Educating Patients On The Use Of A DASH Diet

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Educating Patients On The Use Of A DASH Diet

Need a 500 word paper on Christian worldview pertains to the way Christians see the world, their relationship to God, and how they interpret interactions with their environment.

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In what way did you incorporate your Christian worldview into your work with the DPI Project? Support your position with evidence or scripture.

My DPI project was: Educating patients on the use of a DASH diet to help lower their blood pressure.

Discussion: Alterations In Cellular Processes

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Discussion: Alterations In Cellular Processes

Week Assgn

This week, you examine cellular processes that are subject to alterations that can lead to disease. You evaluate the genetic environments within which these processes exist as well as the impact these environments have on disease.

Scenario: due by Day 3 of Week 1: Discussion: Alterations In Cellular Processes

An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has history of malabsorption syndrome and difficulty eating due to lack of dentures. The patient has been diagnosed with protein malnutrition

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Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:  I suggest that each bullet point be a subject heading and submit in APA format.  Each bullet point should reflect a subject heading followed by subsequent content reflective of primary source(s) of reference published within the last 6 years.

. The role genetics plays in the disease.

. Why the patient is presenting with the specific symptoms described.

. The physiologic response to the stimulus presented in the scenario and why you think this response occurred.

. The cells that are involved in this process. Discussion: Alterations In Cellular Processes

. How another characteristic (e.g., gender, genetics) would change your response.

At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.

Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.

For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.  Discussion: Alterations In Cellular Processes

  • By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:

  • The role genetics plays in the disease.
  • Why the patient is presenting with the specific symptoms described.
  • The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
  • The cells that are involved in this process.
  • How another characteristic (e.g., gender, genetics) would change your response Discussion: Alterations In Cellular Processes

The Impact Of Healthcare Trends On The APN Roles

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The Impact Of Healthcare Trends On The APN Roles

Arnautova (2018) in the article ‘Top Healthcare Industry Trends to Watch in 2018 and Beyond’ outlined five (5) trends that will revolutionize how we provide and consume healthcare services over the next decade. These healthcare trends include: The Impact Of Healthcare Trends On The APN Roles

  1. Telemedicine
  2. Artificial Intelligence
  3. Robotics
  4. IoT and wearables
  5. Blockchain

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Select 1 of the 5 trends and discuss the potent positive and negative impacts the trend will have on the APN role(s) (Clinician, Educator, Researcher, Administrator, Entrepreneur, Consultant, and Leader).

Reference: Arnautova, Y. (2018). Top healthcare industry trends to watch in 2018 and beyond. Retrieved August 20, 2018 from https://www.globallogic.com/blogs/top-healthcare-industry-trends-to-watch-in-2018-and-beyond/ The Impact Of Healthcare Trends On The APN Roles

Expectations

Due 3/5/21

  • Length: A minimum of 250 words, not including references
  • Citations: At least one high-level scholarly reference in APA from within the last 5 years

Assignment: Ethical And Legal Implications Of Prescribing Drugs

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Assignment: Ethical And Legal Implications Of Prescribing Drugs

What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?

These are some of the questions you might consider when selecting a treatment plan for a patient Assignment: Ethical And Legal Implications Of Prescribing Drugs.

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As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.

To Prepare

· Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.

· Review the scenario assigned by your Instructor for this Assignment.

· Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.

· Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.

· Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.

By Day 7 of Week 1

Write a 2- to 3-page paper that addresses the following: Assignment: Ethical And Legal Implications Of Prescribing Drugs

· Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.

· Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.

· Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.

· Explain the process of writing prescriptions, including strategies to minimize medication errors.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The College of Nursing Writing Template with Instructions provided at the Walden Writing Center offers an example of those required elements (available at  https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632 ). All papers submitted must use this formatting Assignment: Ethical And Legal Implications Of Prescribing Drugs.

Cost Comparison Analysis

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Cost Comparison Analysis

Cost Comparison AnalysisEconomic issues are always to be considered during the process of program planning and evaluation. Economic evaluations are analyses that center on the cost of a program and the relationship of the cost to the outcome or impact of the program.A cost comparison analysis compares the costs of at least two programs. CEA, CBA, and CUA are examples of cost comparison analyses.Use the South University Online Library or the Internet to research on cost comparison analysis. Create a report in a 4- to 5-page Microsoft Word document that includes the following:An analysis and explanation of the pros and cons of a CEA.

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Describe how health program planners would use a CEA to assist them in making decisions about their programs.An analysis and explanation of the pros and cons of a CBA. Describe how health program planners would use a CBA to assist them in making decisions about their programs.An analysis and explanation of the pros and cons of a CUA. Describe how health program planners would use a CUA to assist them in making decisions about their programs.Select two public health programs that you would like to compare by means of an economic evaluation. Analyze, identify, and describe the type of economic analysis that you would use in the evaluation. Cost Comparison Analysis

Understanding Environmental Health in Totality

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Understanding Environmental Health in Totality

Now that you have understood the impact of environmental factors on human health, create a 7- to 10- page Microsoft Word document addressing the following questions:

  • Describe three waterborne diseases and suggest methods for their prevention. Understanding Environmental Health in Totality
  • Provide one example of a toxic chemical that may enter the public water supply? Describe some of the health effects that are attributed to toxic chemicals present in drinking water.
  • What health hazards are associated with uncontrolled and older waste sites in the United States? Describe the processes through which hazardous solid wastes can affect human beings.

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  • Compare and contrast the current methods for treating sewage from those that were used in the Middle Ages? Historically speaking, what factors spurred the development of today’s sanitary sewage systems?

  • Describe the stages for processing sewage. At what stage of processing is it permissible in the United States to dispose of wastewater from sewage into waterways? Understanding Environmental Health in Totality
  • What health-related considerations relate to the use of recycled water? What level of processing is required for wastewater to be recycled? Describe some of the uses of recycled water.
  • Even though workers in professional occupations usually are not exposed directly to hazardous agents, they are prone to occupationally associated illnesses. What types of hazards and associated illnesses predominate in professional occupations? What interventions would you propose to mitigate these hazards?

Support your responses with reasoning and examples.

Cite any sources in APA format.

Submission Details

Name your document SU_HSC3002_W5_A2_LastName_FirstInitial.doc.

Submit your document to the W5 Assignment 2 Dropbox by Tuesday, August 29, 2017.

Assignment 2 Grading Criteria Maximum Points
Described three waterborne diseases and suggested methods for their prevention. 20
Provided one example of a toxic chemical that may enter the public water supply. Described some of the health effects that are attributed to toxic chemicals present in drinking water. 30
Explained the health hazards associated with uncontrolled and older waste sites in the United States. Described the processes through which hazardous solid wastes affect human beings. Understanding Environmental Health in Totality 20
Compared and contrasted the current methods for treating sewage from those that were used in the Middle Ages. Explained the historical factors that spurred the development of today’s sanitary sewage systems. 30
Described the stages for processing sewage. Discussed the stage of processing in which it is permissible to dispose of wastewater from sewage into waterways. 20
Discussed the health-related considerations in the use of recycled water. Discussed the level of processing required in order for wastewater to be recycled. Described some of the uses of recycled water. 40
Discussed the types of hazards and associated illnesses that predominate in professional occupations. Explained the interventions that were proposed to mitigate these hazards. 40
Written components. Understanding Environmental Health in Totality

Interaction Between Nurse Informaticists and Other Specialists

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Interaction Between Nurse Informaticists and Other Specialists

Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.

Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients.  Interaction Between Nurse Informaticists and Other Specialists

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In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved. 

                                                  To Prepar e:   

Review the Resources and reflect on the evolution of      nursing informatics from a science to a nursing specialty. 

Consider your experiences with nurse Informaticists or technology specialists within your healthcare organization 

Post a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization.

Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions. Interaction Between Nurse Informaticists and Other Specialists

                                   Required Readings

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

· Chapter 25, “The Art of Caring in Technology-Laden Environments” (pp. 525–535)

· Chapter 26, “Nursing Informatics and the Foundation of Knowledge” (pp. 537–551)

American Nurses Association. (2018). Inclusion of recognized terminologies supporting nursing practice within electronic health records and other health information technology solutions. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/Inclusion-of-Recognized-Terminologies-Supporting-Nursing-Practice-within-Electronic-Health-Records/

Glassman, K. S. (2017). Using data in nursing practice. American Nurse Today, 12(11), 45–47. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2017/11/ant11-Data-1030.pdf 

Macieria, T. G. R., Smith, M. B., Davis, N., Yao, Y., Wilkie, D. J., Lopez, K. D., & Keenan, G. (2017). Evidence of progress in making nursing practice visible using standardized nursing data: A systematic review. AMIA Annual Symposium Proceedings, 2017, 1205–1214. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977718/

Office of the National Coordinator for Health Information Technology. (2017). Standard nursing terminologies: A landscape analysis. Retrieved from https://www.healthit.gov/sites/default/files/snt_final_05302017.pdf 

Rutherford, M. A. (2008). Standardized nursing language: What does it mean for nursing practice? Online Journal of Issues in Nursing, 13(1), 1–12. doi:10.3912/OJIN.Vol13No01PPT05. 

Note: You will access this article from the Walden Library databases.

Thew, J. (2016, April 19). Big data means big potential, challenges for nurse execs. Retrieved from https://www.healthleadersmedia.com/nursing/big-data-means-big-potential-challenges-nurse-execs

Wang, Y. Kung, L., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3–13. doi:10.1016/j.techfore.2015.12.019.  Interaction Between Nurse Informaticists and Other Specialists

Note: You will access this article from the Walden Library databases.

Required Media

Laureate Education (Executive Producer). (2012). Data, information, knowledge and wisdom continuum [Multimedia file]. Baltimore, MD: Author. Retrieved from http://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6051/03/mm/continuum/index.html

Public Health Informatics Institute. (2017). Public Health Informatics: “shipping” information for better health [Video file]. Retrieved from https://www.youtube.com/watch?v=q1gNQ9dm0zg.

Public Health Informatics Institute. (2017). Public Health Informatics: knowledge “architecture” [Video file]. Retrieved from https://www.youtube.com/watch?v=sofmUeQkMLU. Interaction Between Nurse Informaticists and Other Specialists

Interaction Between Nurse Informaticists and Other Specialists

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Interaction Between Nurse Informaticists and Other Specialists

Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.

Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients.  Interaction Between Nurse Informaticists and Other Specialists

ORDER A FREE-PLAGIARISM PAPER HERE

In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved. 

                                                  To Prepare:   

Review the Resources and reflect on the evolution of      nursing informatics from a science to a nursing specialty. 

Consider your experiences with nurse Informaticists or technology specialists within your healthcare organization 

Post a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization.

Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions. Interaction Between Nurse Informaticists and Other Specialists

                                   Required Readings

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

· Chapter 25, “The Art of Caring in Technology-Laden Environments” (pp. 525–535)

· Chapter 26, “Nursing Informatics and the Foundation of Knowledge” (pp. 537–551)

American Nurses Association. (2018). Inclusion of recognized terminologies supporting nursing practice within electronic health records and other health information technology solutions. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/Inclusion-of-Recognized-Terminologies-Supporting-Nursing-Practice-within-Electronic-Health-Records/

Glassman, K. S. (2017). Using data in nursing practice. American Nurse Today, 12(11), 45–47. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2017/11/ant11-Data-1030.pdf 

Macieria, T. G. R., Smith, M. B., Davis, N., Yao, Y., Wilkie, D. J., Lopez, K. D., & Keenan, G. (2017). Evidence of progress in making nursing practice visible using standardized nursing data: A systematic review. AMIA Annual Symposium Proceedings, 2017, 1205–1214. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977718/

Office of the National Coordinator for Health Information Technology. (2017). Standard nursing terminologies: A landscape analysis. Retrieved from https://www.healthit.gov/sites/default/files/snt_final_05302017.pdf 

Rutherford, M. A. (2008). Standardized nursing language: What does it mean for nursing practice? Online Journal of Issues in Nursing, 13(1), 1–12. doi:10.3912/OJIN.Vol13No01PPT05. 

Note: You will access this article from the Walden Library databases.

Thew, J. (2016, April 19). Big data means big potential, challenges for nurse execs. Retrieved from https://www.healthleadersmedia.com/nursing/big-data-means-big-potential-challenges-nurse-execs

Wang, Y. Kung, L., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126(1), 3–13. doi:10.1016/j.techfore.2015.12.019. 

Note: You will access this article from the Walden Library databases.

Required Media

Laureate Education (Executive Producer). (2012). Data, information, knowledge and wisdom continuum [Multimedia file]. Baltimore, MD: Author. Retrieved from http://mym.cdn.laureate-media.com/2dett4d/Walden/NURS/6051/03/mm/continuum/index.html

Public Health Informatics Institute. (2017). Public Health Informatics: “shipping” information for better health [Video file]. Retrieved from https://www.youtube.com/watch?v=q1gNQ9dm0zg.

Public Health Informatics Institute. (2017). Public Health Informatics: knowledge “architecture” [Video file]. Retrieved from https://www.youtube.com/watch?v=sofmUeQkMLU. Interaction Between Nurse Informaticists and Other Specialists

Assessing a Healthcare Program

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Assessing a Healthcare Program

Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives. Assessing a Healthcare Program

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Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.

To Prepare:

· Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.

· Select an existing healthcare program or policy evaluation or choose one of interest to you and get approval to use it from your Instructor.

· Review the healthcare program or policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described. Assessing a Healthcare Program

The Assignment: (2–3 pages)

Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:

· Describe the healthcare program or policy outcomes.

· How was the success of the program or policy measured?

· How many people were reached by the program or policy selected?

· How much of an impact was realized with the program or policy selected?

· At what point in program implementation was the program or policy evaluation conducted?

· What data was used to conduct the program or policy evaluation?

· What specific information on unintended consequences was identified?

· What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.

· Did the program or policy meet the original intent and objectives? Why or why not?

· Would you recommend implementing this program or policy in your place of work? Why or why not?

· Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation. Assessing a Healthcare Program

ADMINISTRATIVE AND CLINICAL USE OF THE EHR

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ADMINISTRATIVE AND CLINICAL USE OF THE EHR

1. Plan of care, evaluation, subjective data, and objective data are all parts of

A. a telephone encounter.

B. documentation.

C. the progress note.

D. a clinic visit.

2. Mr. Smith has an appointment with Dr. Johnson at 9:00 A.M. for his annual wellness exam. Mrs. Adams calls the clinic first thing in the morning due to fever, chills, and cough for 3 days and is given an appointment at 9:00 A.M. with Dr. Johnson as well. This is an example of ADMINISTRATIVE AND CLINICAL USE OF THE EHR

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A. overlap.

B. accommodating.

C. jamming.

D. double-booking.

3. A provider performs _______ to signify that everything in the note is correct.

A. technological signature

B. digital signature

C. annotation

D. autograph

4. Dan has made an appointment for review of his medication, as he recently relocated to the area with his family. Before his appointment, he has been asked to fill out and bring _______ form. ADMINISTRATIVE AND CLINICAL USE OF THE EHR

A. disclosure

B. health history

C. review of systems

D. consent

5. Incident reports are reviewed by the staff to aid in

A. policies.

B. prevention.

C. change.

D. procedures.

6. Which of the following is an appropriate way to reduce no-show appointments?

A. Ensure the patient writes down their appointment.

B. Perform reminder calls one to two days preceding the appointment.

C. There are no good ways to reduce no-shows.

D. Schedule all appointments within seven days of the appointment day.

7. A patient notes that they smoke a half a pack of cigarettes per day and drink a six pack of beer every night. Where would this be documented in the chart?

A. Medical history

B. Social history

C. Chief complaint

D. Problem list

8. Which of the following is not considered an integrated device?

A. Telephone

B. Signature pad

C. Scanners

D. Camera

9. _______ allows for disclosure of protected health information (PHI) through phone, fax, or email without specific patient authorization. ADMINISTRATIVE AND CLINICAL USE OF THE EHR

A. Confidentiality

B. HIPAA Security Rule

C. HIPAA Privacy Rule

D. Clinic policies and procedures

10. _______ is the most important responsibility of all members of the medical office.

A. Communication

B. Accountability

C. Documentation

D. Punctuality

11. All of the following require an incident report to be filed except

A. if the wrong patient is contacted for an appointment reminder.

B. if the employee suffers a needle stick.

C. if the wrong medication is administered to the patient.

D. if the patient falls in the hallway.

12. The process of a data code being unreadable until its destination is reach is called

A. cryptic.

B. jumble.

C. decryption.

D. encryption.

13. The _______ is a centralized location for a summary of a patient’s acute and chronic conditions.

A. chief complaint

B. medical history

C. disease list

D. problem list

14. Which of the following are not guidelines for proper telephone etiquette?

A. Answer by the third ring is possible

B. Answer with a pleasant greeting

C. Speak slowly and clearly

D. Keep a straight, professional face

15. Myrtle uses a cane to ambulate. She came to the clinic for an appointment, but before making it inside the building she tripped and fell on the curb. What type of document needs to be created?

A. Incident report

B. Fall report

C. Accident report

D. Injury report

16. Through the use of _______ a patient may view open appointments or schedule their own appointment.

A. patient access

B. patient flow

C. patient gateway

D. patient portal

17. Cindy has a hand-written fax number from a patient’s parent to fax a note to the school for use of a medication while at school. Cindy is unable to read all of the fax numbers. What should she do?

A. Avoid sending the note since the correct number wasn’t given

B. Call the patient to confirm the number

C. Send to the closest number

D. Ask other office staff ADMINISTRATIVE AND CLINICAL USE OF THE EHR

18. What’s the default landing page in SCMO when entering a patient encounter?

A. Allergies

B. Chief complaint

C. Vital signs

D. Progress note

19. _______ is a rundown of organ systems that can be used to pinpoint certain concerns or unusual findings.

End of exam 

A. Review of systems

B. Report of symptoms

C. Report of systems

D. Review of symptoms

20. “It feels like an ice pick in my head” and “I’m coughing up a lung” are considered

A. chief complaints.

B. reason for visit.

C. presenting symptom.

D. medical concerns. ADMINISTRATIVE AND CLINICAL USE OF THE EHR