Medicare-eligible physicians at primary care practices (PCP) that did not implement an electronic health record (EHR) system by the end of 2015 face stiff penalties. One year prior to the 2015 deadline, approximately half of all primary clinics have not implemented a basic EHR system. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants’ experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 rural PCPs in the southeastern region of Missouri. Participant perceptions were elicited regarding overcoming barriers to implementing EHRs systems as manadated by federal legislation. Interview questions were transcribed and processed through qualitative software to discern themes of how rural PCP physicians and physician assistants might overcome barriers to implementing electronic health records. Through the exploration of the narrative segments, 4 emergent themes were common among the participants including (a) limited finances to support EHRs, (b) health information exchange issues, (c) lack of business education, and (d) lack of change management at rural medical practices. This study may provide rural primary care physicians and administrators with strategies to promote the adoption of EHRs, provide cost efficient business services, and improve change management plans.

Preventable medical errors result in the loss of 200,000 lives per year with associated financial and operational burdens on organizations and society. Widespread preventable patient harm occurs despite increases in healthcare regulations. High reliability organization theory contributes to improved safety and may potentially reverse this trend. This single case study explored the introduction of a safety culture and subsequent improvements in patient safety in a reliability-seeking organization. Fourteen participants from a subacute nursing facility were selected using purposeful sampling criterion. Data were collected through participant interviews, document reviews, and group observation. Five themes emerged from an analysis of collected data including process standardization, checks and redundancy, authority migration, communication, and teamwork. The themes uncovered the need for extensive education and training, communication, and teamwork to improve patient safety. The results of the study may be useful to improve safety and enhance leadership to promote a culture of safe patient care.

Using stock market and economic data from 1900 to 2008 from 27 separate presidential administrations in the United States (U.S.), including 15 Republican and 12 Democratic, this paper examines the relationships between the market return after each Election Day and economic performance during the presidential term. Using the theoretical framework of political economy, the authors examine how Wall Streets reaction to a presidential election acts as a predictive measure of future economic performance. The analysis shows that the after-election market movement has progressively been more accurate in predicting the future Gross Domestic Product (GDP) growth but not the future unemployment rates. Given that the results show a higher correlation over time, the model appears to provide a good starting point for judging the economic potential of future presidential administrations.

Sournia, «la précarité de sa nosologie médicale, les erreurs auxquelles le mène son scientisme naïf et réductionniste Une meilleure connaissance de

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