RCHC Community Project Abstracts

Back to subject search page or search by preceptor site The Decision To Transition: Paper Charts vs. Electronic Medical Records (EMR) Project Date: 9/7/2009 Choosing to switch from paper charts to electronic medical records (EMR) is a major decision, philosophically and financially, for physicians and clinics. This study attempted to compare and contrast the advantages and disadvantages of paper charts vs. EMR and to identify the attitudes that physicians in Grants Pass, OR have towards these two systems. The methodology for this study was qualitative and an interview approach was utilized. Four physicians were interviewed based upon their time spent using paper charts/EMR and their intention of transitioning to EMR. Physician concerns for transition to EMR included quality of patient care, financial stability, time efficiency and impact on quality of life. Recommendations from physicians currently using EMR were included for health care providers considering the transition from paper charts to EMR. Prevention of Osteoporosis Across the Lifespan Project Date: 10/13/2008 Osteoporosis is a major public health concern, affecting an estimated 10 million Americans and costing the American healthcare system close to $19 billion1. Though the diagnosis of osteoporosis typically does not come until after age 50, research has shown that prevention of the disease must begin far earlier than this. In an effort to promote prevention earlier in life, and thus hopefully decrease the prevalence of osteoporosis in generations to come, I preformed a review of the literature on evidence for preventive measures throughout the lifespan. These prevention guidelines were then incorporated into “smart phrases” in the electronic medical record, which could be entered into the patient instructions area with the ease of a couple key strokes. No longer would there be a need to have clinicians memorize the recommended calcium intake for a 3 year old or what type of activities are recommended to help build strong bones. Now the clinicians could simply enter the pre-written smart phrases into the patient instructions area and have the information easily at hand for both themselves and the patient. Not only will this help educate the patient on what they can do to prevent osteoporosis but it facilitates a discussion between the clinician and the patient about risk factors and what the patient can do now to prevent the disease. Thus far, the clinicians in the Scappoose medical clinic like the idea of these smart phrases. Many of them agreed that it was difficult to know what guidelines or evidence was out there concerning osteoporosis prevention early in life. They appreciate these smart phrases for putting that information at their fingertips. Future research that could stem from this project includes assessing how useful these smart phrases actually are, how often they are actually utilized by clinicians and if in fact they helped to decrease the incidence and prevalence of osteoporosis in future generations. The Use of Pre-Printed Order Sets for Inpatient Community Acquired Pneumonia Treatment to Increase Compliance with National Quality Measures in a Rural Hospital Project Date: 8/4/2008 Physician order sets for specific inpatient diagnoses are a potential method to decrease the incidence of medical errors. Computerized physician order entry (CPOE) is the gold standard of order sets and has been shown to decrease adverse events in larger hospitals. However, the cost of implementing CPOE is often financially infeasible for smaller, rural hospitals. An alternative is to CPOE is the use of pre-printed physician order sets for inpatient treatment. This study analyses the use of pre-printed order sets for meeting national quality measures for the treatment of community-acquired pneumonia in a 21 bed rural hospital located in Florence, Oregon. The data set collected was too small to draw any conclusion whether pre-printed order sets increased compliance with national standards. However, the pre-printed order set was used on only 22% (7/32) of pneumonia patients in the study. Increasing physician usage of the order set will be necessary to determine if pre-printed order sets are more effective in achieving national benchmarks. Colon Cancer Screening in Rural Oregon A Small Case-Series for Reedsport, OR. Project Date: 4/28/2008 Purpose: To establish demographic data for those undergoing colonoscopies in rural Oregon. To determine whether current screening with colonoscopy is cost-effective for Reedsport, and Dunes Family Practice. Methods: I performed a chart review of 145 cases dated between 01/03/07 and 03/26/08. Records were evaluated for general demographic data. pertinent past medical/surgical/family/smoking history, presenting symptoms, prior and current colonoscopic & pathologic findings. Results: All 145 cases were included in series (83 females, 62 males). Mean age was determined to be 64.83 years. Approx. 25% had prior history of polyps, 3 % with colon cancer previously. 79% had a positive colonoscopy, with 23% having any type of polyp. Of those with polyps, approximately 47% (15 cases) had adenomatous and 6% (2 cases) with malignant findings. Incidence of colon polyps and cancer was calculated to be 22 per 100 individuals per year and 1.4 per 100 individuals per year, respectively. Total life-years gained for cases was calculated to be 20 yrs. Conclusions: Incidence of colon polyps and cancer found to be significantly higher than national and Oregon average. This is likely due to demographic factors including age and prior health status. Current screening with colonoscopy was found to be cost-effective based on general acceptance of screening procedures with cost per life-year gained <$25,000. Difficulties in Narcotic Prescriptions for Chronic Pain Patients in a Rural Clinic Project Date: 3/17/2008 Background : It is difficult and time-consuming for different providers in a small rural healthcare practice to determine when a pain medication is due for a patient under a narcotic contract, because of different levels of patient understanding and variability in the wording within the prescriptions. Furthermore, the dispensation of narcotics causes significant tension in the doctor patient relationship. Question: I set out to determine if there was a way to improve the communication between a patient and a provider and among different providers in a group. Methods: I conducted a number of interviews with staff and patients and used the GE Centricity electronic medical record to better define the population with narcotic prescriptions within the practice, and then attempted to use the electronic medical record to generate uniform narcotic prescriptions. Results: The population receiving narcotics prescriptions in this practice were disproportionately Medicaid and Medicare patients. Although prescribing practices varied significantly among providers, the idea of creating a uniform disclaimer for narcotics prescriptions was met with enthusiasm. Therefore, a quick text generator, or “dot phrase” was created that could be entered into a prescription that read “Do not refill. Do not drink alcohol while taking this prescription. Do not operate a motor vehicle if impaired. Limit to Applegate Medical Providers. Limit to _______ Pharmacy. This medication is to last until ________.” This was then linked into the patient’s medication chart, the current visit note, and the after-visit summary. Although this was not a complete solution, the project was viewed as a success by groups prescribers Effect Of Computer-Based Patient Record System On Patient Satisfaction In Eugene, Oregon. Project Date: 2/11/2008 Background and objectives: Computer-based patient record system is being increasingly implemented in physician offices. Implementation of electronic medical record changes the work process during the patient encounters. Studies have identified that physicians are concerned about electronic medical record utilization in the exam room negatively impacting physician-patient relations, leading to diminished patient satisfaction. The objective of this study was to determine the effect of computer-based patient record system in the examination room on patient satisfaction one year after implementation of the electronic medical record system when the physician is proficient at utilizing the EMR. The other objective was to determine patient satisfaction with web-based services, particularly secure messaging, lab result reporting, and medication refill requests, and confidentiality. Methods: A survey was given to 50 patients at the end of the visit at a family medicine physician’s clinic in Eugene, Oregon. The survey assessed the following factors: overall patient satisfaction, patient’s perception of the doctor’s proficiency, effect of computers in the exam room, patient satisfaction with patient web portal system, and patient’s concern about the confidentiality. Results: Majority (84% to 86%) of those surveyed rated computers in the exam room as very or somewhat positive in all five aspects of physician-patient communications. 83% to 100% of those who used the web-based services rated the four aspects as very satisfied. Discussion: This study showed that at 1 year after implementation of the electronic medical record system, CBPR in the exam room had a positive effect on all five aspects of physician-patient communications. Majority of the patients were very satisfied with the web services, which is consistent with other studies and adds to the existing data. Evaluation of chronic pain management patient burden on CEFP clinic, Klamath Falls, OR. Are we simply refilling opioid medications? Project Date: 9/10/2007 Klamath Falls, is a larger than rural community in S. Oregon. However, due to its proximity to other outer lying rural areas, CEFP serves as the hub in the wheel and center of focus for much regional primary care. There is only on Pain Management specialist in Klamath Falls, and this provider does not take OHP. Thus the burden of low income pain management falls mainly on CEFP. Currently many urgent care visits are taken up by medication refills and frustration of residents in trying to deliver appropriate care is evident. Most notably, loss of professional autonomy is cited by residents in their frustrations in dealing with this patient population. This does not allow for continuity of care and addressing of other patient health issues. In fact these patients are seen more often but with less emphasis on other health maintenance issues. A 6 mos interval of chronic pain management visits was queried from CEFP electronic medical record system. 158 unique patients involving a total of 1075 patient visits in the last 6 mos. These patients were chart reviewed to identify continuity of same provider care and top categorical assignment of other co-morbid health conditions in an attempt to identify strategies to better improve delivery of health maintenance. These results will help the faculty and residents determine if: 1) they are meeting their health care mission to their patients 2) if a pain refill medication clinic is specifically needed to relieve burden on the urgent care practice and allow patient visits to focus more on other health issues. Utilization of an electronic medical record to monitor and improve preventive healthcare at Ontario Family Medicine Project Date: 7/2/2007 Preventive healthcare is an integral part of providing primary care. To guide the use of preventive services, the U.S. Preventive Task Force and Center for Disease control have established based recommendations for health screening and vaccinations. Despite strong evidence supporting the importance of preventive healthcare, the rates of providing these services are often less than ideal in the time pressured setting of primary care. However, the use of electronic medical records with health screening features has been shown to dramatically improve service rates. Ontario Family Medicine is currently using PowerMed electronic medical record, but has not been utilizing the Health Screening section of the program. This project aims to take the first steps to utilize an electronic medical record's health screening capability to improve the provision rates of preventive services in a rural primary care setting. Using current Task Force and CDC guidelines a list of core recommendations that fits the adult patient population of Ontario Family Medicine was established. These recommendations were entered into the program, and then cross-linked to orders so that when an order is entered, it will automatically update the patient's Health Screening section. Next the practitioners and clinic staff were trained on how to view the new Health Screening section, and enter orders. Finally the programs ability to generate reports on overall practice screening rates was evaluated. Continuity of Care and Medical Information of Children in Foster Care Project Date: 9/11/2006 In 2005, more than 6000 children entered foster care in Oregon and the population is growing. Foster children are at particular risk for adverse health outcomes and these risks are exacerbated by a common failure to obtain, document, and transmit medical information to case workers, foster parents, and health and social service providers. This jeopardizes the children's health, undermines attempts to provide them with services, and risks unnecessary resource allocation and financial burden for the children's families, foster families, state and healthcare system. The purpose of this project, which was conducted in collaboration with the Josephine County branch of the Department of Human Services (DHS) Child Welfare Office and Siskiyou Pediatric Clinic, LLP of Grants Pass, Oregon, was to address this problem by creating a medical data collection tool and protocol to facilitate the recording and transmission of medical information of children in foster care. The project consists of four phases: information gathering; design and development; implementation; and evaluation, modification, and expansion. At the time of this report, the project is completing its second phase and will soon be implementing the pilot instrument and protocol. To date, the response from the pediatricians and social service providers involved in the project has been very positive. Helmet Use in Klamath Falls Project Date: 3/20/2006 Safety helmet use within the pediatric population continues to be an important part of preventive health. The bicycle is associated with more childhood injuries than any other consumer product except the automobile with head injuries accounting for the majority of bicycle-related deaths and hospital admissions. There are many factors that contribute to the use of safety helmets including access to obtaining a helmet, education regarding appropriate use of helmets, as well as many compliance issues. This study attempted to examine the percentage of children without access to a safety helmet and questioned what particular barriers to helmet ownership exist within the Klamath Pediatric Clinic population. The design included a seven question survey including age and sex of the child, whether the child owned a safety helmet and asked how often the child wore the helmet during bicycling, skateboarding/roller blading, and skiing/snowboarding. The survey was initially given to all parents who came to the pediatric clinic with children 3-18 years old. When this proved to be of low yield, parents were questioned verbally in the waiting area of the clinic, using the same questionnaire as a guide. Adolescent Injury in Reedsport, Oregon Project Date: 3/20/2006 Unintentional injury remains the leading cause of adolescent and young adult morbidity and mortality in the U.S. The leading causes of non-fatal injury for 13-24 year-olds are: being struck by or against an object, falls, motor vehicle accidents, overexertion and cuts or piercing. Reedsport, Oregon, a town of 7,900 located on the central coast has an aging population in which adolescents comprise 11% of its population. A recent unintentional motor-vehicle-related fatality of a teenager and injury of another in this small town has raised awareness on the lack of data for the incidence of adolescent injury in the community, including what types of injuries are occurring and what are the associated variables. A medical records search for Reedsport adolescents aged 13-24, who were seen and treated in the ER of the Lower Umpqua Hospital during calendar year 2005 for injuries or trauma was completed. A total of 100 charts were reviewed and descriptive statistics on injuries compiled. Reedsport adolescent injury patterns appear comparable to national statistics, although there is a lower incidence of motor-vehicle related accidents among Reedsport adolescents seen at this ER. The value of implementing a systematic adolescent preventive services program and a specific model for doing so are also discussed. A Chart Review of Domestic Violence and Specific Co-morbidities on the Warm Springs Reservation Project Date: 3/20/2006 There is a higher rate of domestic violence (DV) in Native American communities, and in turn certain medical problems (DMII, cholelithiasis and cholecystitis, ect) also occur disproportionately in native populations. While it is known that there are a number of co-morbid conditions and problems that victims of DV experience, this has not been examined at length in Native Americans. The clinic staff on the Warm Springs Reservation have been concerned with the problem of DV for some time, and have led in the initiative to make screening for DV a GRPA requirement. As an extension of their efforts to identify victims of DV and increase outreach to this segment of the patient population, they had earlier examined the medical records of a random selection of 100 female patients and found that 58% of these women were identified as victims of some sort of DV. This information has proved useful in discussing the severity of DV on the Warm Springs Reservation, and has been employed as part of educational and grant writing activities. The attempt herein is to look at a select number of medical problems in the same patient sample, in order to gauge what variations in medical problems exist between those with a history of DV and those who have not been victims of DV. The hope is that this information can also be used in expanding educational efforts regarding DV and its comorbidities. Transforming Rural Primary Care: Electronic Medical Records (EMR) in Coos Bay, Oregon Project Date: 2/13/2006 EMR has advantages over paper-only charting systems in accuracy, speed, portability, and information retrieval and sharing. Yet it is costly to initiate and introduces its own set of possibilities for error, to include digital security breach and computer “crash.” In any case, EMR is not widely used in the United States, with estimates ranging from 7-33% of primary care clinicians. However, it is being used in the continuity clinics of 46% of Family Practice residency programs. The Bay Clinic Internal Medicine practice in rural Coos Bay, Oregon, is transitioning to partial EMR from a paper-only system. It plans to uniformly implement EMR within one to three years, and interface with the pending internet-based EMR of Bay Area Hospital. Bay Clinic is one of the sites for a required Rural Medicine clerkship for third-year medical students from Oregon Health & Science University (OHSU), in Portland. Study observations are made using the “PRAXIS Version 3.2” EMR by Infor-Med Medical Information Systems, Inc., between February 15 and March 15, 2006. The medical student used the EMR for every patient encounter, primarily to chart. One internist used the EMR for roughly 50% of his patient encounters on a given day, primarily to chart. A second internist used the EMR for every patient encounter: to chart, set clinical reminders, e-mail staff, write clinic letters, and print prescriptions and patient handouts. Both internists increased their average number of patients evaluated per day by about 25% (self-report), as compared to their practices when using paper only. We do not believe that using computers in the exam room diminished provider-patient interaction. Future studies may focus on the quality of this interaction, and of charting in general, as influenced by EMR. We anticipate that using EMR at this rural site will continue to benefit rotating medical students in learning practice guidelines and workflow efficiency. Evaluation of Diabetes Mellitus Management in John Day, Oregon: Are current standards of care being implemented? Project Date: 2/13/2006 Diabetes Mellitus is a major medical problem in the United States, affecting 6% of the population. Due to the morbidity and mortality associated with diabetes, standards of care have been designed to help reduce complications of the illness. As part of maintaining its status as an Oregon Federally Certified Rural Health Center, the Strawberry Wilderness Community Clinic (SWCC) is required to perform yearly chart reviews. The purpose of this project was to develop a chart review form for diabetes screening and treatment based on established diabetes guidelines. This form was then used in a chart review of thirty patients, ten from three physicians, to assess if SWCC is currently implementing these guidelines in its practice. Results of the review demonstrated that physicians are meeting guidelines for HbA1c measurement, use of ACE inhibitors, reviewing self monitored blood glucose readings, and checking creatinine annually. Areas of improvement were found to be screening for dyslipidemia and microalbuminuria. The biggest deficits in care were found to be in ensuring that patients received yearly dilated eye exams, visual foot inspection at each visit, comprehensive foot exams annually, and using aspirin therapy in patients > 40 years of age. These results can be used by the SWCC to help design methods to improve deficits in diabetes management and therefore reduce morbidity associated with the disease in their community. Hyperbilirubinemia: Incidence, Accuracy, and Compliance with Guidelines in a Clinical Setting. Project Date: 7/5/2004 Jaundice, which occurs in most newborn infants, is usually benign. Still, the potential neurotoxic effects of bilirubin, which can cause jaundice, are serious enough that newborns must be identified and monitored for severe hyperbilirubinemia, kernicterus, or acute bilirubin encephalopathy. This project attempts to determine the incidence of jaundice in the Klamath Pediatric Clinic in Klamath Falls, Oregon, as well as the accuracy of computer records on jaundice compared to charts in the clinic. Recently, the American Academy of Pediatrics published updated clinical practice guidelines on the management of hyperbilirubinemia. Therefore, this project also attempts to review how the clinic follows these new guidelines and gives recommendations for improvement. The Potential Benefit of Electronic Medical Records In the Management of Chronic Illness: A Case Study of Coronary Heart Disease and Depression in Lebanon, Oregon. Project Date: 3/24/2003 In recent years electronic medical records (EMR) have become an increasingly important part of documenting and providing medical care. In addition to saving money, reducing errors, and improving documentation, EMRs can potentially improve patient health by allowing physicians to better monitor patient progress and increase information access to patient populations. This report was designed use a patient population in Lebanon, Oregon as a case study to gain an understanding of how EMR could affect the care provided for a chronic medical condition. The paper charts of 62 admissions (97% of the total) coded for acute myocardial infarction at Lebanon Community hospital for the year 2002 were selected as markers for coronary heart disease (CHD). These were reviewed to determine the prevalence of a comorbid diagnosis of major depression or medical treatment of depression. Depression is a major risk factor for increased severity and mortality in cardiac events, therefore managing depression can have a significant impact on patient outcomes. This study found that 15-19% of patients hospitalized with an acute myocardial infarction were either diagnosed or being treated for depression. However due to systemic barriers it was difficult to efficiently assess patients’ long- term history and to evaluate whether depression in these patients was successfully being treated. This was because information was often missing from charts, hospital and outpatient records were not integrated and documentation was often incomplete. The Samaritan Health System that provides care in Lebanon is part of a network of five hospitals and 21 outpatient clinics. This system would likely receive more benefit from an EMR through greater efficiency and better quality control and decision-making support than the initial cost of installation, training and conversion of old records Issues Regarding Charting in a Rural Oregon Health Clinic Project Date: 2/11/2002 In any clinic, it is important to have a system in place that allows one to have quick and easy access to a patient's history. Many clinics and hospitals are using a computerized record keeping system that has separate 'pages' with information regarding prior visits, diagnoses, and both current and past medications. But what happens in a clinic that uses hand-written records? What type of system works in this setting? I haven chosen to explore this issue in a pediatric clinic in Woodburn, OR by examining the system that is now in place and then making some recommendations regarding possible future chart changes. Getting Wired In Klamath Falls. Project Date: 1/2/2002 In the past 12-24 months, electronic communications have begun to be accepted into the world of health care. Currently, 62% of consumers seeking health care information are interested in getting it from their own physician. Over two-thirds of U.S. consumers rate communications with their physician as a primary reason for physician selection. 54% of consumers would switch their physician for the ability to interact online. The Klamath Pediatric Clinic web site was created in August of 2001 as a result of a survey that indicated similar consumer interest in a physician web page. An email system was also set up that allowed patients and their families to access their doctor via email. However, since it's establishment, the site has received few visitors and only one email has been sent through this system in the last 6 months. The intent of this project was to determine why there's a disparity between the initial survey results and actual utilization of the web site. A survey was created which addressed general Internet use, awareness of and interest in the Klamath Pediatric Clinic site, as well as features that would motivate consumers to use the web site. Project goals include determining if and why individuals are not utilizing this resource, determining what features would motivate consumers to use the web site, and utilizing the survey results to direct further action in order to increase overall use of the web site. Survey Results: The majority of responders utilize the Internet at least three times per week. 69% of those surveyed were not aware of the Klamath Pediatric Clinic web site. 62% of desired features are currently offered on the site. 86% of those surveyed are interested in visiting this site. These findings suggest that the reason consumers are not utilizing the Klamath Pediatric Clinic web site is because of lack of awareness. Thus, advertising was increased with the hopes of increasing consumer awareness of the site. Business cards and pamphlets with the web site address were made available in the clinic. A link to the web site was created through the search engine, www.google.com. The Use of Medication Lists in a Community Health Center. Project Date: 11/5/2001 OBJECTIVE: To determine the effectiveness and accuracy of medication lists. Specifically, whether they help to reduce medication regimen complexity, enhance patient education. To implement simple strategies to increase the value of an already established medication list system. DESIGN: A questionnaire was designed and given to randomly selected non-pediatric patients during a 3-week period. The questionnaire included various demographic information. It also included a list of the patient's medications taken per the patient and per the patient's chart as well as the reason the medication was prescribed per the patient and per the patient's chart. Finally, the questionnaire included a list of non-prescribed medications and alternative forms of care (i.e naturopathy). SETTING: The West Salem Clinic, a community health center serving low-income individuals in Salem, Oregon. RESULTS: A total of 28 patients were interviewed during the three week period. Patients were taking an average of 8.4 medications. The average age of patients was 61.7; there were 19 females and 9 males. The percentage of errors per the patient recollection of his or her medication was 36.4. The percentage of errors per the patient's chart was 18.2. Nearly 62 percent of patients were unaware of the reason for taking at least one medication. The majority of patients over 65 were insured via Medicare (80%) and the majority of patients under 65 were insured by the Oregon Health plan (75%). Non-prescribed medications were mentioned in 36.4% of responses and 18.2% of patients reported using alternative forms of medicine sometime in their lives (no patients were currently using alternative forms of medicine). CONCLUSIONS: Patients at West Salem Clinic are taking a relatively high number of medications. Errors were seen by both the patient and the patient's chart. Many patients did not understand why they are taking certain prescribed medications. Compared to other studies medication lists used by the clinic seem to have a decreased number of errors suggesting the efficacy of an already existing system. However, steps aimed at increasing patient education and awareness as well other adjustments can help improve an already efficacious system. Usefulness Of Medication Contracts In Treatment Of Chronic Pain Project Date: 7/2/2001 The epidemiological characteristics of 25 patients with chronic pain on medication contracts who are receiving care at West Salem Clinic were studied through a 16 question survey. Furthermore, the effectiveness of their pain management and their overall satisfaction with their care before and after signing a medication contract was assessed. We found that of the patients on medication contract the majority were Caucasian females between the ages of 40-60 who are unemployed and have an educational level up to college. We also found that the 84% of the patients felt that their pain was inadequately controlled before a medication contract and that 82% were dissatisfied with their care. Currently (after being on a medication contract) 47% felt their pain was not being controlled and only 23% were dissatisfied with their care. Based on these observations, it is possible that medication contracts directly or indirectly have a positive effect on the management of patients with chronic pain issues. Coos Bay Medical Informatics: Physician and Administration Perspectives, Expectations and Assessment of Implementing an Electronic Medical Record. Project Date: 8/13/2001 The exponential expansion of costs in the U.S. health care system are driving the U.S. health care system towards a state of bankruptcy: 15% of the Gross Domestic Product is now being spent on health care. Despite the incredible availability of computers and electronic media, the American Health Care industry still relies mainly on paper to record and transmit information at many key points. The storage, maintenance, and access costs consume more than 40% health care institution budgets and 25% of the health care provider's time. At Indiana University Medical Center, an Electronic Medical Record has been created that contains most patient data (numeric coded test results, drug use, diagnosis, clinic activity, textual reports, and itemized charges) for an urban tax supported teaching hospital, a VA medical center, and their outpatient facilities. This Electronic Medical Record is well connected with the surrounding clinics that feed into the hospital forming a streamlined medical record that is well protected and efficient. Although, the interventions of technology are expensive, a series of carefully controlled clinical trials has shown consistently that by using the EMR, they were able to lower costs by 8-13%. In addition length of hospital stays were shortened by almost a full day, and delays in initiating drug therapy and concurrent drug interaction errors were lowered by one third. In the end of the 16 month randomized controlled clinical trial, involving more than 5000 inpatients, physicians using the workstations in their clinics, generated hospital bills $887, per patient, less than those who used paper charts to write all orders. Given the major advantages, there are still many hidden pitfalls that must be considered before implementing such a system. Some of those that come up, are data security, and data integrity, data safety and data ability. Although all of these concerns are quite valid, proper implementation of data encryption tactics can be used to fulfill the guidelines elucidated by the Health Insurance Portability and Accountability Act (HIPAA). These goals and guidelines are quite similar to those of The Data Protection Act of 1984 seen in the UK. Keeping the aforementioned research in mind, the question of "why" implementation of an electronic data record has been successfully shown time and again. The task of this project, seeks to clearly delineate the Bay Area Hospital and its surrounding clinics' expectations in regard to the incoming computer information system that they wish to implement. In addition and more importantly it strives to elucidate the varying goals between the physician, nurse, and administrative perspective of how such as system can be successfully implemented without breaking a budget of $3.5 million dollars earmarked over the next five years aimed to serve the Coos County patient population. In clear terms this project aims to answer the following questions: 1. What do physicians seek f Back to subject search page or search by preceptor site