Tuesday, December 31, 2019

pestel of nike - 1213 Words

Political Factors Political factors has to do with politics of the day prevailing in country. It is generally assumed that if political temperatures are down; businesses tend to flourish and the vice versa is also correct. In this particular case, it can be said that it is neutral and thus not expected to cause much rubble in the new companies operations. However, future political challenges cannot be ruled out. Nike being number one sportswear in the USA, its profits, turnovers, marketing sponsor ships and advertising surmount all other sports wear companies. This company is not only positioned as a market leader but also leaders in the industry labor practices initiatives. Although Nike had suffered bad publicity over the last†¦show more content†¦Technological Factors Technological factors are trends in new technology keep on advancing on daily basis. Technology can create new products and services as well as phase out existing ones. For instance, mobile telephone created new business for GSM carriers whereas it spelled doom for other business like the postal and courier services. For the case of Nike Company, money is expected to use both existing and new technology to grow its business portfolio. If well adapted, technology can considerably reduce Nike s operational costs and thus grow its profit margins. Nike enjoyed technological innovations in sports wear by producing and selling sport shoes, which are ultra- supper light to athletes. Technological advancement and diffusion of technology in the manufacture of Nike shoes led to quality improvement and competitive advantage. This has played a major role in benefiting the consumers and the organization returns on investment. Nike employ specialists in the areas of exercise psychology, engineering design, and related fields to run the business. They also utilize research committees and advisory boards made up of athletes, coaches, trainers, and other experts to consult and review designs, concepts and materials for the improvement of the products. Employee athletes and other athletes wear-test sport wear and evaluate the design of the products and development. Technical innovations in the design of foot wear,Show MoreRelatedNike s Core Competency : The Risky Business Of Fairy Tales1413 Words   |  6 Pagesscandal such as criminal activity or cheating. Nike has been successful with any of their endorsements, but there are cases of athletes not so successful. In Nike’s endorsement history, there are multiple cases that athletes were involved in scandals. Phil Knight, who is the Chief Executive Officer at Nike, states that these scandals are, â€Å"part of the game† (Rothaermel MiniCase 8. Nike’s Core Competency: The Risky Business of Fairy Tales. 447). Nike continues to endorse these athletes such as MichaelRead MoreEnvironmental Scan of Amazon And Nike1104 Words   |  5 PagesRunning Head-ENVIRONMENTAL SCAN OF AMAZON AND NIKE The Internal and External look of Amazon and Nike Jaime Enriquez MGT 498 January 31, 2011 Eligah King ENVIRONMENTAL SCAN - AMAZON AND NIKE In todays businesses e-commerce is becomingly more effective in the modern world. Two major companies stand out, one solely relying on online business and the other both store and online services. Most individuals are familiar with these companies, Amazon and Nike. Both of these companies carry strong pointsRead MoreCompany Analysis of NIKE 20143326 Words   |  14 Pagesï » ¿NIKE COMPANY ANALYSIS Word count: 2856 Table of Contents INTRODUCTION/ COMPANY BACKGROUND This report examines NIKE Inc. one of the leading sports brand in the world. It uses business analysis techniques such as SWOT, PESTEL, Porter’s five forces, and Ratio analysis to analyse the business environment and performance of this company. NIKE Inc. is one of the world’s biggest sporting brand based in Oregon USA. Founded in 1968, NIKE is the world’s biggestRead MoreNike s Competitiveness And External Environment1488 Words   |  6 Pages The PESTEL analysis covers six areas of interest. The political factors for Nike are the possibility of tariffs being imposed by the United States federal government in their overseas operations. According to the world manufacturing map, Nike has factories in 42 countries (Nike, Inc, 2017). Therefore, tariffs, sanctions, or embargos that could be placed because of turmoil in countries such as, Russia, North Korea, or Venezuela; have the potential to be catastrophic for companies like Nike. ConsequentlyRead MoreNike, an International Business2766 Words   |  12 PagesContents Table of Contents 1 Introduction 2 Brief Historical of NIKE 3 Financial Statement 5 Total Revenue 6 Operating Income 6 Net Income 6 Recent News of Nike 7 PESTLE analysis 8 Political 8 Economic 8 Social 9 Technology 9 Marketing Strategies 11 Conclusion 12 References 13 Introduction In this assignment, we are going to study about the Nike in its home country, United State (U.S.). We choose Nike as our study due to; firstly, most of our team members like sportingRead MoreMarketing Analysis of Li-Ning5098 Words   |  21 Pagesinternational sports brand representing China. In this report, it makes a marketing plan for the next three years according to detailed analyse of internal and external environment of LI-NING, which is based on the model of Benchmarking, Product Lifecycle and PESTEL. At the same time, it finds the key issues of LI-NING facing through news. Afterwards, according to the key issues, build the feasible objectives. And then it detailed recommend target market segment, positioning and marketing mix and critical factorsRead MoreAdidas Is One of the Largest Companies in the Sporting Goods Industry.3166 Words   |  13 PagesCOMMUNICATIONS EFFECTIVENESS TABLE OF CONTENT 1.Executive summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...3 2.Introduction 2.1 Adidas Overview†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...3 2.2 Europe sports equipment market overview†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...4, 5, 6 3.Situtational Analysis 3.1 PESTEL Analysis†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..7, 8 3.2 Porter’s Five Forces Analysis†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...9 3.3 SWOT Analysis†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.10, 11 4.Consumer Analysis†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦12, 13 5.Marketing Objectives†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..14 6.Communications Mix 6.1 SportsRead MoreNikes Market Audit2227 Words   |  9 PagesMarketing mix, are conducting the Market Audit to achieve their goals†¦ Nike Nike operates its business within the sports footwear and apparel market. Originally designing and producing running shoes, their portfolio has broadened to include a wide range of sports and leisure wear. This is all endorsed by top sporting personalities and has gained a faithful reputation among them. Mission statement of Nike†¦ In its mission statement Nike expresses that it requires doing business in a responsible way, leadingRead MoreNike Company Analysis Essay2938 Words   |  12 PagesUnit 6 Assignment 2 Nike, Incorporated Company Analysis Michael G. Castro Capella University MBA6008 – Global Economic Environment Professor Hadsell February 15, 2013 Introduction Being the world’s leading innovator in athletic footwear, apparel, equipment and accessories, Nike holds to their mission to bring inspiration and innovation to every athlete in the world (Bowerman, 2011). Not only does Nike design, develop, and sell a slew of products and services to help athletes, theyRead MoreLi Ning Marketing Plan2787 Words   |  12 PagesCompany Limited is a major Chinese athletic company which makes athletic shoes and sporting goods. Li-Ning branded products are targeted for consumers play in sports such as running, basketball, badminton, football, tennis, and fitness. Li-Ning counts Nike and Adidas as its main competitors which endorses a number of athletes and teams, both domestic and abroad. In 2005, Li-Ning created a joint-venture with French sports apparel company, AIGLE, which was given the exclusive right to be the distributor

Monday, December 23, 2019

Scin140 Amu Quiz 1 Essay - 2304 Words

Quiz 1: Chapters 1 and 2 Part 1 of 1 - 96.0/ 100.0 Points Question 1 of 25 4.0/ 4.0 Points Which of the following statements associated with poverty is CORRECT? 1) Poverty is defined as having a per person income of less than $2 per day, expressed in U.S. dollars adjusted for purchasing power. 2) The number of people living in poverty has been steadily declining and today less than one billion people live in poverty worldwide. 3) Poverty is a condition in which people are unable to meet their basic needs for food, clothing, shelter, education, or health. A.1 only B.2 only C.3 only Correct D.Both 1 and 3 apply as descriptions of poverty. Answer Key: D Feedback: Section 1.1 Human Impacts on the†¦show more content†¦A.The actions of humans directly impact the wellbeing of the natural environment. B.Future generations will have the resources necessary for quality of life. C.A shared global responsibility is necessary for conservation practices. Correct D.All of the above are implied by environmental sustainability. Answer Key: D Feedback: Section 1.2 Sustainability and Earths Capacity to Support Humans Question 9 of 25 4.0/ 4.0 Points All of the following statements describe environmental science EXCEPT: Correct A.No exceptions, all of the above statements describe environmental science. B.The goal of environmental science is to try to establish general principles about how the natural world functions. C.Environmental scientists seek to develop viable solutions to environmental problems that are based as much as possible on scientific knowledge. D.Since environmental problems are generally complex and scientific understanding of them is often less complete, environmental scientists are often called on to reach scientific consensus before the data are complete. Answer Key: A Feedback: Section 1.3 Environmental Science Question 10 of 25 4.0/ 4.0 Points To test a hypothesis about a given variable, experimental and control groups are tested in parallel. Which of

Sunday, December 15, 2019

Iran’s Influence in Iraq Free Essays

ABSTRACT In the period after 2003, Iran was extensively involved in Iraq by demonstrating its leading role in the international context. However, Iraq has been confronted with substantial instability as a result of Iran’s invasion, even though scholars have presented mixed arguments about this issue. This paper discusses the role that Iran has played after 2003, which has affected both the dimensions of stability and instability. We will write a custom essay sample on Iran’s Influence in Iraq or any similar topic only for you Order Now The primary objective of Iran after 2003 was to observe a positive economic change in Iraq and also to ensure that the Western troops were taken off. Different factors affected Iraq’s stability, including inherent sectarian divisions and the role of other states. There were two types of influence on Iran and they are: first and foremost was that the projects politically influenced leveraging close historical relationships with several Shi’a organizations in Iraq like the Islamic Supreme Council of Iraq (ISCI), the Badr organization, and the Dawah political party. A second factor was that Iran had used the Iranian Revolutionary Guard Corps (IRGC) and Qods Force (QF) to provide paramilitary training, weapons, and equipment to various Iraqi militant groups, including Moqtada al-Sadr’s Jaysh al-Mahdi (JAM) and the Special Group Criminals (SGCs). Iran also had an influence on the legal and constructive functions of Iraq. Although it was seen that Iran’s policy in Iraq is also duplicitous, it publicly called for stability but diverted Iraq’s government and illegally sponsored anti-government militias. INTRODUCTION Although the factors and consequences surrounding Iran and Iraq war have been extensively discussed in the research literature, the post-war implications have been hardly understood. The United States has been accusing Tehran of its undue interference, which was done by Arab leaders for establishing an Islamic Republic[1], and by prominent Iraqi officials of an array of illegitimate meddling. It has been observed that Iran’s influence in Iraq has created a quite complex situation for the entire region. Iran had vital interests in Iraq, which can be perceived as strategic important for establishing power relations in the region. In order to maximise the success of Iraq from its political transition, it is very important that Tehran and Baghdad work together. In addition, it is fundamental for all involved parties to prevent the US from further deterioration of its relations with the Islamic Republic.[2] Therefore, the objective of the present research is to explore Iran’ s role and influence in Iraq in both political and military aspects. The essay is divided into introduction followed by theoretical remarks regarding the Iraqi insurgency, and the political stability. In reviewing the literature on the conflict between Iran and Iraq, it becomes clear that Iran has played a role in bringing about instability in Iraq since 2003, which has been further divided into different sections. The first and the foremost division occurred between those academics who cite Iranian influence to be the most significant destabilising factor in post-2003 Iraq, and others who hold the opinion that Iran’s influence is considered either positive or insignificant. As per Barzegar[3], the first approach is that Iran’s influence in Iraq is both strong and negative. At the same time, it has been indicated that Iran had a negative foreign policy. The nature of Iran’s relations had changed with various militant groups in Iraq and after the fall of Saddam’s regime in 2003. Moreover, Iran had deployed thousands of intelligence and paramilitary people to Iraq, as Iran had conflicting and negative goals in Iraq. The primary goal of Iran was to expand its influence at both national and local levels in Iraq. Thus, it was seen that it had made links with the local actors, even when they opposed Iran’s preferred clients at the national level. It may be also argued that Iran follows a policy of favouritism. In the beginning after the invasion, Iran has tried to combat US power. The US had a strong position in Iraq, which could have a negative impact on the security of Iran. With the worsening situation in Iraq, and with the regime change that the US tried to impose in Iraq, the United States became less of a driver of Iranian actions, although it was always an important factor in the Iranian leadership’s calculations. Soon after 9/11 Iran also had changed some of its policy as there were significant changes in the US policy. Initially Iran had cooperated with the US with regards to al-Qaida and to some degree in Afghanistan’s issues. However, later on Iran believed that the United States rebuffed its gestures. In addition to this Iran also had exploited the situation that followed the US regime and change in Iraq so as to expand its influence there.[4] As of today, Iran has its closest ties with the Islamic Supreme Council of Iraq (ISCI), formerly the Supreme Council for the Islamic Revolution in Iraq (SCIRI). This relationship basically was on the exceptionally close and subservient days when SCIRI’s role was that of an Iranian proxy to be wielded against Saddam’s regime during the bitter 1980-8 Iran-Iraq war. Indeed, Iran even organised part of SCIRI into the Badr Corps to fight against Iraqi forces on Iran’s behalf. Today, as the International Crisis Group notes, â€Å"although the extent of ISCI’s continued involvement with it is a matter of debate, there is no question that Tehran exerts significant influence over the Party and that ISCI’s ties to Iran’s security establishment remain strong†.[5] Therefore, ISCI has been recognised as having the strongest ties to Iran. It has also been shown as quite cooperative with the United States.[6] For instance, ISCI had members, which were a part of Iraq’s intelligence and police forces. These members are now working with the United States in its capacity as part of the Iraqi government; they have also gone after ISCI rivals like Muqtada as-Sadr’s Jaysh al-Mahdi (JAM). In spite of ISCI being Iran’s closest ally in Iraq, Tehran has had many other relationships, which were maintained at any cost including weakening ISCI, such as Iran’s ties to JAM have grown to the extent of even hosting its leader Muqtada al-Sadr. This happened despite his repeated criticisms of Tehran and violent rivalry with ISCI. Thus, all these efforts were done to accomplish the initially set goals, including the major idea of maintaining a solid local influence.[7] IRAN-IRAQ WAR (1980-1988) It is important to clarify the circumstances leading to the 1980-1988 Iraq-Iran war in order to understand Iran’s and Iraq’s complicated relations. In 1979, after the rule of the Shah of Iran was overthrown in 1979, under the leadership of Ayatollah Khomeini, an Islamic Republic of Iran was established. Soon after assuming power, Ayatollah Khomeini not only exported the Islamic revolution to other countries in the Middle East but also to Iraq.[8] Because of all this Saddam Hussein in 1980 decided to initiate a war; thus, for the next two years there was a persistent war between Iran and Iraq, resulting in Iraq being expelled from Iran. [9] Although at this juncture Iran could have been declared victorious, Khomeini fought across the Shatt al-Arab waterway in Iraq to overthrow Saddam Hussein and forced his resolution in there. Khomeini had thought that Shiites would support him in his invasion but they were least interested to do it. Throughout the Arab countries it was assumed that it would take time for Iran to overthrow Saddam Hussein before the vulnerable monarchies of the Gulf fell, including the prised Saudi Arabia and its oil. Till now America was just waiting and watching all the drama (war), but at this juncture it decided to get into the war itself and tilt towards Iraq.[10] During the reign of Saddam Hussein, Iran launched a number of Shiite groups who violently opposed the Iraqi Baathist regime and this particularly took place before the Iran-Iraq war had started. The Supreme Council for the Islamic Revolution (SCIR) in Iraq was led by Ayatollah Muhammad Bakr al-Hakim and his militia, the Badr Brigade, also joined forces with Iran in the Iran-Iraq war and very actively participated in the war by supporting the Iranian side. [11] After responding to the President George H. W. Bush’s ill-fated call for a Shiite uprising, which happened in 1991, SCIRI temporarily occupied the Iraqi port of Basra. Soon after the reprisals, SCIRI continued to be with the Shiite group and opposed Saddam Hussein. They were competing with different groups, such as Ahmed Chalabi’s Iraqi National Congress. After the US invasion and also after the establishment of the interim Iraqi government, SCIRI established itself as one of the most important and main political parties, which represented southern Shia (the other being Dawa). [12] Bakr al-Hakim, who was an Iraqi religious leader, was killed in the US led Iraq war. Abdul-Aziz Al-Hakim was the SCIRI’s political leader and was very famous in Iraq as a politician.[13] Moreover, SCIRI and Dawa had supported Abdul-Aziz al-Hakim when he was in Iran and was exiled; they also gave their support to the Iranian regime and advocated an Iraqi Islamic theocracy. After returning back to Iraq, they withdrew their support from Dawa and another government party, which was led by the velayat-e faqih. As a result, they started propagating the meaningful role of religion in governance.[14] IRAN’S STRATEGY TO INFLUENCE IRAQ Soon after the fall of Saddam Hussein’s regime in 2003, Iran tried to influence Iraq by adopting the strategy that Iran and Iraq are neighbours with a long history of dealing with one another. In addition, they both have same historic, religious, economic, and cultural factors of influence. Moreover, the eight-year long war was a result of their troubled relationship, in which Iran tried to position itself to influence the formation of a new government in Iraq. This took place through the use of all elements of national power: diplomatic means, information technology, military, and economic resources. Iran has tried to achieve its goals in Iraq by adopting different strategies. For instance, Iran openly supported pro-Iranian factions and armed militias; it also tried to influence Iraqi political leaders by building strong economic ties in Iraq, which were considered a manifestation of goodwill towards Iran.[15] According to Joseph Felter and Brian Fishman,[16] Iran has persistently tried to affect the political landscape of Iraq. It has been argued that Iran has a well-developed plan so as to exert influence in Iraq in order to minimise or avoid the American power projection in the Middle East. Two significant modes of Iranian influence have been identified in Iraq. The first mode was associated with the idea to influence Iraqi politics through the assistance of various Shiite organisations, such as the Supreme Council of Iraq, the Badr organisation, and the Dawa political party. The second method suggested support of the Iranian Revolutionary Guard Corps (IRGC) and Qods Force (QF) to obtain arms and ammunition as well as paramilitary training to various Iraqi militant groups to include Moqtada al Sadr’s Jaysh al Mahdi (JAM) and the Special Group Criminals (SGCs). Iran’s influence on Iraq has been identified as economic and religious. Iran’s ambitions for influence have spread to different diplomatic, military, and economic sectors of Iraq. Iran wanted to influence Iraq not only politically but through the involvement of mass media by creating a specific image in minds of Iraqi people so as to get help for its strategy. In economic terms, Iran has helped Iraq to build its trade and expand it accordingly.[17] IRANIAN MILITARY INFLUENCE IN IRAQ Because of the influence over the military, it had made many insurgent groups to operate in Iraq and some of them were directly opposing the US military in Iraq. With such influence in Iraq, Iran could possibly retaliate against the United States. In turn, this prompted the United States to convince the United Nations to impose economic sanctions on Iran because of its nuclear program. Iran also executed return attacks on the US forces using proxy militia groups in Iraq in case the US decided to take direct military action.[18] Since 2003, Iran had pursued extensive collaboration with Iraqi political allies, such as the United States, in order to participate in the nascent democratic political process. It has also armed, trained, and funded Shiite militias with the idea to defeat the United States, which would prevent further intervention of the US army in that particular area.[19] As Katzman mentions,[20] in the period from 2005 to 2008, Iran had increased support for Iraqi Shiite militias and took over both the material aid like physical arming of militia groups and the contribution of troops, as well as training or harbouring of insurgents. The Quds forces were supplying material to Iran, and they were charged for territorial actions, although reports have said that the military training in the Iraqi Shi’a militia was done by the Lebanese group Hezbollah.[21] The major terrorist activity was completed by Iran and Quds Force. This was confirmed in 2010 by the US State Department[22], but it appears that not only this Iranian government was involved between the IRGC and the Special Groups inside Iraq.[23] It has been noted that the Iraqi military group linked most strongly to Iran, is probably the Badr Corps, the armed wing of the ISCI, which, even prior to 2003, was described as â€Å"Iran’s most important action arm inside Iraq†.[24] Bergner (2007) stated that Iraqi Shiite groups were not in the situation to bring about such massive and destructive attacks, without weapons and training from Iran, implying that Tehran has carefully planned its actions. Again it was argued that links between military groups in Iraq were made in Iran, and this further fuelled instability. However, the question whether other agents or groups were involved in creating such an unstable situation remains open.[25] IRANIAN POLITICAL INVOLVEMENT IN IRAQ By 2011, it has been observed that Nouri al-Maliki, Prime Minister of Iraq, was openly against the Vice President Hashemi. In addition, there was persistent agitation between Erbil and Baghdad, which made the members of Iraqiyya and the Kurds to actually consider prime minister’s ouster seriously, which occurred in the 2012 spring. At this point Maliki’s opponents took the help of Sadrist because it was necessary at that point of time to obtain 163 votes, which were required to pass a non- confidence motion. Sadr was not willing to break with the other Shiite blocs and side with Maliki’s Kurdish and Sunni opponents in a non- confidence motion, in spite of having meetings between top Kurdish, Iraqiyya, and Sadrist officials (including Sadr himself) in Erbil and Najaf.[26] President Jalal Talabani was also under high pressure from the Iranian government to help and support Maliki, but he directly opposed the initiation of a non-confidence vote in the parliament, sa ying that there is no proper support for this action.[27] However, by June 2012, it has been evident that the non- confidence vote had faltered. It was in late 2012 reported that the President Talabani had changed his position on a non- confidence motion because of growing tensions among Arabs and Kurds.[28] By the end of 2012, Talabani suffered a stroke there by ending any chance of renewing push to remove Maliki through a non-confidence measure. De-Ba‘athification served the Iranian ambition more than the Iraqi one. The extensive period of Saddam Hussein’s Ba‘athist rule had left a deep societal mistrust and sectarian divisions. This institution, de-Ba‘athification, was created after Saddam’s downfall in 2003, but it was very quickly politicised, which also applied a ban on the former members of the Ba‘ath party. Again it was noted that there were links between the Iranian-backed militant groups and the head of the Shi‘a-dominated commis sion and his deputies, Ahmed Chalabi and Ali al- Lami.[29] Iran has been involved in Iraqi politics since 2003. Yet, Iranian efforts to exert influence over politics in Iraq have been evident since 1980s. However, the main point which is debated is whether Iran is committed to exerting long-term control over such a government, and whether the Iranian government would be comfortable in allowing a Shiite Iraqi government to become militarily and political powerful. It has also been claimed that the Iranian government had exerted persistent political pressure over the US to force the Americans to withdraw their troops in 2008 as per US-Iraq Security Agreement.[30] It has also been observed that Iran normally exerts pressure on the political sphere in Iraq through Iraq’s Shiite political parties by using its religious prowess to garner favour in the Shiite community. It appears that many of the political links were falsified after the Iran-Iraq war. This resulted in a huge number of Iraqi political figures being exiled in Iran and returning in the aftermath of the 2003 invasion to influence the politics in their home country. Iraqi Prime Minister, Nouri al-Maliki, had to spend a substantial amount of time in Iran, although most of his exile was spent in Syria, but this was during the rule of Saddam Hussein.[31] Similarly, it has been also noted that the Shiite cleric Moqtada al-Sadr had strong links with the Iranian religious government and political establishment, although the Sadrist movement was basically anti-Iranian.[32] There were lots of other people, who felt that Iran had a negative impact on the instability of Iraq. According to Alsis et al.,[33] after the war the elections backed all major Shiite parties, so that if any of the party wins elections can be beholden to Tehran. Again this was the strategy of Iran to get support, which had led to Shiite divisions, and thus the cause of conflict and instability in many case s. Such political instability was the major cause of the development of various divisions in Iraqi society. The eruption of these division fuelled pressure not only in Iraq but in the entire region. During the 2010 elections, many incidents of violence were reported. This raised the question about the politically unstable country considering the presence of weak coalitions and holding of elections. This has provided Iran with an opportunity to demonstrate its support for Shiites, as this could be conducive to social stability, or such a condition may simply serve to whitewash and thus diminish the reality of the ground situation. The Brookings Institute Iraq Index (2006)[34] had charted a peak in multiple fatality bombings in January 2005, during the elections, and again during other months of the same year. All this has been seen very common in Iraq and somehow very much seen during Ramadan and elections, or in other words, it was considered quite normal during religious and political events. For example, Cordesman cites that â€Å"the number of attacks peaked to some 700 per week in October 2005, before the October 15th referendum on the constitution, compared to 430 per week in mid- January†.[35] In relation to these events, many political groups and parties, who are said to have links to political establishments of Iran and also independent elements within Iran, have argued that most of these groups have strong influence and links to the Islamic Supreme Council of Iraq (ISCI). It has been observed in recent years that the Mahdi Army, which is led by Moqtada al-Sadr, has become very powerful and influential due to reported links with Iran of Sadr.[36] ECONOMIC INFLUENCE Since the US invasion, trade between Iran and Iraq has steadily increased and Iran is now Iraq‘s biggest trading partner[37], and the trade consists of building materials, chemicals, consumer goods, and foodstuffs, much of it via the border at Mehran and Mundhirriya/QasrShirin. In addition to this, Iran has negotiated electricity deals with Iraq that were implemented after the CPA era.[38] According to the Iranian ambassador to Iraq, Iran supplies 750 megawatts of electricity to Iraq daily. Moreover, two Iranian banks have received an approval to open their branches in Iraq.[39] Nonetheless, Iran’s investments in real estate and businesses in Basra, Karbala, and Najaf have been seen as exploitative rather than a form of gratitude from Iraqis.[40] To add to this Iran-Iraq economic ties are strong, and this has been encouraged to some extent by the impact of international sanctions on Iran and in other markets. It was demonstrated by Iran‘s ambassador in August 2010 that Iran would double its trade volume with Iraq.[41] Iranian officials have also indicated that they welcome a strong economic integration between the two countries, â€Å"Our message to Iraqi brothers in my visit is that Iran is fully ready to expand ties with Baghdad. We announced that Tehran is prepared to put its scientific, technical, engineering, economic and commercial potentials at the disposal of Iraq†.[42] In 2005, there were reports that to get a job in Basra, this requires the sponsorship of Iran, as teaching posts were filled only by those who were supporting Iran[43]. As a result, most traders in southern parts of Iran speak Farsi and many accept Iranian currency. Iranian exports include electricity, refined oil products, and cars. It al so helps to fund reconstruction. Iraqis have also started receiving medical care from Iran. Thus, Iran has presented a strong economic influence on Iraq. IRAN’S BROADER ROLE IN IRAQI SECURITY The interests of Iran and Iraq security coincide in certain areas and security competition is complicated as it is seen by some Iraqis that Iran is making huge efforts to acquire nuclear weapons as a Muslim bomb, and not as a threat to Iraq.[44] It was also noted that Iran has given some funding to Iraq‘s security forces in 2005, and Iraq had to promise the United States that Iran would not train Iraqi security forces.[45] Iran had pressurised on the security arrangement between the US and Iraq. General Odierno who was the Commander of the Multi-National Force in Iraq at that time said on October 12, 2008, that Iran may try to corrupt the members of the Council of Representatives so as to vote against the Status of Forces agreement.[46] However, in December 2011 Iran indicated that the US forces should withdraw from Iraq, as the US should not use Iraqi land, sea, and air for launching or for any transit point when they attack other countries.[47] It has been argued that some Iraqi military and intelligence officials had significant influence over elements of the Iraqi Ministry of the Interior, and had accused Iran of providing shaped charges and artillery to Iraqi militants. Moreover, Iran had also recruited thousands of Iraqis for gathering information; in fact, Iran has had intelligence agents in northern Iraq for at least 20 years.[48] As per Dafna Linzer, the rough estimate about Iranian intelligence officers in Iraq in 2007 was about 150.[49] It was also observed that some of the Iranian people felt that an increase in Iraq would be a threat to them, while others have attempted to use Iraq‘s military as a wedge to force the US out of Iraq.[50] As per Iran‘s Foreign Minister Ali Akbar Salehi, â€Å"Considering the fact that the Iraqi Army can provide security, their presence in the country is not justifiable†.[51] THE ROLE OF THE IRANIAN REVOLUTIONARY GUARD IN IRAQ Immediately after the fall of Saddam in 2003, Iran began funnelling much of its aid to militias in Iraq via the Qods Force, which is a branch of the Islamic Revolutionary Guard Corps.[52] They not only provided funding, weapons, operatives, and training to groups in Iraq, but also to Islamic militants in Palestine, Bosnia, Hezbollah in Lebanon, fighters in south Sudan, and the Taliban in Afghanistan.[53] It was argued by Mahan Abedin, who is a director of research at the London-based Centre for the Study of Terrorism that Qods’ training was largely focused on utilising intelligence and this was the key to their success. As per official figures, the number of Qods and Iranian intelligence personnel in Iraq was 150, while US commanders believe there were only fewer Shiite provinces.[54] Although the United States was slow to grasp the full extent of Iran‘s expanding role in Iraq, but on July 19, 2005, the United States sent a secret cable to Iran which stated that a British soldier was killed by an explosive which was supplied by Iran, although Iran denied there involvement, which lead to confrontations. [55] The Commander General Petraeus, who was in power during the Multi-National Force operation in Iraq, stated in his testimony to Congress that â€Å"none of us earlier this year appreciated the extent of Iranian involvement in Iraq, something about which we and Iraq‘s leaders all now have greater concern†.[56] Moreover, the Qods was a tool used by Iran directly or indirectly for hurting the US military and also disrupting American interests in Iraq. In 2007, General Petraeus stated that, â€Å"There should be no question about the malign, lethal involvement and activities of the Qods Force in this country†. He went on to add that Iran was â€Å"responsible for providing the weapons, the training, the funding and in some cases the direction for operations that have indeed killed US soldiers†.[57] American officials did not accuse the Qods Force directly for attacking Americans and very carefully said that they were not aware of leadership of the Iranian govern ment as being involved in the Qods Force‘s activities.[58] Such uncertainty in the US regarding the potential involvement of Iran in hte Qods Force raises certain issues that should be addressed by American politicians. Although the American president, George W. Bush, confidently said that those arms, ammunitions and explosives, which were used in Iraq, were certainly from the Qods Force, but â€Å"we are not aware whether or not the head leaders of Iran ordered the Quds Force to do what all this and what all they did †. [59] As per the US intelligence reports, which leaked in 2010, certain details were provided about the precise extent to which Iran was involved in 2006-2009 violence. The report also said that the IRGC used Hezbollah to train militants in Iran before crossing to Iraq. Moreover, General Petraeus had stated Hezbollah‘s role in a 2007 report to Congress.[60] The reports draw on testimony from detainees, captured diaries, and weapons originating in Iran which included explosively formed penetrators, bombs, and surface-to-air missiles. Thus, by all these reports it can be concluded that Iran had a hand in training and resourcing of specific attacks, including assassinations of Iraqi ministry officials, mortar attacks on the Green Zone, and also on kidnappings of American soldiers. In addition, General Petraeus implicated Iran in the 2007 car bombing and killing of two southern Iraqi governors. Besides using Hezbollah to train terrorists, the reports point to both the Badr Corps and Mahdi Army as allies in Iranian efforts.[61] According to the Long War Journal, which is basically based on interviews with senior military and intelligence officials and also mid-level military people, the Qods Force streamlined its operations in Iraq by creating the Ramazan Corps. The Corps was responsible for most of Qods Forces operations in Iraq in 2007 and consists of the Fajr command in the south, Nasr command in the north, and Zafar command in central Iraq. The Qods Force’s aid also included Mahdi Army, the Badr Brigades, the Qazali Network, the Sheibani Network, and many more groups and parties, as they mostly targeted political rivals, the Iraqi Security Forces, and Coalition forces. Moreover, when Badr Brigades and SCIRI formed a government, Iranian groups targeted them.[62] Again as per Brigadier General Kevin Begner, on July 2, 2007, Iran had supplied the Iraqi militias with $3 million per month.[63] Again in 2011, the US raised concerns over Iran‘s involvement in Iraqi violence and said that the incre ase in the number of Americans dying in the summer of 2011 was because Iran had supported Iraqi militants. Again in July, Admiral Mullen said that Iran was supplying militias in Iraq so as to take credit for withdrawing American troops.[64] During the war, which lasted for 8 years, Iran has developed strong ties in terms of religious and political influence with Shiite parties. During this period, Iran played a very important role in mediating between the Iraqi political leaders. It also had strong relations with the Sadrists who are one of the largest political parties in Iran’s ruling collation. Moreover, IRGC also had a significant influence over Iraqi security forces. Iran also has a large mix of resources, which were available in the process of exerting influence upon Iraq after Saddam Hussein was toppled in 2003. Iran also used its influence in Iraq so as to divert the US goals, and pursue its own goals and interests. Iran used its sway in Iraq in order to keep the pro-Iranian Shiite Prime Minister Maliki in power and also to maintain stability along its western border. Thus, it can be argued that Iran’s role in Iraq is very complex, and not a simple task to mould Iraq as per the wishes of Iran. [65] CONCLUSION From all that has been discussed and looked at above, it is beyond doubt that since the invasion of Iraq by the United States and the downfall of Saddam Hussein, Iran has exerted more and more influence in Iraq by both conventional and unconventional methods. It has used a number of tools ranging from economic, political, military, regional to historic to exert such influence and has also formed proxies both with organisations of different profiles and objectives. Sectarianism and factional divisions have also been largely exploited by Iran to achieve its goals. Iranian influence in Iraq is vital to Iran since it considers its importance as a means of establishing its regional dominance and counters the influence of the United States in Iraq. Such efforts of establishing its influence in Iraq have not been without setbacks considering that Iran has had to work with organisations that have been counter-productive in their goals and objectives. The situation in Syria in the past few years has also lessened the viability of Iran’s dominance in the region. Even with such setbacks, Iran has enjoyed some benefits from its dominance in Iraq since trade between the two countries has flourished in a critical moment when Iran was undergoing trade sanctions from the United States and Western countries. One can only wait to see how long such influence will be exerted and whether such status enjoyed by Iran now will continue to exist regardless of the political situation in Iraq. How to cite Iran’s Influence in Iraq, Essay examples

Saturday, December 7, 2019

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