Battle tactics of the U.S. Civil war Essay Example | Topics and Well Written Essays - 2500 words

Fight strategies of the U.S. Common war - Essay Example War broke out and the rifles turned into a significant strategic weapon of this war. (Dupuy, 82) The military chiefs of that time knew that the utilization of the improved rifles in the war would unquestionably change the strategies that were utilized on the front line. Toward the start of the war, the vast majority of the rifles had moderate excusal gags. In this manner, the men were assembled to shape an enormous volume of terminating unit, which would make more harm the resistance making them leave the front line. Albeit, later on, the viable scope of the rifles and different weapons improved, the fundamental development of the men continued as before. On the off chance that the men were organized in little gatherings, at that point it would be hard for the pioneers to appropriately control them and make them battle. Consequently, to stay away from such disarray, the units of men were appropriately prepared in the weaponry division. The officials endeavored to prepare the fighters with the end goal that the soldiers could convey their most extreme potential and utilize their capability appropriately to abstain from losing. For instance, the Zouaves were educated to drop down on the ground out of nowhere before the contrary unit could strike at them, at that point out of nowhere rise and accuse them of their blades. Be that as it may, when there were disappointments the soldiers, and not the strategies, were accused. Griffith makes reference to, It is by all accounts the case that strategic assaults in the Civil War accomplished their neighborhood destinations preferably less much of the time over those of Napoleonic occasions, in spite of the fact that that doesn't really imply that they were less valuable in deciding the conclusive outcome of hanks or crusades. (Griffith, 29) We likewise observed the utilization of various as good as ever military procedures in the war. There were numerous progressive improvements in the utilization of ammo and guns. The improvement in the utilization of the Mini Bullet or Mini Ball permitted an individual to stack the rifle and shoot it at a more prominent speed than what was conceivable before. The most significant advancements came in the rifles, which assumed a key job in the improvement of the strategies of the war, in spite of the fact that they were not new to the warriors. Prior a skillet of black powder was utilized in the gun. In any case, before the war the percussion top was concocted where a top was utilized to light the black powder in the gun. This made it conceivable to utilize the weapon in practically all climate types. The percussion lock additionally improved the pace of shooting of the rifle. The way where the black powder gun barrel was rifled was likewise improved. This positively affected its preci sion and range. Prior the compelling scope of the smooth bore gun was distinctly around 300 ft. Consequently, this made perils for the carrier. By and by, in the wake of rifling the barrel, the successful range was expanded to around 750 to 900 ft. Along these lines, this made the carrier of the weapon all the more destructive and hazardous. A tremendous improvement was likewise made in the gun plan of the multi-fired rifle. The 1855 model and later on the 1861 model rifles embraced the utilization of the .58 bore and made it there standard for the infantry weapons. (Woodworth, 34-7) Infantry was the essential battle segment of the military in the American Civil War. The infantry of the American Civil War basically included the infantrymen and generally had little weapons before all else. Be that as it may, as the war advanced

Case Study of Smith and Jones Samples for Students Myassignment

Question: Talk about the Case Study of Smith and Jones. Answer: Presentation Duty arrangement of the nation assumes significant job in rising government support. The fun is used for the advancement of the nation just as for the fundamental consumption of the nation. The basic consumption, for example, the framework advancement, protection financial plan, and cost for keeping up the lawfulness inside the nation, helping the denied and elderly individuals the administration finance is utilized. The cash gathering from the expense help in this issue and consequently the administration use to acquire revision the tax collection approach as per the need of the nation. Principle study The assessable salary incorporates pay according to the standard ideas is called as normal pay. Area of ITAA 1997 remembers for the assessable pay of the citizen where the citizen is the occupant of Australia. All the conventional pay earned by the citizen all through the Australia would be remembered for the assessable salary during that time of time[1]. The capital increase charge is recognized on account of the Pre CGT land where, the benefit is delineated to be considered as the pre CGT charge and is additionally not assessable to the idea of the expense. The upgrade of the expense can be effortlessly dictated by demonstrating that the Pre-CGT charge isn't material by indicating the improvement of the nature. The thought can be effectively recognized as the upgrade of the movement which is being utilized for indicating the structure of the work and furthermore the expense of the base salary for the Smith and Jones are portrayed to be expanding in nature. This the figure essentially portrays the execution of the passage 104-10(5)(a) of the ITAA 1997 which is material to the case according to the endeavors are made[2]. In this way the upgrade of the structure can be portrayed by actualizing the capital addition burdens on the salary produced using the touching of the sheep on the land and on the improvement of the properties that ar e made on the land. According to the Assessable Income Tax Law, the applicable annual expense will be made on the capital gains as it is being found in the exercises proceeded by the Smith and the Jones. Hence the structure unmistakably portrays the suitable arrangement of the examination and furthermore the improvement of the investigation can be made by demonstrating the fitting clarifications to the contextual investigation as it is attempted in this case[3]. Aside from this, the limit of the outcome can be made by indicating the advancement costs and the contribution of the salary all through six years made by the Smith and the Jones. The previously mentioned contextual investigation it is seen that Smith and Jones are property engineer. They have bought a property eight years back, which has tremendous potential. The property is utilized for brushing reason throughout the previous six years and thenSmith and Jones have partitioned the land into 5 hectors squares and offered the land to one purchase[4]. In this situation as Smith and Jones are including in the property advancement calling and they utilize the property for brushing throughout the previous six years and afterward they exchange the property; subsequently, according to the tax collection rule in Australian tax assessment Office (ATO) they need to pay charge on the pay they earned from the touching and the upgraded estimation of the property to the government[5]. As indicated by the law it must be considered as the customary salary and the annual expense rule ought to be applied for this case. The capital addition charge is likewise applicable for this case as the property during this year built up a great deal and in this manner, the pace of the property has been expanded a ton. In this circumstance Smith and Jones need to pay capital addition charge for the benefit they make from the capital increase of the property. End The tax assessment framework underpins the basic government use. As per the expense results the different kinds of charges use to be forced on the citizens [6]. As indicated by the attempted contextual analysis both standard annual duty and capital addition assessment will be applied. References Cooper, Graeme S,Executing Income Tax(Australian Tax Research Foundation, 2008) Hurley, Annette,Tax Laws Amendment (Personal Income Tax Reduction) Bill 2008(Standing Committee on Economics, 2008) Krishna, Vern,Income Tax Law(Irwin Law, 2015) Bricklayer, Tom,Income Tax Law(Taxation Concepts, 2012) Whittenburg, Gerald E, Martha Altus-Buller and Steven L Gill,Income Tax Fundamentals(1st ed, 2013) Woellner, R. H,Australian Taxation Law 2012(CCH Australia, 2013) Graeme S Cooper,Executing Income Tax(Australian Tax Research Foundation, 2008). Annette Hurley,Tax Laws Amendment (Personal Income Tax Reduction) Bill 2008(Standing Committee on Economics, 2008). Vern Krishna, Income Tax Law (Irwin Law, 2015). Gerald E Whittenburg, Martha Altus-Buller and Steven L Gill,Income Tax Fundamentals(1st ed, 2013). Artisan, Tom, Income Tax Law (Taxation Concepts, 2012) Woellner, R. H, Australian Taxation Law 2012 (CCH Australia, 2013)

Should Students Use Free Essay Samples For Entertainment Purposes?

Should Students Use Free Essay Samples For Entertainment Purposes?The internet has made it possible for every school or university to offer various types of free essay samples. What are these samples?Free samples of essays are provided for students to help them improve their essays and improve their writing skills. Some examples of the types of essays that can be found in the free samples are essay samples about celebrity deaths, business-related essays, assignments in English as a second language, and exams. All these samples are a good way for an aspiring writer to practice their writing skills and improve upon them.Should students use these essays for entertainment purposes? It depends on the purpose and intention of the writer.Should they be used for opinion articles in various newspapers? It is considered inappropriate to use this type of sample essay for opinion articles. It is always better to use examples for learning purposes. However, if a student is using the free sample e ssays for entertainment purposes, he or she should consider the effect of his or her writings as well as its potential for spreading virus or contagion to the rest of the students.As part of the college essay writing course, students are encouraged to use free samples. The purpose is to help in the enhancement of writing skills and improve on their quality. It is not to be construed as plagiarism, since it is provided by non-commercial websites, which do not have that license to charge for its usage.Some of the other examples that are available on the websites offering free sample essays include use of resources from videos, movies, audio and poetry books. Other examples may include music and quotes from a variety of sources.There are many who would argue that the use of sample essays for entertainment purposes is no different from the ideas of plagiarism. This may be true for some cases but the fact is that the main purpose is not to make the writer rich nor is it to spread virus o r contagion in the classroom.While a person may think that the purpose of these sample essays is not important, the fact is that such samples can help writers improve their work and put it into motion. Should students consider using the samples?

Marx And The German Ideology - 874 Words

‘It is not consciousness that determines life, but life that determines consciousness’ (Marx, The German Ideology). Discuss. The life determines consciousness motif presented by Marx in the German Ideology is a representation of his view on ideological beliefs, which misrepresent the world to subjects. The theory also explains how economical life influences thinking, through notions such as interests. In this essay I will discuss the claim made above by Marx through looking at what he meant by the terms ‘life’ and ‘consciousness’. Having then looked at how life influences our thinking, I will explain the significance of the notion of interests. This will build up to the latter half of the essay where I will look at how Marx is presented with a self-defeating worry. From this, I will provide my response by explaining how life determines consciousness, concluding that Marx’s theory isn’t self-defeating and his meaning is intact. I will begin by outlining Marx’s general argument for the way economical life influences our thinking. Marx’s view of human consciousness centers on his materialist method, which looks at how the economic and social life of man, influence his actual life and his thinking . Marx’s view is thus in direct contrast to German philosophy, since he holds thoughts as being determined by extra mental entities which is our consciousness, and this is what we use to define ourselves. The notion is borrowed from his teacher Hegel, for whom consciousness was aShow MoreRelatedKarl Marx on the German Ideology843 Words   |  3 PagesKarl Marx on the German Ideology: Karl Marx and Friedrich Engels collaborated to produce The German Ideology, which was one of the classic texts generated by the two. Even though The German Ideology stands our as one of the major texts produced by the two, it was never published during Marx’s lifetime. This was a clear expression of the theory of history by Marx and its associated materialist metaphysics. One of the main reasons this text is a classic text by these philosophers is the fact thatRead MoreKarl Marx And The German Ideology1713 Words   |  7 PagesKarl Marx was born on May 5th, 1818, in Trier, Germany. (Rà ¼hle, 1943) He was a university scholar who gained knowledge in topics such as philosophy, law and history. (Rà ¼hle, 1943) Marx eventually switched from studying law to study philosophy, in which he gained his doctorate degree at Jena in. (Calhoun, Gerteis, Moody, Pfaff, Virk, 2012) Marx was known for being not only a social critic but also an economist. Marx is also known to have close working ties to Frederick Engels, a fellow sociologistRead MoreKarl Marx And The German Ideology1437 Words   |  6 PagesINTRODUCTION Long before our time, two prominent German philosophers emerged at the forefront of ideology and thinking. These two men were Karl Marx and Friedrich Nietzsche who pioneered the idea of truths, religion, reality, etc. Karl Marx’s essay, â€Å"The German Ideology,† otherwise known as Marxism, focused upon the materialistic processes that brought life into our world and the abuse of the burgeouse on the proletariat. This theory later went on to found the core beliefs of communism and playedRead MoreKarl Marx s The German Ideology2228 Words   |  9 PagesIn The German Ideology, Karl Marx explores and attempts to shape a definition of ideology. Marx says that ideology is the production of ideas, of conceptions, of consciousness, all that men say, imagine, conceive (Blunden). Marx goes on to say that this includes language of politics, laws, morality, religion, metaphysics, etc. (Leitch 655). Subscribing to the idea of base and superstructure, Marx identifies ideology as the superstructure of a civilization. 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Marx and Engels both formed the theory that it isn’t what we think that decides out reality, it is instead our reality that decides what it is that we are capable of thinking. It is in essence the idea that we as human beings are refined not by what we think, but by our reality, which in turn decides the capabilityRead MoreKarl Marx s View On Race And Ethnicity865 Words   |  4 PagesRace is rarely mentioned by the three early proponents of the field of sociology, Karl Marx, Emiele Durkheim and Max Weber. However, when it is cited, these sociologists voiced very diverse opinions on the matter of race and oppression. Marx regarded race as vestige of the pre-industrial era and thus, would be superseded by â€Å"reductionism† (Cite). Emiele Durkheim believed race, which he referred to as â€Å"ethnicity,† was a factor in connecting an individual to a subgroup of society, but played littleRead MoreSocial Class Differences On The Long Run Essay1403 Words   |  6 Pagesperiod after that. The results of this study suggest that social class differences may be growing in the long run. This paper will examine this graph from the perspectives of both Adam Smith and Karl Marx. Using Marx and Smith’s findings in German Ideology and Wealth of Nations, this paper will discuss Marx and Smith’s main theories on capitalism and describe how these theories can be applied to the interpretation of the graphs in the study â€Å"Inequality in the Long Run.† This paper will also discuss theRead MoreThe Nazi Ideology Of National Socialism1355 Words   |  6 Pagesand agreeably answered by the Germans. Some, like Adolf Hitler, believed the Jews were an untrustworthy and tainted breed and, ultimately, should be terminated. This leads to the Nazi ideology of National Socialism. A philosopher by the name Martin Buber believed that Judaism was more than a nation and could not solely behave as one. On the contrary, Bruno Bauer proposed that Je ws cut their religious ties all together and become politically emancipated while Karl Marx critiques this idea and proposesRead MoreThe Communist Manifesto And Das Kapital1507 Words   |  7 PagesKarl Marx A German philosopher, economist, journalist and revolutionary scientist, Marx was best known for his work in economics. He laid the foundations for today s theories of labor and capital. The Communist Manifesto and Das Kapital were among the most famous of his published works. Born to a middle-class family in Trier, Prussia in 1818, his parents were Jewish, but converted to Christianity in 1816 due to strict anti- Jewish laws. He was baptized as a Christian at the age of six but later

Student Athletes Are Deserving Of Economic Remuneration

The seven most popular sports (in order) in the United States are: NFL, MLB, NCAAF, auto racing, NBA, NHL, and NCAAM (Rovell, 2014). Five of the sports included are professional where the athletes are paid. However, two of them--NCAAF and NCAAM--are amateur sports headed by student-athletes who are not paid. When these college sports are on par with professional organizations that are worth billions of dollars, then the amateurism behind the NCAAF and NCAAM is questioned. In fact, the NCAA generates almost a billion dollars annually. Since the athletes in question are amateur student-athletes, paying them might damage the integrity of the sports. Therefore, there is an ongoing contested debate over whether student athletes are deserving of†¦show more content†¦However, amateurism is an illusion because the NCAA â€Å"insatiably embrace[s] commercialism in all facets of intercollegiate athletics except on a single issue — athlete compensation† (Zola, 2013). The 1980s is where NCAAM and NCAAF exploded as businesses. The Supreme Court, in 1984, struck down the NCAA’s restrictions on television appearances. This coincided with the government deregulation of cable television and, ultimately, led to massive television contracts and sports stations covering NCAAM and NCAAF. As the athletic departments of universities expanded profoundly, they continued to reiterate the student in student-athletes. By doing so, they built the boundary up as an effective defense from allowing college athletes to get a cut of the newfound income. In 1988, the NCAA became an effective private institution when the Supreme Court ruled against Jerry Tarkanian and allowed the NCAA to dismiss due process during their investigations. Amateurism, in the sake of college football and men’s basketball, is a falsehood and a boundary created by the NCAA and enforced by college coaches and athletic departments. The meaning behind the category of student-athletes wa s empowered by the NCAA in the 1950s to fend off lawsuits and implement the sanctity of college sports as amateur sports. The NCAA’s moral authority lies in the term â€Å"student-athlete† and â€Å"is meant to conjure the nobility of amateurism, and the precedenceShow MoreRelatedShould College Athletes Be Paid?3174 Words   |  13 PagesShould College Athletes Be Paid? College sports are a highly paid business. It is produced sold just like all other commercial products. The NCAA generated over $70 million in the basketball tournaments. Schools who made it to the finale instantly earned over $1.3 million. $275 thousand was given to those who were invited to the tournament. Football is just the same. The (1988-89) seasons produces $53 million and $66 million and was split between all participating schools. College athletes should receiveRead MoreOverview of Hrm93778 Words   |  376 PagesHuman Resource Management (MGT501) VU MGT - 501 T his subject/course is designed to teach the basic principles of Human Resource Management (HRM) to diverse audience/students, including those who are studying this as a supporting subject for their bachelor degree program. This course is designed to provide you the foundations of HRM whether you intend to work in HRM or not, most of these elements will affect you at some point in your career. Either you will be working with some organizationsRead MoreOrganisational Theory230255 Words   |  922 Pagessterling service in bringing together the very diverse strands of work that today qualify as constituting the subject of organisational theory. Whilst their writing is accessible and engaging, their approach is scholarly and serious. It is so easy for students (and indeed others who should know better) to trivialize this very problematic and challenging subject. This is not the case with the present book. This is a book that deserves to achieve a wide readership. Professor Stephen Ackroyd, Lancaster UniversityRead MoreDeveloping Management Skills404131 Words   |  1617 Pages xvi CONTENTS P R E FA C E What’s New in This Edition? Based on suggestions from reviewers, instructors, and students we have made a number of changes in the eighth edition of Developing Management Skills. †¢ Added new skill assessments in Chapter 1 and a new case in Chapter 3. †¢ Revised parts of the book to reflect suggestions and feedback from instructors and students. †¢ Clarified instructions for scoring skill assessments and updated the comparison data for each assessment. †¢ Updated

Essay on Developmental Matrix - 995 Words

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(Few achieve identity achievement in | | |Every primary sex organ increases in size and matures |idea or premise that uses logic to draw specific |these areas.) | | |in function |conclusions. |Relationships are crucial with parents and non-parent adults.| | |Secondary sex characteristics develop – body shape, |Dual-process model – Advanced logical thought |Adolescents become independent and clash with the parents’ | | |males growShow MoreRelated The Characters in The Matrix Essay3889 Words   |  16 PagesThe Characters in The Matrix The Matrix (Wachowski Wachowski 1999) is a battery powering an unending chatter of thought, images, productions, and discourse. In the film, a stabbing needle penetrates the black plug mounted on the back of a human skull, and the mind is overwhelmed by the matrix, an extensive simulacral world that, to its unknowing inhabitants, is in every way the same as reality, and to those merely passing through, is a sinister, green-tinted prison. 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Thus, social context and other human beings play an important role in the cognitive growth of an individual, because higher mental functions, such as logical memory, selective attention, decisionRead MoreAlice Saddy Case Study1316 Words   |  6 Pagesï » ¿Alice Saddy Case Study 1. Abstract The individual case managers, support workers and human resources manager working at the Alice Saddy Association which is a non-profit organization London and Ontario supporting people with developmental disabilities who were living individually rather than in group houses informed the executive director that the employees thought the present business structure triggered confusion, slowed down decision making ability and endangered all everyone involved withRead MoreNew Technology from 1945s to 20002151 Words   |  9 Pagesrapid changes in technology. POST WORLD WAR II AND LATE 1940s (1945-1949) Technology played a crucial role in determining the outcome of the World War II. 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Electronic Medical Record Implementation Costs and Benefits free essay sample

Electronic Medical Record Implementation: Costs and Benefits Sheryl L. Venola Assignment 3 (24 July 2011) NURS 517 Intro to Health Care Financing Saint Xavier University Professor: Dr. Roger Green, DNP, MSN, BSN Abstract This paper discusses the adoption of an electronic medical record system purchased by Howard Regional Health System in Kokomo, Indiana; the rationale behind its timing and choice in expenditure; the ramifications of not implementing the system (e. g. recent health care legislation requirements); the benefits to the organization as well as to the patients it serves, and a cost effectiveness analysis. Additionally, the American Recovery and Reinvestment Act of 2009 is discussed including compliance mandates that will require eligible providers and health care institutions to meet electronic health technology implementation deadlines or face no compensation for their implementation as well as reductions in Medicare and Medicare reimbursements. Also included are discussions of the â€Å"meaningful use† guidelines established by the Centers for Medicare and Medicaid and the differences between electronic medical records and electronic health records. Finally, the advantages and disadvantages of electronic medical records are detailed. In response to the to changes in the health care delivery system as a result of the Affordable Care Act (ACA) signed into law in March of 2010, Howard Regional Health System (HRHS) has recently purchased the Cerner electronic medical record (EMR) system at a cost of $22,000,000. According to chief executive officer, James Alender, accountable care is the focus of this change in addition to stimulus money for electronic health record (EHR) system implementation, which could offset their initial expenditure by approximately $3,100,000 based on the volume of Medicare business the organization had in 2008 (Munsey, 2011). This monetary investment comes in the wake of health information technology implementation requirements set forth in the American Recovery and Reinvestment Act of 2009 (ARRA). The Recovery Act specifies that eligible providers and hospitals with a fixed Medicare and Medicaid patient populations must adopt EHR systems by 2015 or face reduction in their compensation under these programs (Department of Health Human Services [DHHS], 2009). Additionally, the act assigned funds to the Centers for Medicare and Medicaid Services (CMS) to assess existing EHR systems and to provide incentives for eligible providers and hospitals in implementing such systems. With continued funding and legislative measures affecting the organization’s financial future, the adoption of the Cerner system seems to be one of the most important steps in ensuring its financial security in the years to come. If hospital executives and the Board of Trustees were to ignore the requirements set forth in the AARA and ACA legislation, the institution would be in serious jeopardy of losing not only is share of federal funding, but its ability to participate in health care delivery on any level at all. This would signal their demise and would certainly affect the surrounding community as it is one of two hospitals in Kokomo, Indiana, and is the only health care organization of its size in this region of the state. The patients Howard Regional serves will benefit from electronic recording of their health and medical information in many ways. Alender states that Kokomo’s â€Å"snowbirds† should have access to their records so they can be as mobile as they are, suggesting that this will reduce health care costs by reducing duplication of tests, if treatment is obtained away from home. He goes on to assert that digital records will allow more efficient movement of patients through the system allowing seriously ill patients to move more quickly through the emergency department, and other acute care departments within the system. Additionally, if that same patient requires further care away from HRHS, the treating hospital would have access to the previous records so that work already completed is not repeated (Munsey, 2011). Their medical information could be updated with each visit rather than their having to â€Å"provide the same information over and over again (Gurley, 2003). † Gurley also agrees that because patients and providers are better informed through electronic record-keeping, there is less duplication of testing as well as enhanced treatment coordination among health care providers. Along with the patients, the hospital reaps many tangible and intangible benefits from EMR as well. The information in the electronic record is easily accessible to multiple clinicians at multiple locations at the same time, with nearly immediate retrieval time. For this reason, it is updated frequently and is available for access at any workstation whenever the information is required making time spent with patients more efficient (Gurley, 2003). According to Shi and Singh (2003, p. 65), one of the most important aspects of electronic records is the integration of specific patient profiles with clinical decision making tools built into the software which provide evidence-based practice reminders and guidelines for effective, efficient treatment. This type of alert system can result in reduction of medication errors and in appropriate treatment options, saving both the patient and the clinician from harm. The data analysis capability of the EMR can also be used to identify developmen ts among patient populations allowing for early intervention when indicated. It can also be utilized to identify areas in which the organization may need to expand or scale back depending on the trends the data indicates (Dolan, 2011). Having used the Cerner system in the past, this RN noted that with the clinical record being streamlined in such a way that narrative documentation was necessary only by exception, completing it required less time, which left more time for bedside care along with completion of educational requirements, which were also mostly computerized. Hence, the savings could be significant and provide for increased nurse satisfaction related to the ability to provide more actual patient care as well as complete proficiencies without having to stay after a shift or come in on a day off. As mentioned above, EMR can reduce duplication of services, assist in fast-tracking acutely ill patients, reduce the duplication of tests and services that aren’t medically necessary (e. g. the patient’s condition has not changed substantially), allow clinicians to spend less time on documentation possibly reducing overtime, each of which can result in cost savings for the institution. According to Randall T. Huling Jr. , MD, president of Olive Branch Family Medical Center in Olive Branch, Mississippi, since switching over to EMR in January of 2010, they have increased revenue by an estimated $650,000 with an annual cost reduction of more than $85,000. Additionally, they have been able to raise provider productivity by 10,000 visits, raise their fee collection percentage from 68 to 72 percent, and increase the charges per patient from $157 to $172 (Byers, 2010). Wang et al (2003) performed a five-year cost-benefit analysis using primary data from several internal medicine clinics, using their own internally developed EMR system, utilizing a health care organization perspective framework and a conventional paper-based medical record as the reference point. Costs of implementation were approximated to be $3,400 per provider in the first year and included redesign of workflow processes, extraction of data from paper charts, and training. Yearly maintenance cost, including system and network administration and additional technical support personnel, were estimated to be $1,500 per provider annually. The temporary loss of productivity resulting from the transition to an electronic from a paper system, was interpreted using a decreasing loss rate of 20% in month one, 10% in the second month, and 5% in the third, returning to baseline in the following months. With annual averages for provider revenues, this cost amounted to $11,200 in the first year. Although their five-year net benefit per provider was $86,400 and the â€Å"net financial return to a health care organization from using an ambulatory medical record system is positive across a wide range of assumptions (Wang, et al, 2003, p. 401),† the authors cautioned that several variables could affect the net revenues organizations could expect. The patient mix can affect revenues depending on the number of capitated versus fee-for-service patients served by the health care organization. With capitated arrangements, savings to the patient resulting from decreased use of utilization of services, revenues accrue to the provider. However, less utilization of services in fee-for service arrangements result in loss of revenue to the provider, but the payer (i. e. the insurer) saves in expenses. They did postulate that these insurers might provide incentives to providers using EHR realizing that their profits could be increased with more providers utilizing these systems, The study evaluated cost savings from drug suggestions and warnings provided by the EMR software, which aided in prescribing of formulary drugs and prevention of adverse drug events. However, the study was not able to evaluate the intangible cost savings from averted malpractice claims, injury to patients, or reduced quality of life of clients. Additional tangible and intangible savings that were not included due to unavailability of sufficient data were reductions in malpractice premium costs, decreased staffing needs, less paper charting-related storage and supply costs, increased provider productivity, generic drug substitutions, enhanced reimbursement resulting from proper coding, and reduced denials related to insufficient documentation of medical necessity (Wang et al, 3003 p. 402). Limitations of the study cited by the authors included the fact that the research model was centered on primary data from their institution, published literature estimates, and an expert opinion panel which they convened. They also conceded that EMR implementation might produce other costs, including greater system integration expense for larger institutions dependant on the complexity of the various system interfaces involved. Additionally, although effectiveness of electronic medical record interventions has been well-established in inpatient settings, there is less certainty of their effects in the outpatient environment. Other costs could be related to decreased or lost productivity during unexpected network or computer system downtime, reassignment of clinical staff, or redesign of the workflow process (Wang et al, 2003, p. 402). Obviously the above results are based on one study utilizing results from a group of ambulatory clinics making it difficult to extrapolate data to a hospital setting even when that hospital has significant outpatient programs. Indeed, Thompson and Fleming (2008) pose questions regarding the uality and quantity of data found in existing literature, suggesting that health care institutions be cautious in their information sources in order to be better informed in the EMR decision-making process. The authors state that amount of comprehensive studies are lacking requiring hospitals to obtain more sources containing information they are seeking and rigorously compare data so that they can better extrapolate the results to their individual organizations (Thompson Fleming, 2008) . They also caution using staff time savings as a factor unless that variable is given a value and that it is used to actually cut costs. For example, if an average of 30 minutes per staff member is realized in utilization of the EMR, how will that impact staffing? Will staffing needs be reduced allowing for fewer staff members per shift, resulting in actual cost reductions? If staff are able to complete other duties that would have required use of overtime or coming in on days off, this would also decrease expenditures. However, the authors point out that staff members are often allowed to perform other tasks that don’t result in salary reductions, although this is implicit when staff time saving related to EMR is discussed (Thompson Fleming, 2008). It is obvious that the decision to adopt an electronic medical record is not an easy one to make given all the variables discussed previously, but the information presented thus far has not taken into account the more recent changes produced by health care reform. These changes are discussed in the following paragraphs. The American Reinvestment and Recovery Act provides incentives for eligible providers (EP) and health care organizations (i. e. those who serve a defined percentage of Medicare and Medicaid recipients) for the implementation of EHR. The use on EMR and EHR are have often been used interchangeably, but they are not the same. An electronic medical record is the legal record of the care a patient receives from a health care provider or institution during their encounter with either entity. The electronic health record belongs to the patient and encompasses the entirety of their care across all providers within a community, region or state (Garets Davis, 2006, pp. 2-3). For the purposes of reimbursement, however, providers must use a certified EHR (EHR Incentives, p. ). The recovery Act has appropriated $140,000,000 for each of fiscal years 2009 through 2015, with an additional $65,000,000 for 2016 to be used for administrative funding. Funds are to be made available until completely utilized. â€Å"In coordination with the Office of the National Coordinator (ONC) for Health Information Technology, CMS will develop the policies, such as the definition of ‘meaningful use,’ needed to implement the incent ive program (DHHS, 2009). In addition, it will be necessary to provide education to eligible participants to facilitate their understanding of all the conditions and guidelines regarding their eligibility, the selection of Medicare or Medicaid incentive programs, the incentive payments, and the demonstration of â€Å"meaningful use. † Recovery Act reporting compliance will require guidance to individual states, which will involve Federal and State staff time and require modification of accounting and payment data reporting systems (DHHS, 2009). When the aforementioned requirements were set forth by the DHHS in 2009, the meaningful use guidelines had not yet been established. Following is a link to the summary overview for meaningful use objectives of EHR* (Blumenthal Tavenner, 2010) as it currently stands, which outlines the steps individual providers and health care institutions (hospitals, ambulatory care centers, clinics, et al) must take in order to receive stimulus funds for the costs associated with implementing electronic health systems (EHR). The initial payments will be made beginning in 2011 depending on each state’s timing in adoption of the Medicare and Medicaid programs. For hospitals, the calculation is based on the volume of Medicare and or Medicaid patients served, but the baseline payment is $2,000,000. Each program is separate, but EPs and institutions can apply for one or both programs, however if they choose only one program, they cannot later add the other, so it benefits them to choose both at the outset since they can drop out of either one at any time (EHR Incentives). Given the stakes of not participating, providers should work diligently to eet all the requirements set forth in order to maximize the return on investment they should obtain in simply adopting EHR. The incentives offered will merely help them realize those return sooner rather than later. Finally, given the state of internet security and the government’s desire to push providers toward electronic data capture, it is only natur al that there would be concerns regarding EMR and EHR technology. Advantages of EHR over paper records include an expansive storage capability, availability of the data from many access points at the same time, and nearly immediate retrieval time (Gurley, 2003). The paper record is fragmented and depending on the charts used (e. g. some tend to fly open when dropped, causing paper to be scattered), pieces of the record can be lost. Additionally, when a patient is hospitalized more than once, their old chart must be retrieved in order to provide continuity of care. Electronic systems bypass this and allow clinicians to obtain information from previous visits much more quickly allowing the patient to have a streamlined entry to and exit from the system. Electronic health records also have built-in medical alerts and reminders allowing providers to be notified of abnormal lab results, potential drug interactions, and timing of tests required for monitoring blood levels associated with certain conditions or as a side effect of medications. It can also provide evidence-based practice plans for certain diseases and disorders facilitating the provider’s choices in judging the right path in caring for each patient. The electronic software allows the clinician to capture information enabling them to provide payers with the outcome based criteria they require in reimbursing the physician. Finally, EHR provides a major step in ensuring patient safety by clearly written order entry by physicians avoiding the mistakes that can occur with handwritten orders when those entries are illegible (Gurley, 2003). The major disadvantage of EHR adoption appears to be the costs associated with implementing them. According to Kent Gale, start-up costs could range from between four and five million dollars for a smaller (200-bed) hospital to $100,000,000 for an organization with three hospitals. He went on to tate that a typical 400-bed facility with a more extensive EHR would likely spend between $20,000,000 and $30,000,000 (Byers 2010). Also, unless one is technologically-savvy, there can be considerable learning needs on the part of physicians and staff. In these cases, it is much better to have systems that are more intuitive and user-friendly in order to get everyone onboard. As previously mentioned, privacy concerns are at the forefront in people’s minds where electronic documentation is concerned. Security measures must be ever-evolving in order to meet the challenge and audits of access to medical data must be done to ascertain the appropriateness of information access. Paper records have also had the potential for unauthorized access without the knowledge of the patient or provider and these invasions of privacy are much harder to detect (Gurley, 2003). Essentially, the electronic record has its advantages and disadvantages, but with all the benefits they can provide to patients, providers, insurance companies, as well as the government in collection of statistics, it appears to be the best choice for all concerned. With a great deal of effort and constant vigilance, electronic health records can provide for safer, more cost efficient care, and conserve resources for use in other areas that are currently lacking. I believe that in the end, Howard Regional’s decision to adopt EHR will result in huge savings and increased revenues that will benefit not only the organization, but the communities they serve. References Blumenthal, D. , Tavenner, M. (2010, August 5). The â€Å"Meaningful Use† Regulation for Electronic Health Records. New England Journal of Medicine, 363, 501-504. Retrieved from http://ww. nejm. rg/doi/full/10. 1056/NEJMp1006114? ssource=hcrc Byers, J. (2010, November). EMR implementation: One day at a time. CMIO: Information, Evidence Effectiveness in Medicine, Digital. CMIO. net, 10-12. Retrieved from http://d27vj430nutdmd. cloudfront. net/5165/51383/51383. pdf Department of Health and Human Services Report (2009). Centers for Medicare Medicaid Services: Medicare an d Medicaid Incentives and Administrative Funding. Retrieved from http://www. hhs. gov/recovery/reports/plans/hit_implementation. pdf Dolan, P. L. (2011, May 2). Electronic medical records: What your data can tell you. American Medical Association: American Medical News. Retrieved from http://www. ama-assn. org/amednews. EHR Incentives: Eligibility. (n. d. ). Retrieved July 18, 2011, from Centers for Medicare and Medicaid Services website: https://www. cms. gov/pf/printpage. asp? ref=http://www. cms. gov/ehhttps://www. cms. gov/pf/printpage. asp? ref=http://www. cms. gov/ehhttps://www. cms. gov/pf/printpage. asp? ref=http://www. cms. gov/EHRIncentivePrograms/15_Eligibility. asprincentiveprograms/01_Overview. asprincentiveprograms/01_Overview. asp Garets, D. , Davis, M. (2006, January 26). Electronic Medical Records vs. Electronic Health Records: Yes there is a difference [White Paper]. Retrieved from A HIMSS AnalyticsTM website: http://www. himssanalytics. org/ Gurley L. (2003). Advantages and Disadvantages of the Electronic Medical Record. American Academy of Medical Administrators, 2004. Retrieved from http://www. aameda. org/MemberServices/Exec/Articles/spg04/Gurley%20article. pdf Munsey, P. (2011, March 26). Howard Regional up to the challenge. Kokomo Perspective. com. Retrieved from http://www. kokomoperspective. com Shi, L, Singh, D. A. (2008). Delivering health care in America: A systems approach. Sudbury, MA: Jones and Bartlett Publishers. Thompson, D. L. , Fleming, N. S. (2008, July). Finding the ROI in EMRs. Healthcare Financial Manager, 62(7), 76-81. Retrieved from http://www. hfma. org/publications/hfm-Magazine/hfm-Magazine Wang, S. J. , Middleton, B. , Prosser, L. A. , Bardon, C. G. , Spurr, C. D. , Carchildi, P. J. , Bates, D. W. (2003, April 1). A cost benefit analysis of electronic medical records in primary care. American Journal of Medicine, 114(5), 397-403. Retrieved from http://www. amjmed. com/article/S0002-9343(03)00057-3/fulltext