Plus is where to go when searching for health information of any kind on the Internet. This site is a service of the United State's national library of medicine and the national institutes of health. The database showcases 750 health topics on conditions, diseases and wellness. Prescription tips and over-the-counter medicines, herbs and supplements are also made available. Medical Doctors and Allied health professionals will find the medical encyclopedia in the site, which include pictures and diagrams very useful. Whenever you want to refresh or remember certain medical terms, the dictionary page, which dwells on spellings and definitions of medical words come very handy. What about current news about health and press announcements? They are abundant in the site and you can subscribe to it through RSS feed. If you are bothered about health information in your locality, the page to go is the Go Local section, which provides service for finding local resources for health, related issues. There is a direct link to PUBMED and NIH (National Institute Of Health) at the bottom of the home page. What's more? Over 165 interactive tutorials with slide shows are conspicuously displayed at the upper right side of the home page. If you are interested on studies for new drugs, you will find the information at the clinical trials link. There are also videos of surgical procedures. Talk about more than enough focused health information on the Internet. You can never miss out when you go to Medlineplus.

Health Information Management Programs

Find Health Information Management Programs in the United States and Canada. Today, health information management programs are essential to candidates aspiring for job opportunities in physicians' offices, home healthcare businesses, outpatient clinics, hospitals, nursing homes and other medical facilities. While no two health information management programs are alike, it is essential to review course offerings at schools and career-training institutes that offer this and related programs. Though the majority of health information management programs are offered as degreed courses, a number of educational facilities may extend medical office specialist training, which can be completed as a job-specific course that results in a diploma or certificate. Health information management programs are often accredited, and require successful completion of certification from the American Health Information Management Association. Common studies in health information management programs include liberal arts, and comprehensive health services administration training. Graduates of health information management programs will have gained the knowledge and skills to successfully plan, direct, coordinate and supervise overall healthcare administration duties. Because healthcare managers (or medical and health service managers) must maintain client/patient records, it is critical that these healthcare workers continue education in computer technology and medical software to keep up with business demands. Though States vary in regulations, students who desire to work in nursing care facilities as health care administrators must complete one of several health information management programs and have obtained a minimum of a Bachelor's degree. In addition, a licensing examination is also required. According to the U.S. Bureau of Labor Statistics, growth in this field is expected to be positive; and individuals who have successfully completed all studies in any one of a number of health information management programs have the potential to achieve annual earnings of over $117k. Find your dream job! Let education within fast-growing industries like massage therapy, cosmetology, information technology, healthcare, business, and others get you started! Explore career school programs near you. Health Information Management Programs ©Copyright 2007 The CollegeBound Network All Rights Reserved NOTICE: Article(s) may be republished free of charge to relevant websites, as long as Copyright and Author Resource Box are included; and ALL Hyperlinks REMAIN intact and active.

Why You Need to Find Health Information

Health living is among the things that we are constantly being reminded to maintain. As the scene of this world keeps changing so are the hardships that we have to endure. When we ensure that we are living healthily, we would escape the other costs that would usually come along with infections. It is true that prevention is better than cure and this does not just apply when we are focusing on costs. We also need to understand that the inconvenience that would normally come from infections is too bad. When we have the right information we would escape all that. Health information promotes healthy living The information would help you understand what you need to do so that you never get into trouble with your health. It would be best when you try and apply whatever you would learn from the information that you get on health. Health information empowers you about drugs There are several drugs that we would usually be advised to take so that we get relief from the various conditions that we would be suffering. Yet, we would need to understand how the drugs work so that we never experience trouble when we are trying to use the drugs. Health information enlightens you on self care Self care is very important when we are discussing about health. You have a great role to play in the way your health responds and you just have to ensure that you are doing your part. With the right information, you would never miss to know what you should be doing as part of good self care. Health information educates you on diseases and conditions We need to know about the diseases and conditions that are likely to get us when we are trying to live healthy. However, all this has to be only when we have the right information that is also current and updates. So, there is need to get to the internet and see what the experts have to say. Health information is good for consumers As a consumer of health products, you need to have a wide knowledge of what the products are able to offer you. At the same time, you also should be able to indicate that you know how to work with the help that you have been granted to you. All this is available in form of information to you. Health information keeps physicians updated Yes, even the service providers have to keep updating themselves. With the field of health and medicine evolving each day, there is need to ensure that they have the latest information so that they help patients well. They are even supposed to be advisors and this required information. Health information educated other health providers There are other health providers other than the physicians. They also have a significant role to play and it is best that they know what they need to do as well. So, the information is equally important for them. In general, we can conclude that health information is important for everyone because we are all involved in the various aspects of health care. We need to get the latest information from the internet to be safe.

Health Information Technology - A Bright Future

The health care industry is getting more technologically advanced every year. And with those advances, comes a need for people who not only understand how to use the technology, but can help make innovations that will continue to advance the system. One of the degrees that can put you at the heart of all the action is a health information technology degree. This type of degree program will teach you how to use technology to collect, analyze, monitor, maintain and report health data. If you're interested in the medical field, a health information technology program offers a truly fascinating point from which to explore your passions and start your career. In the classroom and in the field, when you're enrolled in a health information technology program, you'll learn to process requests for the release of personal health information, code clinical information, process and use health data for clinical quality management, bill patients for services (and provide reimbursement) and learn compliance while protecting patient privacy. And frankly, the jobs you'll receive after you receive your health information technology degree will put you in a position of great responsibility and control. Post-Health Information Technology Program Jobs With the degree in hand, some of the positions you can expect to work in include: o Health Information Technician. Job responsibilities often include reviewing medical charts to check for completion and accuracy, generating reports and assigning diagnosis codes to medical charts for insurance claims and data collection purposes, plus gathering, analyzing and managing information about patients so healthcare providers can properly care for them. o Medical Coder. With a health information technology degree you can enter the field as a medical coder, which, because of its medical and business nature, is often a springboard for advancement opportunities within the healthcare sector. Some of the responsibilities of a medical coder include reviewing medical documents provided by physicians, then translating the information into numeric codes and sequencing diagnostic and procedural codes by using a standard healthcare coding system. This work is crucial to the financial reimbursement of healthcare professionals by the insurance companies that provide policies for the patients. o Health Information Administrator. After completing a health information technology program you may work as a healthcare administrator. In this position you will oversee (or as an entry-level job assist the person who oversees) the business of providing services to patients and manage the health information systems that house the medical facility's patient-related documents, insurance information, and business documentation. o Medical Secretary. Medical secretaries help maintain order in the office and provide the support necessary for proper patient care. Some of the job responsibilities may include transcribing dictation, generating correspondence, assisting physicians with reports, speeches, articles, and conference proceedings, as well as providing technological support and maintaining medical records. The Job Outlook According to a 2006-2007 U.S. Bureau of Labor Statistics (BLS) report, employment for medical records and health information technicians is expected to grow much faster than average for all occupations from now through 2014. A few highlights of the BLS report include: o Job prospects should be very good; technicians with a strong background in medical coding will be in particularly high demand. o Those entering the field will usually have an associate degree; courses include anatomy, physiology, medical terminology, statistics, and computer science. o Most employers prefer to hire Registered Health Information Technicians (RHIT), who must pass a written examination offered by the American Health Information Management Association (AHIMA). To take the examination, a person must graduate from a 2-year health information technology program accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM). Technicians who receive a Health Information Technology degree from a non-CAHIIM-accredited program or who are trained on the job are not eligible to take the examination. o Median annual earnings of medical records and health information technicians were $25,590 in 2004. The middle 50 percent earned between $20,650 and $32,990. The lowest 10 percent earned less than $17,720, and the highest 10 percent earned more than $41,760. With a job outlook so bright - and an education that's both challenging and exciting - choosing a health information technology degree program is an intelligent step to a rewarding career.

Obtaining health advice that is worthy is hard to come by. As a medical student, I am surrounded by mountains of resources, professionals and experiences from which you can benefit. I cannot diagnose, treat or prescribe but I can give health information which can help you with your situation. All information that you give in the email is purely confidential and will be deleted upon receipt. No information will be published anywhere. Why do we do provide a free health information service? Simply put -- because we care. I will have my doctorate in naturopathic medicine two years from now. I already have 3 years of intense medical training under my belt and that is after a B.Sc in Cell and Molecular Biology. I know that most people are completely bewildered with the health industry and are looking for ways to obtain health without spending a fortune and without the standard mechanistic medical protocol. Complementary and Alternative medicine is flourishing and it is due to results patients receive. Holistic medicine heals and restores health to numerous chronic health conditions that traditional medicine cannot touch. Our medical philosophy: Remove the cause of illness, treat the underlying issue and support the individual's mind and body. This is how medicine should be practiced. Treating the symptoms only encourages the illness to penetrate deeper and cause further harm. Some example health topics: * Asthma * Acne and other Skin Complaints * Diabetes Type I and II * Cardiovascular health * Attention Deficit Disorder * Losing Weight * Depression * Irritable Bowel Syndrome * Diets * Alternatives to Gall Bladder Removal * Cell salts - which one? * What should I eat? * Digestive problems * Chlorine issues * Food allergies and sensitivities This list is no way complete. Please write with any health question you have. All questions and responses are held strictly confidential to protect your privacy. I will respond with relevant health information, useful books, thoughts, product options and links. All health information given will contain references. If we do not know the answer, we will either refer you to a website or another useful source. I am not a substitute for a qualified physician. For a sampling of my writing, you may view a number of my articles published here. Take charge of your health. Education and being informed is the best way. Benjamin Lynch has a BS degree in Cell and Molecular Biology from the University of Washington. Currently, he is obtaining his doctorate in Naturopathic Medicine at Bastyr University. Visit Ben's natural health product store, HealthE Goods where one can use our free health information service [http://www.healthegoods.com/content/health_tips.htm] where one may ask specific health questions. We provide physician-grade non-prescription natural health products. Wholesale spa products are available to all that qualify. Do visit our Healthy Lifestyle and Wellness Blog. We are here to help serve the public with proper health information and effective products.

Rebuilding the Tower of Babel - A CEO's Perspective on Health Information Exchanges

Defining a Health Information Exchange The United States is facing the largest shortage of healthcare practitioners in our country's history which is compounded by an ever increasing geriatric population. In 2005 there existed one geriatrician for every 5,000 US residents over 65 and only nine of the 145 medical schools trained geriatricians. By 2020 the industry is estimated to be short 200,000 physicians and over a million nurses. Never, in the history of US healthcare, has so much been demanded with so few personnel. Because of this shortage combined with the geriatric population increase, the medical community has to find a way to provide timely, accurate information to those who need it in a uniform fashion. Imagine if flight controllers spoke the native language of their country instead of the current international flight language, English. This example captures the urgency and critical nature of our need for standardized communication in healthcare. A healthy information exchange can help improve safety, reduce length of hospital stays, cut down on medication errors, reduce redundancies in lab testing or procedures and make the health system faster, leaner and more productive. The aging US population along with those impacted by chronic disease like diabetes, cardiovascular disease and asthma will need to see more specialists who will have to find a way to communicate with primary care providers effectively and efficiently. This efficiency can only be attained by standardizing the manner in which the communication takes place. Healthbridge, a Cincinnati based HIE and one of the largest community based networks, was able to reduce their potential disease outbreaks from 5 to 8 days down to 48 hours with a regional health information exchange. Regarding standardization, one author noted, "Interoperability without standards is like language without grammar. In both cases communication can be achieved but the process is cumbersome and often ineffective." United States retailers transitioned over twenty years ago in order to automate inventory, sales, accounting controls which all improve efficiency and effectiveness. While uncomfortable to think of patients as inventory, perhaps this has been part of the reason for the lack of transition in the primary care setting to automation of patient records and data. Imagine a Mom & Pop hardware store on any square in mid America packed with inventory on shelves, ordering duplicate widgets based on lack of information regarding current inventory. Visualize any Home Depot or Lowes and you get a glimpse of how automation has changed the retail sector in terms of scalability and efficiency. Perhaps the "art of medicine" is a barrier to more productive, efficient and smarter medicine. Standards in information exchange have existed since 1989, but recent interfaces have evolved more rapidly thanks to increases in standardization of regional and state health information exchanges. History of Health Information Exchanges Major urban centers in Canada and Australia were the first to successfully implement HIE's. The success of these early networks was linked to an integration with primary care EHR systems already in place. Health Level 7 (HL7) represents the first health language standardization system in the United States, beginning with a meeting at the University of Pennsylvania in 1987. HL7 has been successful in replacing antiquated interactions like faxing, mail and direct provider communication, which often represent duplication and inefficiency. Process interoperability increases human understanding across networks health systems to integrate and communicate. Standardization will ultimately impact how effective that communication functions in the same way that grammar standards foster better communication. The United States National Health Information Network (NHIN) sets the standards that foster this delivery of communication between health networks. HL7 is now on it's third version which was published in 2004. The goals of HL7 are to increase interoperability, develop coherent standards, educate the industry on standardization and collaborate with other sanctioning bodies like ANSI and ISO who are also concerned with process improvement. In the United States one of the earliest HIE's started in Portland Maine. HealthInfoNet is a public-private partnership and is believed to be the largest statewide HIE. The goals of the network are to improve patient safety, enhance the quality of clinical care, increase efficiency, reduce service duplication, identify public threats more quickly and expand patient record access. The four founding groups the Maine Health Access Foundation, Maine CDC, The Maine Quality Forum and Maine Health Information Center (Onpoint Health Data) began their efforts in 2004. In Tennessee Regional Health Information Organizations (RHIO's) initiated in Memphis and the Tri Cities region. Carespark, a 501(3)c, in the Tri Cities region was considered a direct project where clinicians interact directly with each other using Carespark's HL7 compliant system as an intermediary to translate the data bi-directionally. Veterans Affairs (VA) clinics also played a crucial role in the early stages of building this network. In the delta the midsouth eHealth Alliance is a RHIO connecting Memphis hospitals like Baptist Memorial (5 sites), Methodist Systems, Lebonheur Healthcare, Memphis Children's Clinic, St. Francis Health System, St Jude, The Regional Medical Center and UT Medical. These regional networks allow practitioners to share medical records, lab values medicines and other reports in a more efficient manner. Seventeen US communities have been designated as Beacon Communities across the United States based on their development of HIE's. These communities' health focus varies based on the patient population and prevalence of chronic disease states i.e. cvd, diabetes, asthma. The communities focus on specific and measurable improvements in quality, safety and efficiency due to health information exchange improvements. The closest geographical Beacon community to Tennessee, in Byhalia, Mississippi, just south of Memphis, was granted a $100,000 grant by the department of Health and Human Services in September 2011. A healthcare model for Nashville to emulate is located in Indianapolis, IN based on geographic proximity, city size and population demographics. Four Beacon awards have been granted to communities in and around Indianapolis, Health and Hospital Corporation of Marion County, Indiana Health Centers Inc, Raphael Health Center and Shalom Health Care Center Inc. In addition, Indiana Health Information Technology Inc has received over 23 million dollars in grants through the State HIE Cooperative Agreement and 2011 HIE Challenge Grant Supplement programs through the federal government. These awards were based on the following criteria:1) Achieving health goals through health information exchange 2) Improving long term and post acute care transitions 3) Consumer mediated information exchange 4) Enabling enhanced query for patient care 5) Fostering distributed population-level analytics. Regulatory Aspects of Health Information Exchanges and Healthcare Reform The department of Health and Human Services (HHS) is the regulatory agency that oversees health concerns for all Americans. The HHS is divided into ten regions and Tennessee is part of Region IV headquartered out of Atlanta. The Regional Director, Anton J. Gunn is the first African American elected to serve as regional director and brings a wealth of experience to his role based on his public service specifically regarding underserved healthcare patients and health information exchanges. This experience will serve him well as he encounters societal and demographic challenges for underserved and chronically ill patients throughout the southeast area. The National Health Information Network (NHIN) is a division of HHS that guides the standards of exchange and governs regulatory aspects of health reform. The NHIN collaboration includes departments like the Center for Disease Control (CDC), social security administration, Beacon communities and state HIE's (ONC).11 The Office of National Coordinator for Health Information Exchange (ONC) has awarded $16 million in additional grants to encourage innovation at the state level. Innovation at the state level will ultimately lead to better patient care through reductions in replicated tests, bridges to care programs for chronic patients leading to continuity and finally timely public health alerts through agencies like the CDC based on this information.12 The Health Information Technology for Economic and Clinical Health (HITECH) Act is funded by dollars from the American Reinvestment and Recovery Act of 2009. HITECH's goals are to invest dollars in community, regional and state health information exchanges to build effective networks which are connected nationally. Beacon communities and the Statewide Health Information Exchange Cooperative Agreement were initiated through HITECH and ARRA. To date 56 states have received grant awards through these programs totaling 548 million dollars. History of Health Information Partnership TN (HIPTN) In Tennessee the Health Information Exchange has been slower to progress than places like Maine and Indiana based in part on the diversity of our state. The delta has a vastly different patient population and health network than that of middle Tennessee, which differs from eastern Tennessee's Appalachian region. In August of 2009 the first steps were taken to build a statewide HIE consisting of a non-profit named HIP TN. A board was established at this time with an operations council formed in December. HIP TN's first initiatives involved connecting the work through Carespark in northeast Tennessee's s tri-cities region to the Midsouth ehealth Alliance in Memphis. State officials estimated a cost of over 200 million dollars from 2010-2015. The venture involves stakeholders from medical, technical, legal and business backgrounds. The governor in 2010, Phil Bredesen, provided 15 million to match federal funds in addition to issuing an Executive Order establishing the office of eHealth initiatives with oversight by the Office of Administration and Finance and sixteen board members. By March 2010 four workgroups were established to focus on areas like technology, clinical, privacy and security and sustainability. By May of 2010 data sharing agreements were in place and a production pilot for the statewide HIE was initiated in June 2011 along with a Request for Proposal (RFP) which was sent out to over forty vendors. In July 2010 a fifth workgroup,the consumer advisory group, was added and in September 2010 Tennessee was notified that they were one of the first states to have their plans approved after a release of Program Information Notice (PIN). Over fifty stakeholders came together to evaluate the vendor demonstrations and a contract was signed with the chosen vendor Axolotl on September 30th, 2010. At that time a production goal of July 15th, 2011 was agreed upon and in January 2011 Keith Cox was hired as HIP TN's CEO. Keith brings twenty six years of tenure in healthcare IT to the collaborative. His previous endeavors include Microsoft, Bellsouth and several entrepreneurial efforts. HIP TN's mission is to improve access to health information through a statewide collaborative process and provide the infrastructure for security in that exchange. The vision for HIP TN is to be recognized as a state and national leader who support measurable improvements in clinical quality and efficiency to patients, providers and payors with secure HIE. Robert S. Gordon, the board chair for HIPTN states the vision well, "We share the view that while technology is a critical tool, the primary focus is not technology itself, but improving health". HIP TN is a non profit, 501(c)3, that is solely reliant on state government funding. It is a combination of centralized and decentralized architecture. The key vendors are Axolotl, which acts as the umbrella network, ICA for Memphis and Nashville, with CGI as the vendor in northeast Tennessee.15 Future HIP TN goals include a gateway to the National Health Institute planned for late 2011 and a clinician index in early 2012. Carespark, one of the original regional health exchange networks voted to cease operations on July 11, 2011 based on lack of financial support for it's new infrastructure. The data sharing agreements included 38 health organizations, nine communities and 250 volunteers.16 Carespark's closure clarifies the need to build a network that is not solely reliant on public grants to fund it's efforts, which we will discuss in the final section of this paper. Current Status of Healthcare Information Exchange and HIPTN Ten grants were awarded in 2011 by the HIE challenge grant supplement. These included initiatives in eight states and serve as communities we can look to for guidance as HIP TN evolves. As previously mentioned one of the most awarded communities lies less than five hours away in Indianapolis, IN. Based on the similarities in our health communities, patient populations and demographics, Indianapolis would provide an excellent mentor for Nashville and the hospital systems who serve patients in TN. The Indiana Health Information Exchange has been recognized nationally for it's Docs for Docs program and the manner in which collaboration has taken place since it's conception in 2004. Kathleen Sebelius, Secretary of HHS commented, "The Central Indiana Beacon Community has a level of collaboration and the ability to organize quality efforts in an effective manner from its history of building long standing relationships. We are thrilled to be working with a community that is far ahead in the use of health information to bring positive change to patient care." Beacon communities that could act as guides for our community include the Health and Hospital Corporation of Marion County and the Indiana Health Centers based on their recent awards of $100,000 each by HHS. A local model of excellence in practice EMR conversion is Old Harding Pediatric Associates (OHPA) which has two clinics and fourteen physicians who handle a patient population of 23,000 and over 72,000 patient encounters per year. OHPA's conversion to electronic records in early 2000 occurred as a result of the pursuit of excellence in patient care and the desire to use technology in a way that benefitted their patient population. OHPA established a cross functional work team to improve their practices in the areas of facilities, personnel, communication, technology and external influences. Noteworthy was chosen as the EMR vendor based on user friendliness and the similarity to a standard patient chart with tabs for files. The software was customized to the pediatric environment complete with patient growth charts. Windows was used as the operating system based on provider familiarity. Within four days OHPA had 100% compliance and use of their EMR system. The Future of HIP TN and HIE in Tennessee Tennessee has received close to twelve million dollars in grant money from The State Health Information Exchange Cooperative Agreement Program.20 Regional Health Information Organizations (RHIO) need to be full scalable to allow hospitals to grow their systems without compromising integrity as they grow.21and the systems located in Nashville will play an integral role in this nationwide scaling with companies like HCA, CHS, Iasis, Lifepoint and Vanguard. The HIE will act as a data repository for all patients information that can be accessed from anywhere and contains a full history of the patients medical record, lab tests, physician network and medicine list. To entice providers to enroll in the statewide HIE tangible value to their practice has to be shown with better safer care. In a 2011 HIMSS editor's report Richard Lang states that instead of a top down approach "A more practical idea may be for states to support local community HIE development first. Once established, these local networks can feed regional HIE's and then connect to a central HIE/data repository backbone. States should use a portion of the stimulus funds to support local HIE development."22 Mr. Lang also believes the primary care physician has to be the foundation for the entire system since they are the main point of contact for the patient. One piece of the puzzle often overlooked is the patient investment in a functional EHR. In order to bring together all the pieces of the HIE puzzle patients will need to play a more active role in their healthcare. Many patients do not know what medicines they take every day or whether they have a living will. Several versions of patient EHR's like Memitech's 911medical id card exist, but very few patients know or carry them.23 One way to combat this lack of awareness is to use the hospital as a catch-all and discharge each patient with a fully loaded USB card via case managers. This strategy also might lead to better compliance with post in patient therapies to reduce readmissions. The implementation of connecting qualified organizations began earlier this year. To fully support organizations to move toward qualification the Office of National Coordinator for HIE (ONC) has designated regional education centers (TN rec) who assist providers with educational initiatives in areas like HIT, ICD9 to ICD10 training and EMR transition. Qsource, a non-profit health consulting firm, has been chosen to oversee TNrec. To ensure sustainability it is critical that Tennessee build a network of private funding so that what happened with Carespark won't happen to HIP TN. The eHealth Initiatives 2011Survey Report states that of the 196 HIE initiatives, 115 act independently of federal funding and of those independent HIE's, break even through operational revenue. Some of these exchanges were in existence well before the American Recovery and Reinvestment Act in 2009. Startup funding from grants is only meant to get the car going so to speak, the sustainable fuel, as observed in the case of Carespark, has to come from value that can be monetized. KLAS research reports that 54% of public HIE's were concerned about future sustainability while only 35% of private HIE's shared this concern. Hospital Implications of HIP TN (A Call to Action) From a Financial perspective, taking our hospital into the future with EMR and an integrated statewide network has profound implications. In the short term the cost to find a vendor, establish EMR in and outpatient will be an expensive proposition. The transition will not be easy or finite and will involve constant evolution as HIP TN integrates with other state HIE's. To get a realistic idea of the benefits and costs associated with health information integration. we can look to HealthInfoNet in Portland, ME, a statewide HIE that expects to save 37 million dollars in avoided services and 15 million in productivity reduction. Specific areas of savings include paper or fax costs $5 versus $0.25 electronically, virtual health record savings of $50 per referral, $26 saved per ED visit and $17.41 per patient/year due to redundant lab tests which amounts to $52 million for a population of 3 million patients. In Grand Junction Colorado Quality Health Network lowered their per capita Medicare spending to 24% below the national average, gaining recognition by President Obama in 2009. The Santa Cruz Health Information Exchange (SCHIE) with 600 doctors and two hospitals achieved sustainability in the first year of operation and uses a subscription fee for all the organizations who interact with them. In terms of government dollars available, meaningful use incentives exist to encourage hospitals to meet twenty of twenty five objectives in the first phase (2011-2012) and adopting and implement an approved EHR vendor. ARRA specified three ways for EHR to be utilized to obtain Medicare reimbursement. These include e-prescribing, health information exchange and submission of clinical quality measures. The objectives for phase two in 2013 will expand on this baseline. Implementation of EHR and Hospital HIE costs are usually charged by bed or by the number of physicians. Fees can range from $1500 for a smaller hospital up to $12,000 per month for a larger hospital. Perhaps the most compelling argument to building a functional Health Information Exchange is patient and community safety. The Healthbridge reduction in disease outbreak detection of 3-5 days is a perfect example of this safety benefit. Imagine the implications in the case of a rampant virus like avian or swine flu. The goal is to avoid a repeat of the 1918 influenza outbreak and ultimately save the lives of our most at risk. Rick Krohn of Healthsense makes the case for a socially responsible HIE that serves those who are chronically ill, uninsured and homeless. As the taxpayers ultimately bear the societal burden for our country's healthcare coverage, the need to reduce redundancies, increase efficiency and provide healthcare worthy of the United States is imperative. Right now our healthcare is in the Critical Care Unit it's time to stabilize it through operational excellence starting with our hospital. Let's rebuild the Tower of Babel and enhance communication to provide our patients the healthcare they deserve!