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When preparing to implement an EMR or EPM system with a graphical user interface, your entire staff will need to possess at least some computer skills.
Some staff members will need to be able to check patients in and out; others will have to post money or generate claims. The electronic medical records committee must design a training plan which takes the above factors into consideration. CCHIT had been given an (un)official nod from the government's Office of the National Coordinator for Health Information Technology as the certifying body for EMR standards.
At our practice, mind-mapping software has become indispensable for managing projects of any size. I've successfully rid the home office of paper records by scanning them all - then shredding them.
Many computers have monitor or video out-ports which allow a connection to a second monitor. Although no single device can do it all, I have discovered a PDA or smart phone to be especially useful. Some recent legal cases have established that data which is accessible must be able to be produced, including backup. In the world of paper records, charts that are more than seven years old that were purged are considered legally inaccessible. Eventually, rational minds emerged victorious, and some of the more inane regulations have relaxed somewhat.
Consider forming a Legal, Risk & Compliance (LRC) Committee for your practice, to address the above-mentioned issues and others which may arise. Under the Fair Share Tax Proposal, total government taxes (revenues) as a percent of GDP would be increased by about 10% from 2001-2010 levels back to where they were during the Clinton years. Combining the Fair Share Tax Reform with all the Spending Reforms below would allow elimination of the federal deficit by 2025. This year the our governments spent about $760 billion on healthcare (Medicare, Medicaid, and Chip).
Full annual benefits, starting at age 70 would be $18,000 for all unmarried persons or $30,000 for a married couples. The above change in benefits would be delayed until 2024 and then phased in over 10 years, to give workers the opportunity to adjust fund their tax-free accounts and otherwise adjust their retirement planning accordingly. Under the Fair Share Tax Plan, the regressive and indirect current payroll (Social Security) taxes are ended. Below are selected federal government spending cuts derived from the Simpson-Bowles report as described at the New York Times website.A  I have selected the spending cuts that look sensible to me and excluded those that are already covered under the spending cuts outlined above.
Many economists argue that farm subsidies distort the workings of the market and largely flow to big agricultural businesses.
In the past decade, both the number of federal employees and the number of contractors rose.
The chairmen called for a series of smaller cuts, including eliminating some agencies, cutting research funds for fossil fuels, reducing funds for the Smithsonian and the National Park Service, eliminating certain regional subsidies, and eliminating the Office of Safe and Drug-Free Schools.
The costs of the disability insurance program, which is administrated by the Social Security Administration, have been rising rapidly.
Some economists believe that the Consumer Price Index overstates inflation, giving Social Security recipients larger cost-of-living increases than necessary. Over the last 30 years federal non-discretionary spending as a percent of GDP has been cut in half to about 2.5% of GDP. The biggest threats to state and local government budgets are that there areA over-generous salaries, benefits, and retirement plans for some government workers.
State and local governments should improve public education, especially in the worst schools.
Under the Fair Share Tax Reform, total government taxes (revenues) would be increased about 10% (as a percent of GDP compared to the 2001-10 period, under the Bush tax cuts), although taxes on the typical taxpayer (in fact, the bottom 80%) would be reduced substantially. The proposed Spending Reforms below, once mostly implemented (after 2020), reduce total government spending by about 18% below current levels (the 2001-10 period), to on average 17.0% percent of GDP. If the Fair Share Tax Reform was joined with the Spending Reforms proposed below on this page, our National Debt would start to drop (as a percent of GDP) immediately and could be entirely paid off by 2040.
CLICK HERE to see the spreadsheet with the calculations that produced the chart below for the Federal Budget. A bit of history: President Clinton's tax increases - which had the wealthy pay something closer to their fair share - balanced the federal budget and produced our first federal surplus in decades. FAIR SHARE TAX REFORM - A comprehensive tax reform plan for federal, state and local governments, that reduces total taxes on the working-poor and middle-class by thousands each year, encourages stable economic growth, vastly simplifies our tax laws, and slashes the national debt.
Featuring expert guidance in electronic medical records, finance, administration and legal issues. However, a large percentage of adults still have limited experience with the latest technology.
Maybe the technical staff won't have to understand the claims process, but they will surely need to be proficient using EMR.
The committee will have to determine what the common tasks for every employee will be, then adding additional skills of increased complexity to the appropriate departments and jobs.
According to a report by FierceHealthIT, The Drummond Group, an interoperability testing lab in Austin, Texas, has thrown its hat into the ring.
An organization made up of industry experts, corporations, and other volunteers, CCHIT has also had its share of critics who charge that it is giving preferential treatment to big players in the EMR software community. The ScanSnap 500 is a device which will scan everything, from PDF files to double-sided documents. Many small, high-definition TV sets have a video in-port able to toggle between cable and satellite and a computer signal.
These devices are cell phones that run Windows apps, able to sync with Outlook on your desktop computer to access the Internet, email, and your contact list. No more can you even keep a patient check-in form at the front desk, or risk having a patient learn who else had been in on that day. Although this may seem an unfair burden for a medical practice, experts dealing with these sort of legal cases believe that EMR will result in a decrease of malpractice suits, owing to better documentation and a lower rate of medication-related mistakes.
There are still privacy issues which are specific to the electronic aspects of medicine, in regard to inappropriate disclosure of patients' data. They are used to create the above graph and the accompanying Government Budget Spreadsheet page.
When President Eisenhower, former Supreme Allied Commander during World War II, left office during an earnest Cold War with a nuclear-armed industrial giant committed to our destruction, we were spending 50% less on the military (adjusted for inflation).
Health-care spending per person in Japan and the western Europe is about half of what we pay here, AND they have better outcomes with better life expectancies (link, link). If a small part of that was invested in the taxpayer's simple tax-free account (for education and retirement; established automatically for all employees, with an opt-out provision), then almost all workers would retire in great shape.
It would reduce projected Social Security spending by about $115 billion (about 4%) when completely phased in and going forward. The values listed are the expected savings for 2015 if the cuts were enacted and total $124 billion for that year. As the Congressional Budget Office has noted, advocates of reducing the subsidies argue that doing so a€?could help small farms indirectly, slowing the ratea€? of consolidation.
Would also reduce the number of Minuteman missiles and funding for nuclear research and development, missile development and space-based missile defense. This option would cut disability spending by 5 percent by focusing on states with the loosest standards. This option would use a different, lower inflation measure both for Social Security and in the tax code (thus pushing more households into higher brackets over time). Non-discretionary spending funds things like basic science research, road and railways, environmental protection, sustainable energy research, education, and job training - all critical to future economic growth. Thus, two dollars of spending would be cut for every dollar in total tax increases under the proposed Fair Share Tax Reform.

On that page you can download the spreadsheet and see how the National Debt changes if you change tax rates and shift budget priorities.
It's a lucky fact that most doctors must keep with technological advances out of necessity. The best part is that you don't need to be a computer genius to use these tools - they're intuitive, making projects easy to follow visually.
This application has modules to set up various goals, from business, to family, to personal.
When you set up dual display with the TV as the second monitor, you can double the work area on the desktop. Some people use the phone connection to access the Web, while others connect through a wireless network. Even so, if data is kept on a failed hard drive, and the costs of recovering the data is significant, it could create an undue burden; judges could rule that the expense be shared between the two parties.
When it comes to electronic information, however, inaccessibility could be more difficult to prove, as electronic data can almost always be recovered. An unauthorized email, unsecured wireless network, a computer monitor left on in view of another patient are some prime examples. Reform of government expenditures - using that tax income sensibly - is also critical to the future of our nation.
The proposed spending cuts, once fully implemented, would reduce total government spending (federal, state, municipal), measured as a percent of GDP, by almost 20% compared to average 2001-2010 levels. Despite the revenue increases, taxes on the typical taxpayer (in fact, the bottom 80%) would be reduced substantially. He warned against the defense industry hijacking government in his Military-Industrial Complex farewell address.
Within the United States, around the the city of Seattle and at the Mayo Clinic, they spend about 30% less per Medicare patient than the national average, AND have better results.
Social Security could be viewed as a safety net to assure that no-one who contributed to the economy over a lifetime lives their retirement years in poverty.
Early initiation of Social Security benefits, as early as age 60, reduces annual benefits. Eligibility for full benefits would require 40 years of filing a tax return with an income corresponding to at least full-time work at the minimum wage (during the transition, payment of the a€?olda€? Social Security payroll tax would count as a year toward the 40) OR a lifetime declared income of $6 million (in 2014 dollars) with at least 10 years of filing an at-least-minimum-wage tax return. Supporters note that growing numbers of workers are classified as disabled, though the average job is less physically taxing. The American Society of Civil Engineers has given the nationa€™s infrastructure an overall grade of D. Governments must honor commitments already made but should request give-backs (eg to avoid layoffs) where appropriate. The Spending Plan includes a 20% increase beyond inflation in state and municipal education spending phased in over 5 years. Alternatively, we could drive the National Debt down to 40% of GDP and cut working-poor and middle class taxes even more substantially starting in about 2030. Early initiationA  of Social Security benefits, as early as age 60, reduces annual benefits.
The Republicans then cut taxes on the wealthy, started running up the national debt, and we now have the worst economy and bleakest employment prospects in 80 years. For example, almost all of your employees will need to know how to use the system to look up appointment info. Next, the department should rotate through the training room to receive training on the necessary tasks for their particular jobs. Some newer versions such as Treo 150W can sync up with your contacts and calendar remotely from any location. In fact, most of the current EMR software systems don't even let a provider delete patient records. We are now spending more than FIVE times that spent by the next most militarized country, China.
Some regions spend twice as much per Medicare patient as do other regions and have worse results. If we wish to save this nation from economic disaster, we simply need to end the unrestrained and wasteful transfer of taxpayer money to the military-medical-industrial complex. Partial benefits are prorated down to 25% benefits for 10 years of at-least-minimum-wage work (or $1.5 million lifetime declared income with at least 5 years of filing an at-least-minimum-wage tax return). Opponents say it is less accurate for the elderly, who buy a different mix of goods and services than other households.
To ensure future economic prosperity, the federal government's spending on infrastructure, research, and the environment should be tripled and 150 billion added to federal education spending. Going forward, statute should limit total compensation to those available for equivalent work in the private sector.
Physicians might consider that Morgellons and Bartonella are in some way intertwined.??Morgellons sufferers report an array of symptoms happening just under the skin, such as the emergence of fibers and filament clusters, specks, particles and sand shaped granules, yet physicians are unaware of this phenomena because they are not using enlargement devices.
Still, many other staff members have limited exposure to computers at work - and limited skill as a result.
A manual was prepared for the EPM software module, and another is being written for the EMR module.
A dashboard can handle your mind maps while helping to delegate the logistics of who, where, what and when of your projects. Although a bit larger and heavier than a regular cell phone, these devices make up for the added weight with increased flexibility. Physician incentives to profit more from every test and procedure they prescribe must be blunted. Together this would cost an extra 380 billion in 2014 and further increased 2% beyond inflation each year going forward. An unaided visual exam using the naked eye is no longer appropriate to an emerging illness involving so many artifacts.
In order to gauge an employee's computer literacy, they can be asked about the applications they've used, and to give examples of the sorts of tasks they've performed. This has become a major area of law and will become increasingly important as EMR becomes the norm.
States pay about one-third of all Medicaid costs and should realize similar savings on those expenditures.
All this additional spending is included in the pay down of the national debt pictured at the top of this page.
No one trusts the judgment of a mechanic who refuses to look under the hood of a car. A more thorough approach needs to be taken using equipment such as dermascopes and microscopes, as this is the only way to identify the microscopic fibers that are the defining symptom of Morgellons, and which separates it from all other diseases. It's also possible to tell an employee's competency through the vocabulary they are familiar with. The bottom line for medical practices is that a reliable and secure backup process is a must. My calculations phase in the 30% cut over 5 years and phase out spending on the Iraq an Afghanistan wars over the same period. Further, often the procedures are done in centers that the physician owns, so he gets both the hospital fee and procedure fee.
Using a dermascope can also prevent misdiagnosing diseases that have some similar symptoms, such as Lyme (although some patients may have both). Where possible, the decision to test or treat should be made by one physician who does not profit from that decision. Microscopic enlargement needs to be at minimum 60x-200x in order to see the fibers clearly. As evidenced in the photos in our galleries, there is something clearly wrong with the skin of Morgellons sufferers. Perhaps more physicians need to be paid with generous annual salaries, rather than per test and operation. Most doctors currently believe that the fibers patients come to see them about are 'textile' in nature.

If you take a look at the galleries of fibers in urine, stool, blood, skin, and hair, you will see that these filaments are invading the body systemically and cannot possibly be textile.
Click here to view other particles in the skin as well as other unidentified artifacts.?• ?Randy Wymore, Director of OSU-CHS Center for the Investigation of Morgellons Disease and Associate Professor of Pharmacology and Physiology had the fibers analyzed at the Tulsa police department's forensic laboratory. The Morgellons particles didn't match any of the 800 fibers on their database, nor the 85,000 known organic compounds. For those insisting the CDC study of Morgellons laid down the law for definitive answers about Morgellons, I'd suggest you listen to Doctor Randy Wymore speak more in depth about the study and its inherent flaws and bias. Many clinicians refer to this condition as delusional parasitosis or delusional infestation and consider the filaments to be introduced textile fibers. In contrast, recent studies indicate that MD is a true somatic illness associated with tickborne infection, that the filaments are keratin and collagen in composition and that they result from proliferation and activation of keratinocytes and fibroblasts in the skin. Previously, spirochetes have been detected in the dermatological specimens from four MD patients, thus providing evidence of an infectious process. (2013) has revealed the presence of Borrelia in Morgellons lesions in everyone tested. It is the subject of considerable debate within the medical profession and is often labeled as delusions of parasitosis or dermatitis artefacta.
This view is challenged by recent published scientific data put forward between 2011-2013 identifying the filaments found in MD as keratin and collagen based and furthermore associated with spirochetal infection. The novel model of the dermopathy put forward by those authors is further described and, in particular, presented as a dermal manifestation of the multi-system disease complex borreliosis otherwise called Lyme disease. The requirements for a diagnosis of delusional disorder from a psychiatric perspective are clarified and the psychological or psychiatric co-morbidity that can be found with MD cases is presented. Management of the multisytem disease complex is discussed both in general and from a dermatological perspective. Despite evidence demonstrating that an infectious process is involved and that lesions are not self-inflicted, many medical practitioners continue to claim that this illness is delusional. We present relevant clinical observations combined with chemical and light microscopic studies of material collected from three patients with Morgellons disease. Our study demonstrates that Morgellons disease is not delusional and that skin lesions with unusual fibers are not self-inflicted or psychogenic.
Proliferative stages of bovine digital dermatitis demonstrate keratin filament formation in skin above the hooves in affected animals. The multifactorial etiology of digital dermatitis is not well understood, but spirochetes and other coinfecting microorganisms have been implicated in the pathogenesis of this veterinary illness. Morgellons disease is an emerging human dermopathy characterized by the presence of filamentous fibers of undetermined composition, both in lesions and subdermally. While the etiology of Morgellons disease is unknown, there is serological and clinical evidence linking this phenomenon to Lyme borreliosis and coinfecting tick-borne agents. Although the microscopy of Morgellons filaments has been described in the medical literature, the structure and pathogenesis of these fibers is poorly understood.
In contrast, most microscopy of digital dermatitis has focused on associated pathogens and histology rather than the morphology of late-stage filamentous fibers. The most effective antibiotics have included tetracyclines (doxycycline, minocycline), macrolides (Zithromax, Biaxin), Septra DS, and quinolone drugs (Cipro, Levaquin, Avelox, and Factive). Often the skin lesions and associated symptoms resolve once the above antibiotics are used in a comprehensive treatment plan" ??Horowitz, Richard (2013-11-12). Why Can't I Get Better?: Solving the Mystery of Lyme and Chronic Disease (Kindle Locations 2662-2666). Still, 100% of the patients, that were felt to genuinely haveMorgellons Disease, have large microscopic-to small macroscopic fibersvisible under their outer layer of skin. These fibers are not associated withscabs or open lesions, nor are they under scarred tissue.
The idea thatMorgellons fibers are mere fuzz and lint, simply sticking to the lesions andscabs, is not possible based on the observations that were just described.These fibers are under "normal-appearing" areas of skin.
The photographs indicate that the particles are very active, and are growing "tendrils," fibers," "ruffles," protrusions," and are creating connections between themselves.
These connecting "fibers" appear to be creating translucent "crystal clear" objects that give the appearance of "crystal fibers."                                                                              —Fungihomeworld. 5mar2010                 ?                   ?        Although Morgellons has no known "cure" at this time, we believe recognizing and identifying the disease gives a patient something to go on so they can start becoming proactive with their health. Often these visits are out-of-pocket expenditures as patients escalate up the food chain to specialists not within their health plans, bankrupting themselves unnecessarily.
Having a diagnosis will allow sufferers to make informed decisions about their next healthcare choices. There is no silver bullet when it comes to Morgellons.
A holistic approach working with diet and pH, plus supplements to rebuild the body's systems is one avenue towards proactive change and symptom reduction. Fibers and particles in various states of emergence from the skin.
This mass exodus happens after coconut oil has been applied to my skin and usually takes 3-4 hours after application to see these kind of results. Fibers under the skin can clearly be seen in these photos as well as in urine and stool, plus the lab doing DNA testing has noted that they are seeing fibers in stool samples. I truly do not understand how this could be misconstrued as a mental illness—and anti-depressants and anti-psychotics are not a fix. This community is looking for a way to repair the health of the body.  A quick Google search revealed that only a quarter of the dermatologists in the United States even own a dermascope. Plus, a scope that only enlarges 10 or 15 times, is not going to be appropriate for diagnosis of Morgellons. The fact that our doctors are supposedly experts and authorities, and considered the last word in the eyes of most of the public, yet are clearly not equipped to diagnose a new disease such as Morgellons, reflects poorly on the medical profession.?You have power to move the Morgellons cause along, if only you will participate.
We need your support and input as health "authorities" to bring credibility to the phenomenon? happening. If you think there are not enough people sick with this disease to warrant your time, think again and heed a call from those of us who are looking at the skin of our friends and families and are finding fibers in them. As of yet, this "healthy" population is asymptomatic, but we believe they are carrying the seeds of this disease in their systems. Imagine a world in which every patient going for a physical with their GP or dermatologist had 3 minutes devoted to examination of the skin with a scope—and what kind of data could be gathered from this! That's the kind of world I would like to live in. One final note before I step off my soapbox is to reinforce the oath you took on becoming a doctor. DOP in patients records have led to loss of their legal rights, hospitalization against their will and in some cases children being removed from their parents.
Also, be cautious as to how you phase things as in "I'm having crawling sensations on my skin." instead of "I'm infested with bugs!" I'd refrain from using the term "Morgellons" until you sense you can trust your practitioner. Click the links to see extensive documentation of Morgellons fibers in Urine, Stool, Blood, Skin, Hair Above: Fiber is magnified 200x.
At the time this was taken, my urine pH was very low (acidic) and I was having a hard time bringing it up to alkaline for two days. When I checked my skin I saw many more fibers then usual and many were still under the skin.
I asked myself what would cause such fiber growth, and made the connection to an acidic system. It it my personal wish to see physicians actually begin to use magnification so that they may understand the phenomena their patients are experiencing.
Photo submitted courtesy of oddiyfuqoro NA will? Above: This particle is one of the classic forms I find being expelled from the body. The Morgellons particles didn't match any of the 800 fibers on their database, nor the 85,000 known organic compounds. For those insisting the CDC study of Morgellons laid down the law for definitive answers about Morgellons, I'd suggest you listen to Doctor Randy Wymore speak more in depth about the study and its inherent flaws and bias. Often the skin lesions and associated symptoms resolve once the above antibiotics are used in a comprehensive treatment plan" ??Horowitz, Richard (2013-11-12).

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11.09.2015, author: admin

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