Introduction to business law multiple choice review questions?

1. Don wants to exchange his performance for Earl’s promise. As consideration, performance that is legally sufficient may consist of
a. an act only.
b. a forbearance from an act only.
c. an act or a forbearance from an act.
d. none of the above.

2. Ken relinquishes the right to his son Lee’s control, care, custody, and earnings. This act is
a. a disaffirmance.
b. an emancipation.
c. a ratification.
d. restitution.

3. Cray returns a digital music player that he bought from Discount City, which refunds the price. Their exchange involves
a. an emancipation.
b. a ratification.
c. restitution.
d. severability.

4. Curt, a doctor, renders medical care to Dora, a minor. According to the reasoning of the court in Yale Diagnostic Radiology v. Estate of Harun, a contract between Curt and Dora is
a. express.
b. implied in fact.
c. implied in law.
d. non-existent.

5. Intoxicated but fully aware of the consequences, Uri agrees to a two-year cell-phone service contract with Wander Talk, Inc., at more than the average market price. This contract is
a. enforceable.
b. not enforceable because contracting parties can change their minds.
c. not enforceable because the contract clearly favors Wander Talk.
d. not enforceable because Uri was intoxicated when he agreed to it.

6. Odell owns Payroll Company, a bookkeeping service losing market share to Quik Work, Inc. Odell pays Remy ,000 to steal a list of Quik’s clients, to whom Odell will aggressively market Payroll‘s services. This deal is
a. enforceable.
b. void.
c. voidable at the option of either party.
d. voidable at the option of the party having less bargaining power.

Medical Schools in California?

I’m looking for a college or university, preferrably a UC, that offers premed or radiology/digital imaging as one of their majors. I’ve tried searching at collegeboard, but the results I received were not consistent with my other college searches. For example, Collegeboard says that only UC Riverside offers Premedicine as a major, but I found a ranking of medical schools in the US that includes a lot of other UC’s. Please help. Who should I ask or where should I go for the most accurate information?

Is willowbrook methodist hospital in Houston a good hospital to work at?

I am wanting to apply for a job as a Radiology Tech at Willowbrook methodist hospital near 1960 and 249 in houston. Can anyone tell me if they are a good hospital? Do they use CR or digital, what is the crime rate in that neck of the woods? Any info would be great. Thanks..also, how is traffic over there? thanks

Curious about types of imaging equipment, radiology?

I’m curious about which imaging equipment does not use some form of ionizing radiation?
a. Fluoroscopy
b. Computed tomography
c. PET
d. MRI
e. digital imaging
f. nuclear medicine
g. sonography

difference bet ween computer radiology and digital radiology?

Can anyone describe Direct Digital Radiography Systems as well as Computed Radiology Systems?

General Information about Digital Radiology…?


I was wondering if anybody could give me some general(and if you have the time)and specific information about the Digital Radiology. Basically what it is, how it’s done, the differences(comparing to analogue) . Thanks alotttt ;)

What is Digital Radiology?

Hi, I was wondering if anybody could give me some general(and if you have the time)and specific information about the Digital Radiology. Basically what it is, how it’s done, the differences(comparing to analogue) . Thanks alotttt ;)

Integrating a Mini-PACS Workstation

The mini-PACS (Picture Archive and Communication System) as you are aware is a type of PACS that is specific to one type of medical imaging modality, such as computed tomography (CT) or magnetic resonance imaging (MRI). The current trend today is toward full PACS RIS integration however. This presents many advantages, as this will facilitate sharing of these images over different platforms, improving diagnoses and allowing for greater opportunities for consultations when needed.

This process is already going on at large for-profit medical centers and major university hospitals; however, for smaller health care facilities and non-profits, often the decision is more complex. This is particularly true of specialty clinics and radiology facilities that focus on one type of medical issue and a single type of modality. Is it better to go with a mini-PACS that serves present needs and deal with the problem of integration when it comes, or should the facility make the costly investment of a full PACS-RIS?

Fortunately, drops in the cost of technology have made such components as the PACS server more affordable for smaller and less well-funded clinics and health care facilities. The web-based PACS makes integration of older specialized systems much less expensive than even a few years ago; prices on a fully-functional PACS-RIS that is capable of reading, processing and storing a wide range of medical images in various modalities start at around $5000.

Granted, a lower-end PACS-RIS will have some limitations; however, it may be the best choice for smaller clinics as it will allow the facility continue to provide much-needed patient services while upgrading its equipment in stages as finances allow.

Keep in mind that due to several factors, there is currently a shortage of qualified radiologists. With a web-based PACS possible to consult with a radiologist almost anywhere in the country. It is possible to add a radiology component to an existing mini-PACS for a reasonable cost; in fact, many such specialized systems have elements  radiology imaging built-in.

If yours in a clinic that deals with a single modality, just be aware that because of economics, demographics and a greater need for efficiency, the trend is toward full PACS integration; stand-alone applications will become increasingly rare. Advance planning and some research into the various PACS options available will be of great help for smaller clinics, non-profit facilities and even private practices when it comes to preparation for full PACS integration and the moving toward the establishment of a full-service facility.

Wayne Hemrick writes about–Integrating a mini-pacs Workstation.

HIPAA Medical Transcription Company

HIPAA compliant medical transcription companies provide quality-oriented digital medical transcription and related services to hospitals, physicians, outpatient clinics and healthcare facilities. Medical transcription services are available for a number of specialties including orthopedics, pediatrics, gastroenterology, radiology, cardiology and many more. One of the major advantages of hiring a medical transcription company is that it provides digitalized documentation with perfect accuracy. There is a steady increase in the demand for medical transcription companies since most of these ensure cost-effective and high quality transcription services.

Ensures the Privacy of Medical Records

The Health and Human Services department has implemented the Health Insurance Portability and Accountability Act (HIPAA) to safeguard the privacy of medical records, prohibiting the usage of personal information for any other purpose. HIPAA compliant medical transcription companies guarantee total confidentiality for client data. Therefore it is important to verify that a medical transcription company is HIPAA compliant. Besides ensuring privacy of medical records, such companies provide secure FTP and browser based file transferring.

Highly Skilled Professionals and Timely Completion of Projects

Medical transcription companies offer transcription of history and physical reports, ER reports, clinic notes, follow up notes, consultation reports and health reports. The role of an expert transcriber is important for achieving perfect documentation. To change voice-recorded files into data files medical transcription companies employ highly skilled and experienced transcription professionals. They offer speedy and reliable solutions utilizing advanced technology and the best digital devices. To maintain high accuracy in transcription, the companies usually have in-house proofreaders, editors and quality analysts to ensure three levels of quality assurance. Furthermore, medical transcription companies complete projects with an accuracy rate of 99% within minimum turnaround time.

A Range of Companies to Choose from

Several HIPAA compliant medical transcription companies provide quick, reliable and cost-effective client-focused services that maintain high quality. Depending on the requirements of the clients these service providers offer short term and long term services. Outsourcing your medical transcription to dependable service providers is bound to take a great workload off your shoulders, giving you more time to focus on your patients.

MTS Transcription Services (MTS), a medical transcription company, provides supreme medical billing and medical transcription services to hospitals, outpatient clinics, physicians and health care facilities of all specialties and sizes across the US.

10 reasons to switch to EHR

An Electronic health record or EHR refers to an individual patient’s medical record in digital format. Electronic Health Records or EHR is an emerging technology .  The question that is frequently asked is, What does it do? How it works? How can it help in medical world? Basically EHR is a software that manages the health records of the patients in an efficient way. EHR basically converts the patient’s record in digital format.  As it is an emerging technology It is still not yet widely used, but those who had, considered it to be the most reliable source for storage and retrieval of individual records with computer aid. EHRs are usually accessed over a network on a computer. It consists of electronic medical records (EMRs) from remote locations, and those records are in different formats like patient demographics, medical history, medicine and allergy lists (including immunization status), laboratory test results, radiology images, billing records and advanced directives.

There are several benefits to switch to electronic health records.

Top 10 Benefits to switch to EHR:

Reduce Errors:

Electronic Health Records (EHR) has proven to reduce the rate of medical errors. It manages all the records of the patients in one place so that all the data will remain synchronized . It  also helps healthcare workers with decision support and provides fast access to medical literature and current best practices in medicine which enable proliferation of ongoing improvements in healthcare efficacy.

Rapid and Remote Access:

EHR provides  Rapid and remote access to patient information to doctors and medical staff. They  can access the information of their patients from anywhere in the world. This retrieval of data helps them to proceed with the treatment of the patient no matter wherever they are. In case of emergency they can  forward the information to other clinicians for further reference without any delay.

Classified information:

Another reason to switch to EHR system is its ability to categorize and specify the information in well maintained manner. Once the data has been entered, it’s safe and it will be categorized in its respective departments. For instance, the time and date of the patient’s arrival and the treatment suggested and the time of discharge from the hospital, drugs prescribed, all can be entered in their specific columns and can be easily traced out later.

Accuracy of information:

Adopting an EMR in your practice helps standardize chart quality and minimize problems that can occur as a result of illegible handwriting, inconsistencies in documentation and other common human errors. Once Information stored it is not prone to human error and it can be retrieved on request of the patient or doctor. This saves time for both the patients and doctors.

Diagnosis and Testing:

With EMR, Duplication of lab tests, diagnostic imaging, work-ups, and other services can be prevented by good record-keeping of any type, because electronic records can be available at many locations at once, integration of services and awareness of duplication is facilitated. Physicians can also prescribe medicines from different pharmacies. The list of pharmacies is integrated into the software to rule out the possibility of any error. This system  also allow doctors to perform diagnostic tests online and view the results.

Reduced Cost in long term:

 One of the major sources of rapid growth in healthcare costs comes from medical imaging. Medicare spending on imaging rose from $6.80 billion in 2000 to $14.11 billion in 2006. Access to a patient’s images in an EHR is an effective way to avoid duplicating expensive imaging procedures. Another high cost to healthcare is the printing and mailing of check which will be handled electronically via direct deposit. Other cost savings include the reduction of medical errors that can otherwise lead to further expensive care.

Storage of Information:

In EMR Information can be stored in many ways. As  information is stored in digital format, it can be in the form of notes, reports, other documentations, facts and figures about the patient’s disease and prescriptions. EMR provides quick access to records

Updates and Notifications:

The best part of this software is the updates section. Whenever a patient’s information has been entered and then later modified, system will automatically update the new information and would send the notification. Hence, the doctor would just have to enter the name of the patient in the software and the whole information of that person would come up including the latest updates as well.

Privacy Issues:

The main concern of the patients is that their privacy has been respected or not. With the help of this software, one can be completely satisfied as far as the privacy issues are concerned. Since the data that has been stored manually in papers can easily be traced by anyone, this would not be possible with EMR Systems Information stored in it would be kept completely confidential. Passwords can be applied and information can be limited so that only the doctor can access it.

Increased Revenue Generation:

The software can be very beneficial in boosting up your business. Integration of the billing system with EMR helps in generating customized reports. Easy access to all supporting documents/reports required for claim processing helps in managing the entire process in a far more effective way – compared to a stand-alone billing system. Also in case of audits, complete patient charts and documentation is available for verification. Some EMR providers also offer the facility of instant online check for insurance eligibility to verify a patient’s medical benefits. This information provides assurance that the insurance record on file is current before services are delivered.

Daniel Ray MD Healthcare EMR Systems | EHR

Web Pacs Enable Real-time Collaboration and Consultation

It’s true; thanks to modern web PACS (Picture Archive and Communication systems), medical professionals are no longer limited by time and space as to with whom they can collaborate and consult for difficult cases. Viztek® PACS are only one of the web PACS available using the DICOM imaging protocol, but its numerous user-friendly and cost effective features have quickly made it one of the most popular among health care professionals.

A Short History of Web PACS One of the first digital medical imaging systems was put into place at the Department of Radiology at the Ohio State University Medical Center back in 1992 – almost at the beginning of the Internet Era. The cost exceeded well over a quarter million dollars; as you might imagine, this exorbitant price tag but such pacs servers out of reach for all but the most prestigious and well-funded medical facilities.

Nonetheless, this web PACS has proved to be an excellent investment; over the past decade and a half, the OHUMC system has paid for itself four times over, and has reduced the time between initial patient diagnosis and physician dictation to three hours – resulting in a savings of over 7000 man-hours. Meanwhile, the cost of PC-based technology has continued its steep decline over the past several years, and this has affected the cost of digital PACS servers as well. Today, there is no clinic or other health care facility that can afford to be without a reliable web based PACS. The DICOM Advantage DICOM web based PACS such as the Vistek® PACS make it possible for medical images made in any modality to be viewed by authorized personnel using a standard PC monitor over a local area network as well as the World Wide Web. What this means for health care professionals is greater access to colleagues when consultation and collaboration is required – which can now be carried out over the Internet in real time.

No longer is it necessary to risk having valuable medical images hand delivered either via post or courier. In addition, web based PACS have made archival chores much easier and more efficient. Medical images can be digitally archived using a server and backed up onto DVDs or compact discs in any way that works best for the clinic or practice. A patient’s x-rays or MRI results, saved in DICOM format, can be stored in the same digital file as his/her insurance information and medical history, and quickly located using the Windows or Safari search function on PC or Macintosh platforms. In addition the Vistek® PACS offers additional user-friendly features that are definitely worth learning about. Economical and efficient, a web pacs is something no health care facility should be without. web based pacs are the future of diagnostic medicine and records-keeping, and thanks to the continuing drop in the cost of PC technology, web PACS are more affordable than ever.

Jonathon Blocker writes about web based pacs. With installations at over 450 imaging centers and hospitals; Dicom Solutions is one of the leading distributors in the medical imaging industry.

Dicom Pacs Help Your Medical Office Run More Smoothly

Dicom pacs is the wave of the future at medical offices and hospitals of all sizes and specialties. An efilm workstation, along with a dicom viewer, allows your medical team to work more efficiently and enables you to provide better care for your patients.

A dicom pacs, or picture archiving and communications system, does a lot of the work that was once done tediously by hand instead by a computer. A pacs system utilizes the speed and maneuverability of the Internet to make life in the medical office much easier for everyone. You can take digital images and enhance them with an efilm workstation. You can archive the images, view them on your dicom viewer, and distribute them to authorized diagnosticians regardless of their locale as long as they have Internet access. Dicom pacs is also versatile. You can look at ultrasounds, MRIs, CT scans, mammograms, and x-rays of all types. All types of medical facilities can use dicom pacs, including dental, veterinary, mammography, radiology and chiropractic clinics. An efilm workstation utilizing dicom pacs offers storage and retrieval capabilities that were very costly in the past but now are much more cost effective by going digital. Because you are working online, you can send images to your colleagues down the hall in your office or around the world in the same amount of time. In times past, the physical storage of digital images was costly and burdensome, requiring a great deal of space and hours of physical maintenance. Now storage and retrieval can be done with the click of a mouse with dicom viewers.

Digital images can be downloaded to CDs for compact storage. Backing up digital images is also easier; they can be stored on a server both onsite as well as offsite, allowing you to keep a copy of all your records in a safe place should disaster strike at the office, and the records there are damaged by fire or water. A dicom viewer can be connected to a printer. This allows you to print images when there are times that you need a hard copy. A dicom viewers also offers other features impossible with film images. You can use the dicom viewer equipped with pacs to allow you to crop, rotate, or zoom in on a particular spot on the image. You can adjust the brightness or contrast easily. These types of adjustments can mean the difference between accurate and faulty diagnoses, so dicom pacs gives you a sharper image for more accurate diagnoses. Using pacs makes imaging, storing, retrieval and distribution easier for all medical personnel at your clinic.

Jonathon Blocker writes about dicom pacs. With installations at over 450 imaging centers and hospitals; Dicom Solutions is one of the leading distributors in the medical imaging industry.

RHIO Interoperability Case Study

The Philadelphia Health Information Exchange


The Philadelphia Health Information Exchange (PHIE), the nation’s first diagnostic imaging exchange was launched in 2003. The network links healthcare providers in one of the largest and most demanding US healthcare markets encompassing some 4 million patients, 55 hospitals and 30 competing health systems.

In linking unaffiliated, even competing, medical facilities together, the PHIE enables the private, secure and seamless movement of patient digital medical records to speed and improve care across the region.

The exchange is based on Hx Technologies’ patent-pending iHistory® platform. iHistory features a distributed (“federated” or “peer-to-peer”) architecture, a design that is optimized for collaboration among competing enterprises and capable of interoperability with other regional exchanges and the anticipated nationwide health information network (NHIN).

The PHIE has focused initially on the sharing of diagnostic imaging data (both images and reports) with expansion to other clinical domains slated for later expansion.

Scope and Expansion

PHIE currently connects patient medical information across multiple disparate institutions, enabling interoperability across many different legacy systems. Initial participants include:

* The Hospital of the University of Pennsylvania

* Thomas Jefferson University Hospital

* Albert Einstein Medical Center

* Children’s Hospital of Philadelphia

* Presbyterian Medical Center

* Pennsylvania Hospital

* UPHS Community Radiology

* Philadelphia Department of Public Health

Expansion to additional data providers and clinical users continues on a daily basis.


To date, the exchange enables physicians at participating facilities to securely access some 5 million imaging studies (which represents over 200 million total images) across 300,000 unique patients.

The PHIE effort has dual clinical and research tracks. On the clinical side, the exchange supports collaborations on patients shared between disparate organizations across departments including radiology, neurosurgery, fetal surgery, plastic surgery, neonatology, neurology, and obstetrics and gynecology. On the research side, investigators from participating sites and Hx Technologies are evaluating the impact of health information exchange along financial and clinical dimensions.


Forrester Research recently completed a study of the Regional Health Information Organization (RHIO) market. Forrester defined a functioning RHIO as one that is that is in active clinical use across a broad cross-section of competing provider institutions. According to Forrester’s study, PHIE is one of only 7 functioning health information exchanges in the US. Of the seven identified by Forrester, the Philadelphia Health Information Exchange was one of only two functioning exchanges operated by a for-profit venture and unique in targeting the largest regional population of all functioning exchanges.

The National Institute of Biomedical Imaging and Bioengineering (NIBIB) and the National Cancer Institute (NCI) continue to recognize the importance of the exchange through their continued financial support of some $2.3 million to date.

Hx Technologies (HxTI) is a technology-based provider of healthcare services dedicated to managing the cost of diagnostic imaging and other medical procedures whose unattended growth threatens patient access to affordable, high-quality care.

We work with healthcare payers, providers, and regional health information organization (RHIOs) to eliminate the redundant procedures responsible for 15% of total spend on diagnostic imaging and which expose patients to unecessary raditation.

Further, we enable patients’ medical information to follow them privately and seamlessly wherever they receive care to ensure that their physicians are equipped to provide the most accurate diagnoses and timely interventions.

Conquest Dicom the Ultimate Image Management Tool

The  standard of DICOM or the Digital Imaging and Communications in Medicine was created by the National Electrical Manufacturers Association. DicomWorks help in the analysis and distribution of medical images including CT scans, MRIs, and ultrasound. Image files which are compliant with part 10 of the Dicom standard is often referred to as DICOM format files. Now, radiologists from all over the world can download the complete copy of the standard to add greater precision to their diagnosis.

Typically a DICOM file contains text as well as images. Information such as the  patient’s name and the type of scan can be stored in these files apart from comprehensive image data, which can also include 3D images. However, in the commonly used Analyze format, the image files and header data are stored in two different files. DICOM file images can be compressed to make room for many images whereas in Analyze format, the images cannot be compressed hence only a few images can be stored in each file. Another advantage in DICOM format is that files can be compressed in JPEG format or Run-Length Encoding format. DICOM is helpful in radiology outsourcing as well as it is the most commonly used standard for receiving scans from a hospital. There are many software packages like My freeware MRIcro software, which will easily convert most DICOM images to and from Analyze format.

With DicomWorks, you can easily view, share, and present your DICOM files. Conquest dicom software written by Marcel van Herk and Lambert Zijp can be used for  DICOM image viewing and slide making,DICOM caching and archive and DICOM image selection, editing, and splitting and merging of series among others.

Radiology conferences and radiology books are ideal sources to learn more about the latest software tools like Dicom images and fetal MRI, which helps in taking images of the  fetus in the womb in less than one second. The multi planar views will help the doctors to make accurate diagnoses of various conditions affecting the baby. Fetal MRI is a useful tool for the physicians to plan life saving surgeries and post natal treatments. Though many consider Ultrasound as the first screening method in pregnancy even today, MRI has evolved to be a problem solving tool, which can go a long way in solving life threatening conditions. It has proved to be a powerful arsenal to deal with fetal abnormalities and develop more effective strategies for dealing with these conditions.

For more information about Dicomworks, Conquest dicom and Chest wall syndrome. Please visit

Faster, More Accurate Diagnoses With Pacs Systems

More and more, health care facilities are discovering the benefits of PACS systems when it comes to diagnosing health disorders faster and more accurately than ever before. The reason is digital imagery, which allows us to see more clearly into the human body without the need to resort to invasive procedures than ever before. However, this is only one of the benefits of modern pacs systems.

A Short History Digital imagery is nothing new; it has been used in film and television since the mid-1980s. However, at the time, this technology was slow, cumbersome and extremely expensive. It did however lay the foundation of digital Picture Archive and Communications, or PAC systems that would revolutionize diagnostic medicine during the following decade.

The first such system to find its way into the health care industry was a Radiology Information System or RIS PACS at the Ohio State University Medical Center Radiology Department in 1991. At that time, only well-funded hospitals could afford PACS systems; the OSU system cost hundreds of thousands of dollars. However, the center’s RIS PACS more than paid for itself over the course of the next ten years. By 2001, the Radiology Department was able to replace their old photo development lab and its costly materials, toxic chemicals and labor intensive procedures with new PC-based pacs workstations.

In addition, their physicians were able to dramatically decrease the amount of time spent in diagnosing and dictating cases; the entire procedure could be completed in three hours. Since that time, there have been incredible drops in the cost of computer hardware, particularly processors, RAM and most importantly, storage media. A RIS PACS system can archive vast quantities of digital files on a server, eliminating the need for large storage rooms with endless rows of file folders. In addition, using their PACS workstations, clinic personnel can create complete patient archives that include not only image data from MRI or CAT scans, but also sound files of dictation, word documents and other data – all stored in one place and easily retrieved when needed. A New Era in Consultation Even television’s Dr. House gets stumped from time to time and needs to consult with faraway colleagues. A RIS PACS system allows you to make medical images available over a LAN or the World Wide Web, so if you run across a particularly challenging case, it’s easy to consult with a colleague anywhere on the globe in real-time.

The RIS PACS can be configured with numerous security protocols and with 128-bit encryption, so only authorized personnel will be able to access sensitive patient records. Finally, todays RIS PACS can be configured to make automatic backups that can be stored on portable media such as DVDs or on an offsite server – insuring that your clinic is in compliance with HIPAA regulations in case of a disaster. An Excellent and Affordable Investment The PACS systems that cost several hundred thousand dollars only ten years ago can be purchased for a small fraction of that amount today. Basic PACS systems now start at around $5000, and are easily upgraded as space and funding allow.

Wayne Hemrick writes about the advent of future technology. Pacs systems and the DICOM standard, patient information can be shared electronically and near-instantaneously by digital imaging users using a host of modality, computer hardware and imaging software vendors.

How Important is Cchit Certification to Physicians in the Electronic Health Record Selection Process?

Your EMR / EHR – Does it have to be CCHIT certified?

What is CCHIT?

CCHIT or Certification Commission for Healthcare Information Technology was founded in 2004 by three industry associations (HIMSS, AHIMA and the Alliance) and is an independent non-profit private sector initiative that certifies EMR / EHR software (used interchangeably in this article) solutions based on a specified set of parameters. Its mission is to accelerate the adoption of robust, interoperable health information technology by creating a credible and efficient product certification process.

The purpose behind CCHIT

There are hundreds of EMR software solutions on the market, each differing in feature functionality, and it is easy for providers to get lost in the cacophony of vendors especially, considering that Providers are not IT experts and often find it difficult to properly assess and select an EMR solution that will best meet their current and foreseeable needs.  CCHIT certification was intended to reduce the risks of physician investment in EMR / EHR products, while achieving the following:

a. Facilitate interoperability of EMR products with the emerging national health information network, sometimes called RHIOs
b. Enhance availability of EMR adoption incentives
c. Ensure that EMR products protect the privacy of personal health information

EHR / EMR Certification Criteria

The main category of certification deals with products designed to be used in physician offices and clinics and commonly referred to as Ambulatory EMR.  CCHIT certified EMR products were required to demonstrate compliance with 116 criteria in 2006. Another 96 criteria were added in 2007 and in 2008, 19 new criteria were added to the certification requirements focusing on the following:

a. Additional electronic prescribing features including access to the patient’s medication history, formulary, and eligibility.
b. Better and safer medication dosing, adjusted for patient weight and other factors.
c. Better ability to prevent adverse reactions due to drug interactions or allergies.
d. Use of standard formats to exchange basic patient information for continuity of care.
e. Enhanced ability to view X-rays and other diagnostic images.
f. Better management of patient consents and authorizations.
g. Increased use of standard formats when receiving and storing laboratory results.

How much do vendors spend for certification?

The initial cost of certification is about $28,000, which provides a three-year certification. Vendors then pay an additional $4,800 in each of the second and third years to cover marketing and licensing fees. An EMR is certified for three years, but if a product is significantly reengineered or re-architected before the end of the three-year period, it must be recertified.  Minor updates usually do not need re-certification.

As of January 2009, certified EMRs include the following:

a. Ninety-two EMRs that have received certification under the 2006 Ambulatory EHR criteria (latest certifications made on 30th April 2007).
b. Fifty-five EMRs (including multiple versions of the same product by the same company) that have been certified under the 2007 criteria.
c. Fifteen EMRs that have been certified under the 2008 criteria. These include a number of products that have been further certified for Child Health and Cardiovascular Medicine.

Compare these numbers against the 300+ EMR / EHR solutions available on the market and it is clear that the smaller niche players, offering cost-effective products, have neither the time nor the financial resources to spend on certification and especially, on re-certification every time they make any significant updates. This certification process is stifling competitors in the free marketplace and will only lead to higher prices and in turn, negatively impact Physicians’ pocket books.

What does certification really fetch?

EMR is a long-term investment and providers must be careful in choosing the right solution. Most practices have very limited time and resources to evaluate every detail of every product of interest.

On the other hand, certification can help with the evaluation and selection process by narrowing down the initial set of solutions because CCHIT certification assures implementation of basic functionality. This should allow a Practice to focus more upon performing due diligence about a companies’ track records in meeting individual practice’s special needs, ease of use, implementation success, financial viability, and after-sales service and support, and financial stability of the EMR vendor.

The flip side to this approach, insisting on certification will potentially cut out a significant population of more powerful (a better mousetrap) solutions from smaller vendors, who cannot afford the certification costs. Just because a product is not certified does not necessarily mean that it will not meet the specific requirements of the Practice. At the same time, a Practice may not really need the 300+ features mandated and evaluated by CCHIT. The real question of the day is, do you need a Rolls Royce when a Toyota Corolla might serve the purpose?

What must a Practice do?

Rather than getting fixated on CCHIT certification, a Practice would do well to create a checklist of features that are important to it. This list should include:

1. Does it support the specific requirements of the specialty? (CCHIT acknowledges that its criteria may not be suitable for settings such as behavioral health, emergency departments, or specialty practices.)
2. Does it allow the Practice to share information electronically with other physicians, hospitals, pharmacies, laboratories, radiology groups, and others? (from a technical viewpoint, any system that has HL7 interface, inbound and outbound, will be able to interoperate with other systems.
3. Does it enable you to measure and report the quality indicators, needed to satisfy payment incentive programs that are based on levels of performance?
4. Does the vendor have the reputation of providing outstanding customer support?
5. Are there any references of the same size practice, specialty, and type in the local market who can vouch for the ease of use of the selected product?
6. Does it help monitor potential adverse drug reactions?
7. Does the EMR interface with the Practice Management or Billing software? You should also find out if you need an integrated system with a common database.

These are only a few of the foundational questions, as there are many non-functional requirements that need to be addressed to ensure successful implementation of an EMR/EHR solution. These requirements are focused around people (commitment, volunteers, etc.), capital (cost, ROI, initial cost vs. annual costs), technology (server-based vs. ASP, tablets or laptops, etc.) and organization (stakeholders, selection and implementation leaders).

If all this seems too time consuming or overwhelming, the Practice must find a good independent EMR/EHR and Practice Management Solutions Firm who can assist in the initial needs assessment phase, vendor evaluation and selection process. These days you can find good Consultants who will do all of the up-front leg work for you at no cost to your practice. Therefore it would be wise to think twice before, employing a company wanting to charge hefty up-front retainers and steep per hour consulting fees ranging from $100 to $200 per hour.

Alok Prasad is the President and CEO of RevenueXL, which is a EMR”>”>EMR and Practice

consulting firm based in Cupertino, CA. RevenueXL provides

business transformation solutions including EMR / EHR

and back office services including Medical Transcription, Medical Billing,

Denial Management and AR Follow-up. RevenueXL prides itself in enhancing and

accelerating healthcare revenues.

Article on Electronic Health Record

Introduction – “What is an EHR”?

An Electronic Health Record (EHR) refers to an individual patient’s medical record in digital format. Electronic health record systems co-ordinate the storage and retrieval of individual records with the aid of computers. EHRs are usually accessed on a computer, often over a network. It may be made up of electronic medical records (EMRs) from many locations and/or sources. A variety of types of healthcare-related information may be stored and accessed in this way.

Types of Data stored in EHR:

An electronic medical record might include:

  1. Patient demographics.

  2. Medical history, examination and progress reports of health and illnesses.

  3. Medicine and allergy lists, and immunization status.

  4. Laboratory test results.

  5. Radiology images (X-rays, CTs, MRIs, etc.)

  6. Photographs, from endoscopy or laparoscopy or clinical photographs.

  7. Medication information, including side-effects and interactions.

  8. Evidence-based recommendations for specific medical conditions

  9. A record of appointments and other reminders.

  10. Billing records.

  11. Eligibility

  12. Advanced directives, living wills, and health powers of attorney

Advantages of EHR over paper records:

1. Medical records may be on “physical” media such as film (X-rays), paper (notes), or photographs, often of different sizes and shapes. Physical storage of documents is problematic, as not all document types fit in the same size folders or storage spaces. In the current global medical environment, patients are shopping for their procedures. Many international patients travel to US cities with academic research centers for specialty treatment or to participate in Clinical Trials. Coordinating these appointments via paper records is a time-consuming procedure and may violate the patient’s HIPAA privacy

2. Physical records usually require significant amounts of space to store them. When physical records are no longer maintained, the large amounts of storage space are no longer required. Paper, film, and other expensive physical media usage (and therefore cost) is also reduced with electronic record storage

3. When paper records are stored in different locations, furthermore, collecting and transporting them to a single location for review by a healthcare provider is time-consuming. When paper (or other types of) records are required in multiple locations, copying, faxing, and transporting costs are significant, as are the concerns of HIPAA compliance

4. Handwritten paper medical records can be associated with poor legibility, which can contribute to medical errors. Pre-printed forms, the standardization of abbreviations, and standards for handwriting were encouraged to improve reliability of paper medical records. Electronic records help with the standardization of forms, terminology and abbreviations, and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies

5. In 2004, an estimate was made that 1 in 7 hospitalizations occurred when medical records were not available. Additionally, 1 in 5 lab tests were repeated because results were not available at the point of care. Electronic records keeping and order entry were found to reduce errors associated with handwritten documents and were recommended for widespread adoption.


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Computed Radiography: Better for Costs and the Environment

Computed Radiography involves equipment that is similar to conventional radiography. Instead of using film to create the image, however, an imaging plate made of photostimulable phosphor is used.

The photostimulable phosphor imaging plate is then put through a laser scanner, called a CR reader, to both read and digitize the image. At that point, the image can be viewed using specific software where zoom, contrast, brightness and filtration can all be adjusted for better evaluation.

There are many advantages to using Computed Radiography. Film can be processed without chemicals. Images can be stored digitally reducing storage costs and making transportation for off-site review very easy.

Fewer retakes are necessary with Computed Radiography so it’s safer for patients because they are exposed to a lower dose than in other forms of x-ray. Previews of images are available in as little as 15 seconds and interpretation is significantly improved because images can be enhanced digitally.

Computed Radiography differs slightly from similar Digital Radiography technology. While both similarly use a medium of some sort to capture x-ray energy, computed radiography uses a cassette inside of which is the imaging plate that records the image. In Digital Radiography, on the other hand, the image is captured directly onto a flat panel detector.

Computed Radiography systems are most often found in the medical field because they are considered to be extremely reliable having been in use in the field for over twenty years. They are also flexible enough to have multiple clinical applications and provide a lower cost, digital alternative.

Computed Radiography is becoming more affordable and eco-friendly. For the same cost as staffing a conventional x-ray lab, including purchasing chemicals, providing dark room storage and paying staff, Computed Radiology does the same job and is far gentler on the environment and on patients as well.

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