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This report was revised on January 11, 2013, after a problem was found with the weighting of the 2011 survey data. Eighty-five percent of physicians who have adopted an EHR system reported being somewhat (47%) or very (38%) satisfied with their system. About three-quarters of adopters reported that using their EHR system resulted in enhanced patient care. Nearly one-half of physicians currently without an EHR system plan to purchase or use one already purchased within the next year. Only 49% of physicians in physician-owned practices were adopters, whereas virtually all physicians in health maintenance organizations, about three-quarters of physicians in community health centers (73%), and 7 out of 10 physicians (69%) in academic health centers had adopted EHR systems (Figure 1). Primary care (58%) and medical care specialists (54%) did not significantly differ from each other in EHR adoption, yet a greater proportion of primary care specialists had adopted EHR systems compared with surgical specialists (48%) (Figure 1). No differences were observed in EHR adoption status by physician gender, race or ethnicity, or practice location in metropolitan statistical area (data not shown). Although 10% of adopters were in the process of implementing their EHR system, the vast majority of adopters (90%) reported actively using their EHR system (data not shown). The majority of physicians who have adopted an EHR system (85%) were either very satisfied (38%) or somewhat satisfied (47%) with their system. NOTES: Data represent office-based physicians who reported having adopted electronic health record systems (55% of sample). A majority of adopters reported having accessed a patient's chart remotely (74%) and having been alerted to critical lab values (52%) by using their EHR system within the past 30 days. NOTES: Physicians with electronic health record (EHR) systems whose systems or scope of work did not include a specified capability responded not applicable. Among nonadopters, about one-third reported having no intention to purchase an EHR system within 12 months (32%), and one-fifth reported being undecided about whether to purchase an EHR system in the next 12 months (20%).
NOTES: Data represent office-based physicians who reported not having adopted an electronic health record system (45% of sample). Overall, in 2011, 54% of physicians in office-based practices had adopted EHRs and 46% had not. The majority of EHR adopters' systems met CMS MU criteria, which would allow the practice to receive incentive payments authorized by the HITECH Act.
The vast majority of physicians who use EHR systems (85%) reported being somewhat satisfied (47%) or very satisfied (38%) with their system. Among nonadopters, about one-half reported either already having purchased a system or planning to adopt a system within 12 months.
Demonstrating meaningful use (MU): To qualify for CMS incentive payments for MU, an eligible provider must use a certified EHR system demonstrating all 15 of the core set objectives and 5 of 10 menu set objectives through associated measures or by attestation in 2011 (2).
Stand-alone and Web-based EHR systems: A stand-alone, or client, server represents an EHR system that is self-contained, in which data and application functionality are delivered on-site. The data for this report are from the National Ambulatory Medical Care Survey (NAMCS) Physician Workflow mail survey.
The authors are with the Centers for Disease Control and Prevention's National Center for Health Statistics, Division of Health Care Statistics. Physician workflow supplement 2011 (EHR adopters), National Ambulatory Medical Care Survey [PDF - 200 KB].
Physician workflow supplement 2011 (EHR nonadopters), National Ambulatory Medical Care Survey [PDF - 115 KB].
All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. The enigma of the German painter Gerhard Richter (b.1932) is finally explored through Robert Storr’s grand exhibition this spring in New York.
It is curious to note, writing back in London, the general paucity in the British art world of coverage on this European master of the late 20th century.
Born in Dresden, Richter survived the Nazi period and the Dresden firestorm (visible from where the family had been accommodated some 100km away).
Here, Richter’s 48 portraits, ranging from Jose Ortega y Gasset through Paul Valery, Kafka, Graham Greene, to Oscar Wilde and Andre Gide served both to perplex and surprise critics who were already claiming that painting was dead.
Richter had in fact shocked the Biennale traditionalists, not so much by the superlativeness of his technical exposition, although that was formidable, as by finding, in this way, a new but freer objectivity than the general cult of personal inspiration allowed at that time. Note: The issues discussed below are covered in more detail at consumer behavior section of this site. The amount of effort a consumer puts into searching depends on a number of factors such as the market (how many competitors are there, and how great are differences between brands expected to be?), product characteristics (how important is this product?A  How complex is the product?A  How obvious are indications of quality?), consumer characteristics (how interested is a consumer, generally, in analyzing product characteristics and making the best possible deal?), and situational characteristics (as previously discussed).
Here, the single parent who assumes responsibility for one or more children may not form a relationship with the other parent of the child. As a person gets older, he or she tends to advance in his or her career and tends to get greater income (exceptions: maternity leave, divorce, retirement). Unfortunately, obligations also tend to increase with time (at least until one’s mortgage has been paid off). Note that although a single person may have a lower income than a married couple, the single may be able to buy more discretionary items. Note that although a single person may have a lower income than a married couple, the single may be able to buy more discretionary items.
Family Decision Making: Individual members of families often serve different roles in decisions that ultimately draw on shared family resources. Note, however, that the role of the decision maker is separate from that of the purchaser. The important thing in a means-end chain is to start with an attribute, a concrete characteristic of the product, and then logically progress to a series of consequences (which tend to become progressively more abstract) that end with a value being satisfied.
An important implication of means-end chains is that it is usually most effective in advertising to focus on higher level items. Dulwich Picture Gallery marks the centenary of John Piper's birth with a major exhibition devoted to his formative years. This exhibition is devoted to Piper's work in the 1930s: paintings, watercolours and photographs. In the final edition of AXIS (the influential abstract art journal edited by Myfanwy Piper), published in the winter of 1937, John Piper wrote about the influence of prehistoric archaeology and air photography on our sense of 'spaces and forms and vistas'. Abstraction in England began in the tentative experiments of the Bloomsbury artists, Vanessa Bell and Duncan Grant, in the years before World War 1.
John Piper (born 1903) worked in his father's law firm, under sufferance, until 1927 when his father died. At the invitation of Ben Nicholson, Piper joined the 7 & 5 society and exhibited in its March 1934 exhibition. Behind AXIS was the Paris experience of emigre artists who viewed abstract art as a calm order in response to contemporary conflict and chaos. Piper himself, a key figure in the magazine's existence, also found that he required things English, and continued his travels around the country to pursue his love of stained glass and Anglo-Saxon and Romanesque carvings. Helen Frankenthaler: Paper is Painting, at Bernard Jacobson Gallery, London is one of three exhibitions of the American abstract painter there, since 2000. As early as the 1950s, combining the immediacy of the drawn line with pure gestural, abstract painting liberated her works on paper from small works, usually studies for larger works, to works in their own right. John Elderfield, a key critic and curator of drawing and all forms of works on paper from the 1960s, and chief curator of painting and sculpture at MoMA, New York, for over 30 years (1975–2008) has written extensively on Helen Frankenthaler. Comparing her works to those artists who all influenced her – Wassily Kandinsky, Jackson Pollock, Willem de Kooning, Ashile Gorky, Elderfield points out that her pioneering work took place using paper, describing it precisely, “because the Frankenthaler [image] is damper in effect than anything these artists made (the sheet was wettened before working), its picture of the world seems disembodied, further removed from the tactile realities we know, and curiously still and suspended, for all the implied momentum provided by the cursive lines.
Her choice to work primarily, solely at times, with works on paper can be seen to belong in part to the revival and re-appraisal of drawing – and those previously considered “lesser” or subordinate works of art, watercolour, pastel, mixed media.
Until the 1970s and 1980s, drawings (and indeed all works on paper) were considered to be of less importance than the larger works on canvas or board that evolved from them.
Born in 1928 in New York, Helen Frankenthaler achieved early recognition as an artist for her contribution to American abstract painting.
Sixty years after her encounter with Pollock’s work, Helen Frankenthaler’s words echo in one’s mind as an encounter with her work is made; there is an air of familiarity but it is ambiguous, and mysterious. The sample includes nonfederal, office-based physicians and excludes radiologists, anesthesiologists, and pathologists.
The proportion of physicians who were adopters increased as the size of the practice increased, with 60% of physicians in 2-physician practices, 62% of physicians in 3-to-10-physician practices, and 86% of physicians in practices with 11 or more physicians having adopted EHR systems (Figure 1). About 15% of providers were either very dissatisfied (5%) or somewhat dissatisfied (10%) with their EHR system (Figure 3). A majority also reported that using their EHR system had resulted in enhanced overall patient care (74%) (Figure 4).


In addition, about one-half of nonadopters reported either intending to purchase an EHR system within 12 months (26%) or having already purchased one (21%) (Figure 5). Differences were observed between physicians who were EHR adopters and nonadopters by age, physician specialty, practice size, and ownership. A majority would purchase their EHR system again (71%), suggesting that EHR adopters are generally positive about their current systems. This finding suggests an increase in EHR adoption is likely to take place in 2012 among 2011's nonadopters, potentially amplifying the impact of federal policy incentives.
Comparisons of several core objectives are available from the NAMCS supplemental EHR mail survey (3). The Physician Workflow study, funded by the Office of the National Coordinator for Health Information Technology, is conducted by the National Center for Health Statistics (NCHS) as a NAMCS supplement.
The 2011 EMR mail sample was a stratified sample of physicians with strata defined by state. Eric Jamoom, Paul Beatty, Anita Bercovitz, and David Woodwell are with the Ambulatory and Hospital Care Statistics Branch; Kathleen Palso and Elizabeth Rechtsteiner are with the Technical Services Branch.
The official Web site for the Medicare and Medicaid electronic health records (EHR) incentive programs. Electronic health record systems and intent to apply for meaningful use incentives among office-based physician practices: United States, 2001a€“2011[PDF - 665 KB].
Richter as a painter can now be taken to epitomise the transformation of painting in the second half of the 20th century.
In contrast, this journal praised Richter early on, in l965, and reviewed his work again in September l972 following that summer’s Biennale while still perplexing the established critics. In the prevalent German regime which followed he used the sound traditional art education available to become a poster artist. A typically unpremeditated painting from such a photograph is ‘Mustang squadron’ (l964), which bears no message, carries in its content no immediately apparent significance, other than that Richter, three years free, could paint American aircraft in British markings, ignoring the still unhealed social scars of Nazi wartime conflict so apparent in west German society of the early l960s. Richter recognised early that painting during this phase of objectivity could be justified not by personal inspiration but only by reality itself. Instead, they had experienced for the first time the deconstruction of the art of painting by Richter, if only to reconstruct the medium with greater validity and meaning in terms of their contemporary reality.
Photography as source material thus enabled Richter to achieve anonymity and objectivity together. The breakup of a non-marital relationship involving cohabitation is similarly considered equivalent to a divorce. The reality is that few families are wealthy enough to avoid a strong tension between demands on the familya€™s resources. Consumers often buy products not because of their attributes per se but rather because of the ultimate benefits that these attributes provide, in turn leading to the satisfaction of ultimate values.
For example, in the flower example above, an individual giving the flowers to the significant other might better be portrayed than the flowers alone.
The exhibition is curated by David Fraser Jenkins, Senior Curator at the Tate, and Frances Spalding from the University of Newcastle; their biographical portrait of the working lives of John and Myfanwy Piper (nee Evans) has been published to coincide with the current exhibition. The present exhibition, however, focuses on the influence of the sea and coastal imagery on the development of his work. The critic Roger Fry, who had organised two seminal exhibitions of Post Impressionist art, the first showing in England of Cezanne, Matisse et al, in 1910 and 1912 respectively, belonged to the same circle of friends and exerted considerable influence on these and other artists at the time. Myfanwy Evans was the driving force behind the magazine AXIS, first published in January 1935. Its members included Barbara Hepworth, Ivon Hitchens, David Jones, Henry Moore and Winifred Nicholson.
Ben Nicholson and Barbara Hepworth, who Evans met through Piper, had some involvement with artists there and were already in the process of developing their own abstract language. Debates on the role of art in society raged and, in response to the Spanish Civil War (1936), a marked shift took place; articles on Seurat, Poussin and Cezanne were included.
Best known for her seminal role as a major influence on Colour Field painting, Frankenthaler’s immediately recognisable mature work has played a key role in the revised status and definition of drawing in recent years. The present exhibition is a reminder of her pioneering contribution and the sheer beauty of her works that emanate light: “it is light that counts above everything. Characterised by their exquisite pure hues, they range from pools of watercolour with few or no marks, created with great control and perfection, to experimental works that appear to have formed by complete chance on the surface – such is the apparent ease with which they inhabit the picture plane. Pollock’s allover style had bequeathed to Frankenthaler an art that transformed drawing into painting to transcend the traditional dualism between the linear and the painterly in being both at the same time.
Experimental methods and diaristic imagery were consequently given greater credence in the visual arts.
Her love of paper began in childhood; for the period 1992 to 2002, she worked exclusively on paper. Traditionally, works on paper were more personal and not intended to be exhibited, or they were studies for major works. The elements are never merely circles, squares and stripes”.15 Entering her world is a foreign place, only in so far as it can never be fully explained.
Bonnie Clearwater, Frankenthaler: Paintings on Paper, Museum of Contemporary Art, North Miami, 2003. Data represent office-based physicians who reported having adopted EHR systems (55% of sample).
Generally, physicians under age 50 were more likely to adopt EHR systems than physicians aged 50 and over.
Stand-alone systems offer faster response times than Web-based systems, and although stand-alone systems have higher initial cost, their maintenance costs are lower. It represents a 3-year initiative to survey office-based physicians about their experiences in and perceptions of adopting and using EHR systems.
Eligible physicians for whom EHR adoption status was not confirmed in the EMR survey were contacted to determine that status. The combined, overall unweighted response rate is based on multiplying the eligibility status rate by the workflow mail response rate among those deemed eligible.
His diverse, brilliantly accomplished technical range of development over four decades should not be allowed to detract from his intellectual achievement in bringing the recovery of painting to a pitch of justifiable validity at the beginning of the 21st century.
The article presciently acknowledged how Richter had consolidated his international reputation as a painter. But he gravitated from Dresden to Dusseldorf as strictures were lessened, via a spell as a visiting lecturer at the Hochschule fur Bildende Kunst in Hamburg, and as an art teacher at Dusseldorf high school before, in l971, joining Josef Beuys as a professor at the Dusseldorf Academy. Here, Richter asserts the legitimacy of the artist copying the swooping fighters against a verdant green pattern of fields.
Thus he arrived at photography: the absolute and two-dimensional representation of reality’.
Yet he is by the same token cunning enough not to try to erase all doubt, even with photographs about the nature of that reality. In some cases, the non-custodial parent (usually the father) will not pay the required child support, and even if he or she does, that still may not leave the custodial parent and children as well off as they were during the marriage. For example, the wife says that her husband can take an expensive course in gourmet cooking if she can buy a new pickup truck. Describing the sea as a 'powerful emotive agent', Piper drew on the imagery of the sea, beaches, cliffs and harbours for his painting. Fry described a purely abstract language as 'a visual music', an immediate expression of reality. It was devoted to Abstract art and John Piper who wrote regularly on art, supported the project with great enthusiasm. In the Listener he wrote that in England no place was further than 70 miles from the coast. He attended the Richmond School of Art in Surrey and the Royal College of Art, London, but left without completing his diploma.
As the first room of the Dulwich exhibition reveals, Piper was producing seaside still-lifes at this time with an assortment of objects: bottles, jugs, shells and books. AXIS promoted Piper's career greatly in terms of published appreciation of his work while providing a platform for his own writings. Then her poetic, calligraphic works of poetry, which provide a mysterious and poignant parallel to life itself – the chance encounter, a momentary vision of nature, a joyous surprise.
The breaking down of hierarchies within the arts, which this implied, and which the rise of the importance of drawing in the 1970s also owes a great deal to the feminist movement. The 1970s and 1980s saw a dramatic shift in the status of drawing, especially figurative drawing.


A seminal early work Mountains and Sea (1952), completed when she was only 23, was used as the basis of a major exhibition at the Solomon R. As viewers we are given the great privilege of being accompanied on a personal journey, by a guide with consummate personal skill and a marvellous insight into the art of the past 60 years. The proportion of physicians who were adopters increased as the size of the practice increased. Web-based systems have the advantage of being easy to access wherever the Internet is available, whereas stand-alone systems may have limited off-site access. Respondents will be followed annually over a 3-year period, beginning in 2011 and continuing through 2013.
Only those NAMCS eligible respondents were mailed Physician Workflow questionnaires within a 2-month period of determining whether they used an EHR system.
The l88 paintings on show at the Museum of Modern Art finally reveal the breadth of experimentation pursued by Richter over the decades; his struggle to relate painting meaningfully to the exponential growth of modern society and culture, while all the time this effected, enveloped and ultimately breached traditional ideas about painting. For a decade Richter had striven to resolve the question of the nature of reality, mistrusting all ideologies, aware now of the challenging potential of new media and materials exploited by others such as Yves Klein and also Manzoni. In l961, just after Andy Warhol had embarked on his Popey canvases and Dick Tracy, Richter had a stroke of good luck.
On the other hand, in some cases, some non-custodial parents will be called on to pay a large part of their income in child support. Alternatively, a child may promise to walk it every day if he or she can have a hippopotamus. In the introductory text to the catalogue, Frances Spalding argues that Piper's distinct abstract language of form, line and colour derived from 'nautical objects, in the shapes and colours of buoys, staysails, masts and hulls of boat'. While establishing himself as an artist, Piper wrote reviews and, in the process, made friends with a number of artists. They are carefully placed on window ledges with views beyond to harbour buildings, quays and boats. Piper was a vital force in the magazine's short life assisting in all aspects of its production. He met a great many other artists and theorists and organised a number of important exhibitions. Frankenthaler’s position as role model and mentor for women artists has been profound, enabling important threads to be maintained, between modernism and conceptual and non-object, art practice. Work on paper has been vital for her while travelling and when no studio space was available.
Mattison in the catalogue for the current show observes, “While Pollock’s works depict nothing in the exterior world, they allude to the forces of nature, as do Frankenthaler’s paintings. Compared with solo practitioners where fewer than one-third of physicians adopted EHR systems, those in 2-physician or 3-to-10-physician practices were twice as likely, and those in practices with 11 or more physicians were nearly three times as likely, to have adopted EHR systems. To be nationally representative and correct for nonresponse bias, survey weights were designed to use characteristics of late respondents (data obtained by phone) as a proxy for nonresponse. But Richter had already drawn upon his traditional painterly skill to resolve anew the question of the nature of reality, mistrusting ready-made solutions or the appropriations of Pop art.
In the widening versatility of his work since that Venice display, Richter showed a growing versatility that confounded the majority of critics, yet even those who were amazed at the originality of Richter's approach could not possibly have conceived of what was still to come. This is particularly a problem when the non-custodial parent remarries and has additional children in the second (or subsequent marriages). Another strategy is reasoninga€”trying to get the other person(s) to accept onea€™s view through logical argumentation.
In fact, Piper was open to many influences in his long career (he lived to the age of 92) and the Dulwich exhibition presents the 1930s as a seminal period for him. A more consistent form of abstraction was the harsh, angular, architectonic work of the Vorticists.
In this, he absorbed the atmosphere of his times in terms of the interplay between various aspects of the visual arts. The publication of Axis: A Quarterly Review of Contemporary 'Abstract' Painting and Sculpture, was announced by Paul Nash in The Times (12 June1933) and described as 'the expression of a truly contemporary spirit'.
He returned to nature, to the beach on the South coast where, as this exhibition shows, he did some of his best work. In interview with Tim Marlow in London, on the occasion of her exhibition at Bernard Jacobson in June 2000, Frankenthaler described the process: “It’s just for the time I am totally into creating a work. But in addition to that, it transcends another traditional dualism: that between drawing and color.
Possessing an immediacy – they fuse the personal shorthand of drawing and the optical resonance of pure hues, “to provide a simulacrum of open-air, illusionistic space, but one that belongs to the surface, into which these forms are puddle and stained”.8 In practical terms, smaller works on paper in recent years have enabled Frankenthaler to continue her art practice with great alacrity, in to old age. It became possible to exhibit and sell such works, and for artists to devote their careers to media that had previously been considered ephemeral, fragile and difficult to exhibit. After Mountains and Sea, 1956–1959, the major study of her work by John Elderfield (1989), rightly established her prominent position in the Abstract movement. Only one-half of those in physician-owned practices were adopters, whereas physicians employed by community health centers, academic health centers, and HMOs were more likely to have adopted an EHR system. Those refusing to participate in the EMR survey were contacted to determine eligibility and included in the workflow survey if eligible.
He found he could, as a painter must, express that concrete reality in terms of light itself.
Quick-wittedly Richter dropped off his luggage there, then was driven back there from Dresden with his wife by a friend, crossing on the subway to west Berlin to retrieve it and gain freedom. Richter is stating his freedom, almost to disengage from the political climate engendering such subjects, in pursuit of an independent realism. While interest in abstract art may have waned during the years of the first war, by 1932 Paul Nash wrote in the Listener that abstract art was again very much alive. As the current 'Art Deco' exhibition at the V&A displays 'style' in areas of interior design, the applied arts, industrial design and architecture were influenced by the great developments in technology. Receptive to many sources at this stage, he appears to have taken as the starting point for his own maritime paintings, Braque's Dieppe paintings of 1929, in reproduction in Cahier d'art.
In 1934 she travelled independently to Paris where she met Mondrian, Brancusi, Kandinsky, Domela, Giacometti, all of whom became seminal figures in 20th century art. There was also a move towards large-scale works in materials that had previously been too difficult to curate, travel or store.
Her close friendship with Clement Greenberg whom she met in 1950, introduced her to the Abstract Expressionist artists.
About 11% of workflow survey respondents had refused to participate in the EMR survey, with more of these respondents being nonadopters than adopters. As early as l962 he had been experimenting with meticulous painted renderings of fleeting photograhic images and blurred copies of snapshots.
Le Corbusier made the connection between maritime imagery and modern art in his seminal writing, Vers une architecture (published in England as Towards a New Architecture 1927), where he described the steamship ('a machine for transport') as a further 'important manifestation of temerity, of discipline, of harmony, of a beauty that is calm, vital and strong'.4 He recommended that a modern house should be conceived as economically as a ship's cabin. Piper later admitted the influence of Braque on his experimentation in collage, in which he achieved a surrealistic effect by using newspaper, marbled paper, and detailed engravings of shells and fish cut from aquarium catalogues. It became possible for British artists to have a dialogue with international modern movements. Such changes owe a considerable debt to the career of Helen Frankenthaler, who curator Bonnie Clearwater describes as, “among the trailblazers of modern painting”.9 She combines a visual intelligence and knowledge of the history of art with experimentation, the ability to capture the moment.
But it was not until l991, at the Tate Gallery, that Sean Rainbird had organised his retrospective there, preceded by Richter’s ‘Mirrors’ shown at the Anthony d’Offay Gallery. A divisive element in the first issue was an article by Paul Nash in which he stated that if he translated totally beyond the image, he would suffer in spirit. John and Myfanwy contributed to the courageous campaign, embarked upon by Roger Fry 25 years earlier, to introduce modern art and ideas to England. Among workflow survey respondents, the proportion that completed the EMR questionnaire was greater for EHR adopters than nonadopters. This was after Richter had participated in the 1982 Berlin ‘Zeitgeist’ exhibition, in the company of Baselitz, Beuys, Clemente, Gilbert and George, Immendorf, Kiefer, Morley, Merz, Penck, Polk and Stella.



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