Broadband for Telemedicine and Health Services

Given the prominence of rural communities in early 21st-century broadband initiatives, especially in telemedicine, this chapter considers issues for program evaluation in both the geographic and health policy contexts. Rural broadband and health needs are important challenges for public policy, as less populated regions lag in both infrastructure and health services. Some Federal Communications Commission projects have linked broadband capabilities and health services infrastructure. Electronic health records also are relevant to a discussion of the role of broadband networks. This chapter briefly reviews the language and intent of broadband-related health services regulations and federal agency programs and then presents detail on rural broadband availability and adoption. Finally, measurement and evaluation issues in this field are addressed, including the need to understand constraints in the rural context, meaningful use for target populations, issues for privacy and security, and the need for randomized trials rather than the anecdotal evidence that currently dominates in this area.

The Impact of the Health Information Technology for Economic and Clinical Health Act on Clinical Pharmacy and Computerized Provider Order Entry

The Health Information Technology for Clinical and Economic Health (HITECH) Act of 2009 encouraged the meaningful use of the electronic health record (EHR) by health care providers in the United States. “Meaningful use” monetary incentives were offered by the Center for Medicare and Medicaid Services (CMS) for health care providers who met standards of documenting in and using the EHR. While clinical pharmacists typically work in clinics and hospitals in the United States, they were not considered eligible professionals who could receive incentives for using the EHR. There is a great deal of literature regarding the use of the EHR by eligible professionals, but not by ineligible professionals like clinical pharmacists. One way that clinical pharmacists assist in meaningful use criteria is by developing computerized provider order entries (CPOEs). The purpose of this study is to assess the perception and use of CPOEs by clinical pharmacists.

समकालीन नेपाली गद्यकवितामा वर्णविन्यासवक्रता [Characterization in contemporary Nepali prose poetry]

पूर्वीय साहित्यशास्त्रमा आचार्य कुन्तकद्वारा प्रतिपादित वक्रोक्तिसिद्धान्त मूलतः एउटा समन्वयशील सिद्धान्त हो । पूर्ववर्ती आचार्यहरूका मान्यतासमेतलाई समाहित गर्ने गरी प्रस्तुत गर्न खोजिएको यस सिद्धान्तमा कुन्तकले वक्रोक्तिका विभिन्न छ भेद तथा तिनका उपभेदहरूको चर्चा गरेका छन् । यस लेखमा उनले प्रस्तुत गरेका वक्रोक्तिका छ भेदहरूमध्ये वर्णविन्यासवक्रताका आधारमा केही समकालीन नेपाली गद्यकविताहरूको अध्ययन विश्लेषण गरिएको छ । यसका लागि सर्वप्रथम वक्रोक्तिसिद्धान्त र वर्णविन्यासवक्रताका बारेमा सङ्क्षिप्त सैद्धान्तिक चर्चा गरिएको छ । त्यस्तै समकालीन नेपाली गद्यकवितामा वर्णविन्यासवक्रताको प्रगोग कसरी भएको छ भन्ने सन्दर्भलाई स्पष्ट पार्न विभिन्न समकालीन कविका कवितांशलाई उहाहरणका रूपमा प्रस्तुत गरी तिनमा पाइने वर्णविन्यासवक्रताको अध्ययन विश्लेषण गरिएको छ । विक्रम संवत् सत्तरीको दशकयता प्रकाशित कविताहरूमा केन्द्रित यस अध्ययनमा वर्णविन्यासवक्रताका छवटै भेदहरूका आधारमा कविताहरूको विश्लेषण गरिएको छ । प्राथमिक र द्वितीयक दुवै स्रोतका सामग्रीको प्रयोग गरी वर्णनात्मक पद्धतिअनुसार विवेच्य सामग्रीहरूको विश्लेषण गरिएको छ । मूलतः निगमनात्मक पद्धतिमा आधारित यस अध्ययनबाट समकालीन नेपाली गद्यकवितामा पूर्वीय काव्यशास्त्रमा वर्णित वर्णविन्यासवक्रताको सफल र सार्थक प्रयोग पाइने निष्कर्ष निकालिएको छ ।[In Eastern literature, the theory of curvature formulated by Acharya Kuntak is basically a coordinating theory. In this theory, which seeks to incorporate the beliefs of the earlier Acharyas, Kuntak discusses the six distinctions of satire and its variants. In this article, the study analysis of some contemporary Nepali prose poems has been analyzed on the basis of chromaticism out of the six distinctions of irony presented by him. For this, first of all, a brief theoretical discussion has been given about the theory of curvature and chronology. Similarly, in order to clarify the context of how the use of colloquialism has been used in contemporary Nepali prose poetry, various contemporary poetic poems have been presented as examples and the study of colloquialism found in them has been analyzed. This study focuses on the poems published in the seventies of Bikram Samvat and analyzes the poems on the basis of all the six distinctions of chromaticism. The material of both primary and secondary sources has been analyzed according to the descriptive method. Basically, this study based on the deductive method has concluded that the successful and meaningful use of the chromatic descriptions described in Eastern poetry in contemporary Nepali prose poetry has been found.]

Association Between Meaningful Use and Florida Counties’ COVID-19 Case and Death Rates Among Medicaid Providers (Preprint)

BACKGROUND Although the Health Information Technology for Economic and Clinical Health (HITECH) Act has accelerated the adoption of Meaningful Use of Electronic Health Records (EHRs) among Medicaid providers, only about half achieve Meaningful Use. Furthermore, the validity of public health reporting of COVID-19 outcomes, which relies on Meaningful Use advanced functions, remains unknown. OBJECTIVE This study aims to examine the difference between Medicaid providers who did and did not achieve Meaningful Use regarding Florida county-level incidence rates of COVID-19 cases and deaths, accounting for county-level race/ethnicity, unemployment, income, prevalence of respiratory diseases, age, poverty, and healthcare environment. METHODS This cross-sectional ecologic study examined the association between Meaningful Use achievement by Medicaid providers and COVID-19 cases and death rates from 67 Florida counties as of November 19, 2020. Provider information was obtained from the publicly available database from the Florida Medicaid Promoting Interoperability Program, formerly Electronic Health Record Incentive Program. The database includes the Area Health Resources File, capturing provider characteristics and population demographic and socioeconomic characteristics at the county level. Cumulative COVID-19 cases and deaths were obtained from the Florida Department of Health Open Data (FDOH) for zip codes which were aggregated by county. Rates were obtained by dividing cumulative incidence or prevalence by the U.S. Census County population. RESULTS As of November 19, 2020, the cumulative incidence rate of COVID-19 deaths was significantly different between Medicaid providers who achieved Meaningful Use and those who did not (P=.0131), with relatively more deaths reported for those not achieving Meaningful Use. County-level characteristics associated with increased COVID-19 death rates in hierarchical models include greater concentrations of persons of African American or Black race (P<.0001), lower median household income (P<.0001), higher unemployment (P<.0001), and higher concentrations of those living in poverty (P<.0001) and without health insurance (P<.0001). CONCLUSIONS Although Federal subsidies successfully influenced the adoption of Electronic Health Records, our findings suggest an emerging further digital "advanced use" divide among patients cared for by Medicaid providers. Policy interventions need to be reevaluated to address disparities in COVID-19 clinical outcomes which appear exacerbated by the limited use of advanced Electronic Health Records functions. CLINICALTRIAL not applicable

After Trump: Restoring Legitimacy to the Pardon Power

The guest editor’s introduction aims to provide an overview of Donald Trump’s extraordinary record of pardoning, and a road map to the essays in the Issue. Together the essays discuss ways to restore legitimacy to the pardon power and increase its usefulness to the presidency, by limiting some of the pardon power’s most extreme uses; supplementing the pardon power with statutory remedies so that the president is no longer personally responsible for so much routine criminal justice business; and managing the pardon power in a way that serves the presidency and not the parochial interests of federal prosecutors. All of these ideas and arguments together suggest that the way to restoring pardon’s democratic legitimacy and usefulness to the president lies in shrinking the portfolio of routine chores for which pardon is now exclusively responsible, and in restoring the independence and stature of the pardon advisory process within the Justice Department. It would be both fitting and deeply ironic if Donald Trump’s irregular and undemocratic pardoning led to a more coherent and meaningful use of the constitutional power in the service of an enlightened presidential policy agenda, to a renewed commitment to the historically close relationship between pardon and the justice system, and even to a transformation of the Justice Department’s unforgiving prosecutorial culture.