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A new draft white where to buy lasix online paper from the Office of the Assistant Secretary for Policy at the U.S. Department of Labor addresses the widespread underfunding of the retirement systems in the nation’s state and local governments. Depending on methods of measurement, the sum of all unfunded pension liabilities in states and localities ranges from about $1.4 trillion where to buy lasix online to just over $4 trillion.

These liabilities vary across states. This report estimates Illinois’s self-reported unfunded pension liability at just under $170 billion (which translates to roughly $13,000 per person), while South Dakota’s self-reported unfunded pension liability is negligible or zero. The report supplies both total unfunded pension liabilities where to buy lasix online and per capita unfunded pension liabilities for each jurisdiction.

It may be useful to think of the debt-per-person figure as revealing an implicit tax burden borne by each member of the state’s population, because if states and localities cannot correct chronic underfunding by other means, they are likely to look to taxpayers to make up the difference. This report explains that there are a number of causes for this underfunding, including a variety of pressures and processes within these retirement systems that can operate to the disadvantage of employees, beneficiaries, and the public generally. These causes include temporal pressures (pressures to delay making difficult decisions), representational pressures (pressures to appoint pension trustees with qualifications other than administrative expertise), ideological pressures (pressures to use politicized pension investment strategies), and where to buy lasix online political pressures (pressures to give organized interests a disproportionately large role in decision-making).

The report outlines a number of recommendations to address the problems it identifies. Specifically, state and local government pension plans should address shortfalls in the short term, stop making unrealistic promises, stop offloading debts to where to buy lasix online the future, create transparency in pension governance, establish automatic funding adjustments, encourage professionalism among pension trustees, and improve retirement security through actuarially defensible management decisions. Finally, the Employee Retirement Income Security Act reflects a powerful federal model for pension plan management and oversight — areas where many state and local government plans fall grievously short.

Adopting rules similar to those governing private-sector requirements would likely have positive consequences if implemented for state and local government pension plans and their beneficiaries. Read the full where to buy lasix online report here. Jonathan Wolfson is the Deputy Assistant Secretary for Policy and Daniel Greenberg is a senior policy advisor at the U.S.

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WASHINGTON, DC lasix and sodium – The U.S. Department of Labor today announced funding opportunities for more than $21 million in Occupational Safety and Health Administration training grants for non-profit organizations.The first availability will provide $10 million under the American Rescue Plan Act of 2021for Workplace Safety and Health Training on Infectious Diseases, including the hypertension grants. To be eligible for these grants, applicants must develop training that lasix and sodium focuses on four program emphasis areas. Identifying and preventing workplace-related infectious diseases, including the hypertension, in industries with high illness rates, those employing frontline workers or those serving susceptible populations.

OSHA standards that address infectious diseases, including hypertension. Workplace hazards identified in OSHA special emphasis programs or other priorities associated with infectious diseases, including the lasix and sodium hypertension. Applications must be submitted at www.grants.gov no later than 11:59 p.m. EDT on July 19, 2021 lasix and sodium.

Applicants must possess a D-U-N-S number and have an active System of Award Management registration. Obtain a free D-U-N-S number from Dun &. Bradstreet. The second funding availability is for the Susan Harwood Training Grant Program.

Funding of $11,787,000 is available for Targeted Topic Training, Training and Educational Materials Development, and new Capacity Building grants. Applicants can apply for a grant under one of the following funding opportunities. Targeted Topic Training grants support educational programs that identify and prevent workplace hazards. These grants require applicants to conduct training on OSHA-designated workplace safety and health hazards.

Training and Educational Materials Development grants support the development of quality classroom-ready training and educational materials that identify and prevent workplace hazards. Capacity Building grants assist organizations that need time to assess needs and formulate a plan before moving forward with a full-scale safety and health education program, as well as expand their capacity to provide occupational safety and health training, education and related assistance to their constituents. Applicants may apply for and receive both an ARPA “Workplace Safety and Health Training on Infectious Diseases, including the hypertension” grants and the standard Susan Harwood Training grants. Applications must be submitted at www.grants.gov no later than 11:59 p.m.

EDT on Aug. 17, 2021. Applicants must possess a D-U-N-S number and have an active System of Award Management registration. Obtain a free D-U-N-S number from Dun &.

Bradstreet. OSHA awards grants to nonprofit organizations, including community and faith-based organizations, employer associations, labor unions, joint labor/management associations, Indian tribes, and local and state-sponsored colleges and universities to provide infectious disease workplace safety and health training. The Harwood Training Grant program supports remote and in-person hands-on training for workers and employers in small businesses. Industries with high injury, illness, and fatality rates.

And vulnerable workers, who are underserved, have limited English proficiency, or are temporary workers. Learn more about the Susan Harwood Training Grant Program.BETHLEHEM, PA – A federal workplace safety inspection of a U.S. Postal Service location in Hanover Township found employees exposed to potentially serious and fatal injuries in the event of an emergency.Responding to a complaint, the U.S. Department of Labor’s Occupational Safety and Health Administration initiated an investigation at the USPS’s Lehigh Valley Processing and Distribution Center.

OSHA determined the facility failed to keep exit routes free and unobstructed at two of the sorting hub’s loading dock areas and cited the USPS with one willful violation. Investigators also found portable fire extinguishers were not readily accessible and there was inadequate workspace in front of the electrical equipment. OSHA issued two repeat citations related to these workplace violations, as the agency cited the location for the same hazards in Raleigh, North Carolina and Los Angeles, California. In addition, the agency cited the USPS with two serious violations for additional safety hazards.

The facility faces $236,783 in proposed penalties for the violations. €œExit routes are vital for safe evacuations should a workplace emergency occur. Employers who fail to keep them clear and unobstructed put their workers at risk of injuries or worse,” said OSHA Area Director Jean Kulp in Allentown, Pennsylvania. €œThe most effective ways to prevent these hazards are to routinely evaluate workspaces and immediately remove materials blocking exits.” The USPS has 15 business days from receipt of its citations and penalties to comply, request an informal conference with OSHA’s area director, or contest the findings before the independent Occupational Safety and Health Review Commission.

Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthy workplaces for their employees. OSHA’s role is to help ensure these conditions for America’s workers by setting and enforcing standards, and providing training, education and assistance. Learn more about OSHA..

WASHINGTON, DC – where to buy lasix online diuretic lasix buy The U.S. Department of Labor today announced funding opportunities for more than $21 million in Occupational Safety and Health Administration training grants for non-profit organizations.The first availability will provide $10 million under the American Rescue Plan Act of 2021for Workplace Safety and Health Training on Infectious Diseases, including the hypertension grants. To be eligible for these grants, applicants where to buy lasix online must develop training that focuses on four program emphasis areas. Identifying and preventing workplace-related infectious diseases, including the hypertension, in industries with high illness rates, those employing frontline workers or those serving susceptible populations. OSHA standards that address infectious diseases, including hypertension.

Workplace hazards identified in OSHA where to buy lasix online special emphasis programs or other priorities associated with infectious diseases, including the hypertension. Applications must be submitted at www.grants.gov no later than 11:59 p.m. EDT on July 19, where to buy lasix online 2021. Applicants must possess a D-U-N-S number and have an active System of Award Management registration. Obtain a free D-U-N-S number from Dun &.

Bradstreet. The second funding availability is for the Susan Harwood Training Grant Program. Funding of $11,787,000 is available for Targeted Topic Training, Training and Educational Materials Development, and new Capacity Building grants. Applicants can apply for a grant under one of the following funding opportunities. Targeted Topic Training grants support educational programs that identify and prevent workplace hazards.

These grants require applicants to conduct training on OSHA-designated workplace safety and health hazards. Training and Educational Materials Development grants support the development of quality classroom-ready training and educational materials that identify and prevent workplace hazards. Capacity Building grants assist organizations that need time to assess needs and formulate a plan before moving forward with a full-scale safety and health education program, as well as expand their capacity to provide occupational safety and health training, education and related assistance to their constituents. Applicants may apply for and receive both an ARPA “Workplace Safety and Health Training on Infectious Diseases, including the hypertension” grants and the standard Susan Harwood Training grants. Applications must be submitted at www.grants.gov no later than 11:59 p.m.

EDT on Aug. 17, 2021. Applicants must possess a D-U-N-S number and have an active System of Award Management registration. Obtain a free D-U-N-S number from Dun &. Bradstreet.

OSHA awards grants to nonprofit organizations, including community and faith-based organizations, employer associations, labor unions, joint labor/management associations, Indian tribes, and local and state-sponsored colleges and universities to provide infectious disease workplace safety and health training. The Harwood Training Grant program supports remote and in-person hands-on training for workers and employers in small businesses. Industries with high injury, illness, and fatality rates. And vulnerable workers, who are underserved, have limited English proficiency, or are temporary workers. Learn more about the Susan Harwood Training Grant Program.BETHLEHEM, PA – A federal workplace safety inspection of a U.S.

Postal Service location in Hanover Township found employees exposed to potentially serious and fatal injuries in the event of an emergency.Responding to a complaint, the U.S. Department of Labor’s Occupational Safety and Health Administration initiated an investigation at the USPS’s Lehigh Valley Processing and Distribution Center. OSHA determined the facility failed to keep exit routes free and unobstructed at two of the sorting hub’s loading dock areas and cited the USPS with one willful violation. Investigators also found portable fire extinguishers were not readily accessible and there was inadequate workspace in front of the electrical equipment. OSHA issued two repeat citations related to these workplace violations, as the agency cited the location for the same hazards in Raleigh, North Carolina and Los Angeles, California.

In addition, the agency cited the USPS with two serious violations for additional safety hazards. The facility faces $236,783 in proposed penalties for the violations. €œExit routes are vital for safe evacuations should a workplace emergency occur. Employers who fail to keep them clear and unobstructed put their workers at risk of injuries or worse,” said OSHA Area Director Jean Kulp in Allentown, Pennsylvania. €œThe most effective ways to prevent these hazards are to routinely evaluate workspaces and immediately remove materials blocking exits.” The USPS has 15 business days from receipt of its citations and penalties to comply, request an informal conference with OSHA’s area director, or contest the findings before the independent Occupational Safety and Health Review Commission.

Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthy workplaces for their employees. OSHA’s role is to help ensure these conditions for America’s workers by setting and enforcing standards, and providing training, education and assistance. Learn more about OSHA..

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A Westchester man is facing charges for allegedly exposing himself to a pair of women and attempting to sexually assault one, the District Attorney’s Office announced.Yonkers resident Folarin Soulaude was indicted for burglary and sexual assault charges following incidents in a Nepperhan Avenue apartment building over the summer when he gained access to one residence posing as a handyman.Specifically, Soulaude, 37, was charged with:Burglary as a sexually motivated felony;Burglary;Sexual abuse;Public lewdness.It is alleged that shortly before Wednesday, June 24, Soulaude knocked on doors in the Nepperhan Avenue apartment building in an attempt to gain entry into homes.Westchester County District Attorney Anthony Scarpino, lasix uk buy Jr. Said that one woman allowed him into her apartment, believing lasix uk buy he was there to fix a pipe. Instead, Soulaude allegedly dropped his pants and exposed himself to the woman upon entering the home.Scarpino said that the woman screamed and fled into the hallway, with Soulaude chasing her, attacking her, and pinning her against a wall, at which point he attempted to take off her pants. Another resident intervened and Soulaude proceeded to flee into lasix uk buy the building’s parking garage.

It is further alleged that after fleeing into the parking garage, Soulaude proceeded to expose himself to a woman who was parking her car, who called the police. Officers then apprehended Soulaude without further incident.Soulaude was arraigned this week and a temporary order of protection was issued for his lasix uk buy victims. He is scheduled to appear back in court on Tuesday, Jan. 12, 2021 lasix uk buy.

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A Westchester man is where to buy lasix online facing charges for allegedly exposing himself to a pair of women and attempting to sexually assault one, the District Attorney’s Office announced.Yonkers resident Folarin Soulaude was indicted for burglary and sexual assault charges following incidents in a Nepperhan Avenue apartment building over the summer when he gained access to one residence posing as a handyman.Specifically, Soulaude, 37, was charged with:Burglary as a sexually motivated felony;Burglary;Sexual abuse;Public lewdness.It is alleged that shortly before Wednesday, June 24, Soulaude knocked on doors in the Nepperhan Avenue apartment building in an attempt to gain entry into homes.Westchester County District Attorney Anthony Scarpino, Jr. Said that one woman allowed him into her apartment, where to buy lasix online believing he was there to fix a pipe. Instead, Soulaude allegedly dropped his pants and exposed himself to the woman upon entering the home.Scarpino said that the woman screamed and fled into the hallway, with Soulaude chasing her, attacking her, and pinning her against a wall, at which point he attempted to take off her pants. Another resident intervened and Soulaude proceeded to flee into where to buy lasix online the building’s parking garage. It is further alleged that after fleeing into the parking garage, Soulaude proceeded to expose himself to a woman who was parking her car, who called the police.

Officers then apprehended Soulaude without further where to buy lasix online incident.Soulaude was arraigned this week and a temporary order of protection was issued for his victims. He is scheduled to appear back in court on Tuesday, Jan. 12, 2021 where to buy lasix online. Click here to sign up for Daily Voice's free daily emails and news alerts..

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UC Davis and two other universities have been awarded a $2.3 million grant from the National Institutes http://www.col-twinger-strasbourg.ac-strasbourg.fr/le-recteur-et-le-maire-de-strasbourg-a-la-rencontre-des-collegiens-de-notre-college-dans-le-cadre-de-la-reserve-citoyenne/ of Health to lasix and potassium train and empower community health workers in research best practices, which could help reduce disparities related to the ongoing hypertension medications lasix. An NIH grant will allow UC Davis Health to train community health lasix and potassium workers to help with research efforts to reduce health disparitiesThe grant from the NIH’s National Center for Advancing Translational Sciences is shared by the UC Davis Clinical and Translational Science Center (CTSC) and the Center for Reducing Health Disparities (CRHD), the University of Michigan, and the University of Florida. All three universities do extensive work in promoting health equity among Latinx and Black populations.The award acknowledges the increasing role that community health workers play in research to engage individuals from underserved communities.“We have been successfully training community health workers for many years to help diverse populations improve their health, and now we’ll have an opportunity to take that training to the next level, to formally teach the essentials of research to community health workers,” said Sergio Aguilar-Gaxiola, director of the CRHD and also director of the community engagement program of the CTSC. As with most gatherings nowadays, the training will be held online.Community health workers, sometimes known as promotoras de salud, are frontline lasix and potassium public health workers who are trusted members of the community or have an unusually close understanding of the community they serve. Sometimes they lasix and potassium are embedded within underserved communities.

In recent years, they have taken on a critical role in research for their ability to reduce barriers in translation, particularly in in the area of health disparities.The grant’s timing allows Spanish-speaking community health workers to be trained in critical research like contact tracing to help slow the spread of hypertension medications, Aguilar-Gaxiola said.Latinos in California are infected with hypertension medications at a rate more than three times higher than whites, according to the California Department of Public Health. Latinos, who are 39% of California’s population, make lasix and potassium up 60% of hypertension medications cases. Also, nearly 80% of hypertension medications related deaths in the 35-49 age group https://borowski-shiatsu-berlin.eu/shiatsu-links/ are Latinx, while this age group represents 41.5% of lasix and potassium the California population. In the same age group, whites represent 7.8% of the deaths and 32.5% of the population.“This particular grant could not be more timely because of the dire need to have this workforce of promotoras or community health workers to potentially help with contact tracing, which is much needed in hard-to-reach populations,” Aguilar-Gaxiola said. €œPromotoras are in the ideal position of using their cultural and linguistic skills to reach their lasix and potassium communities and help slow the spread of the disease.”Grant will develop “champions” among peer mentorsIn addition to training community health workers, the grant also seeks to:Provide standardized education in research best practices for community health workersReduce barriers to accessibility of competency-based training and tools for training community health workers onlineEmpower select community health workers to become training “champions” to serve as peer mentors and facilitate the training of their colleagues at community sitesThe principal investigators are Aguilar-Gaxiola.

Susan Murphy, an associate lasix and potassium professor of physical medicine and rehabilitation at Michigan Medicine and Linda B. Cottler, a dean’s professor of epidemiology and director of community engagement of the University of Florida Clinical and Translational Science Institute.“This grant will allow us to enable community health workers to better support research within their community,” Murphy said. €œThis is lasix and potassium especially important in underserved communities where quality and translation of clinical research are hampered due to health disparities.”The three investigators’ institutions will serve as the first training hubs for the program.UC Davis Health also will work closely with partners that can assist in outreach and recruitment, including the Mexican Consulate in Sacramento, Health Education Council, Rio Vista CARE and other organizations. Community health workers and community members in California, Michigan and Florida will be engaged in content generation, as well as provide feedback on the training and its implementation.“Community health workers understand the needs of their community and are an incredibly valuable resource, especially when it comes to engaging their community members in research that could help us reduce health disparities in the future,” Cottler said..

UC Davis and two other universities lasix 40mg price have been awarded a $2.3 million grant from the National Institutes of Health to train and empower community health workers in research where to buy lasix online best practices, which could help reduce disparities related to the ongoing hypertension medications lasix. An NIH grant will allow UC Davis Health to train community health workers to help with research efforts to reduce health disparitiesThe grant from the NIH’s National Center for Advancing Translational Sciences is shared by the UC Davis Clinical and Translational where to buy lasix online Science Center (CTSC) and the Center for Reducing Health Disparities (CRHD), the University of Michigan, and the University of Florida. All three universities do extensive work in promoting health equity among Latinx and Black populations.The award acknowledges the increasing role that community health workers play in research to engage individuals from underserved communities.“We have been successfully training community health workers for many years to help diverse populations improve their health, and now we’ll have an opportunity to take that training to the next level, to formally teach the essentials of research to community health workers,” said Sergio Aguilar-Gaxiola, director of the CRHD and also director of the community engagement program of the CTSC. As with most gatherings nowadays, the training will be held online.Community health workers, sometimes known as promotoras where to buy lasix online de salud, are frontline public health workers who are trusted members of the community or have an unusually close understanding of the community they serve.

Sometimes they are where to buy lasix online embedded within underserved communities. In recent years, they have taken on a critical role in research for their ability to reduce barriers in translation, particularly in in the area of health disparities.The grant’s timing allows Spanish-speaking community health workers to be trained in critical research like contact tracing to help slow the spread of hypertension medications, Aguilar-Gaxiola said.Latinos in California are infected with hypertension medications at a rate more than three times higher than whites, according to the California Department of Public Health. Latinos, who are 39% of California’s population, make up 60% of where to buy lasix online hypertension medications cases. Also, nearly 80% of where to buy lasix online hypertension medications related deaths in the 35-49 age group are Latinx, while this age group represents 41.5% of the California population.

In the same age group, whites represent 7.8% of the deaths and 32.5% of the population.“This particular grant could not be more timely because of the dire need to have this workforce of promotoras or community health workers to potentially help with contact tracing, which is much needed in hard-to-reach populations,” Aguilar-Gaxiola said. €œPromotoras are in the ideal position of using their cultural and where to buy lasix online linguistic skills to reach their communities and help slow the spread of the disease.”Grant will develop “champions” among peer mentorsIn addition to training community health workers, the grant also seeks to:Provide standardized education in research best practices for community health workersReduce barriers to accessibility of competency-based training and tools for training community health workers onlineEmpower select community health workers to become training “champions” to serve as peer mentors and facilitate the training of their colleagues at community sitesThe principal investigators are Aguilar-Gaxiola. Susan Murphy, an where to buy lasix online associate professor of physical medicine and rehabilitation at Michigan Medicine and Linda B. Cottler, a dean’s professor of epidemiology and director of community engagement of the University of Florida Clinical and Translational Science Institute.“This grant will allow us to enable community health workers to better support research within their community,” Murphy said.

€œThis is especially important in underserved communities where quality where to buy lasix online and translation of clinical research are hampered due to health disparities.”The three investigators’ institutions will serve as the first training hubs for the program.UC Davis Health also will work closely with partners that can assist in outreach and recruitment, including the Mexican Consulate in Sacramento, Health Education Council, Rio Vista CARE and other organizations. Community health workers and community members in California, Michigan and Florida will be engaged in content generation, as well as provide feedback on the training and its implementation.“Community health workers understand the needs of their community and are an incredibly valuable resource, especially when it comes to engaging their community members in research that could help us reduce health disparities in the future,” Cottler said..

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As Pfizer and http://twistedspaces.com/cost-of-cialis-at-cvs/ Moderna wait how to deal with a dog on lasix for the U.S. Federal and Drug Administration to issue an emergency use authorization for their respective treatments, the importance of how to deal with a dog on lasix a seamless – or at least well-connected – supply chain has become increasingly clear.According to the U.S. Department of Health and Human Services, the first rollout of the treatment is likely to be very limited, with state governors and public health departments directing allocation of the first available doses. But if plans to produce tens of millions of doses by the end of 2020 see fruition, professionals say logistics will play an increasingly vital role in getting those doses to how to deal with a dog on lasix people who need them. "This is a phenomenally critical issue that every health system is going to have to manage and figure out the way forward," said Anne Snowdon, executive director of clinical research at HIMSS (parent company of Healthcare IT News).

Snowdon – who created HIMSS Analytics' Clinically Integrated Supply Outcomes Model, how to deal with a dog on lasix which signifies digital health maturity in a system's supply chain processes – called the question of treatment rollout the "classic supply chain strategy" in a recent HIMSS TV interview. "If you are tracking every patient who receives every dose of treatment, and with the simple scan of a barcode or QR code or RFID tag – or however it's labeled – can identify what lot number, what site was it manufactured, when was that manufactured, and now you track that to every individual citizen who receives that dose, you now have an ability to know who had side effects, who had a great response to that treatment, who didn't, and now you've got a data set to work from," said Snowdon. Such how to deal with a dog on lasix data, said Snowdon, can be used to ensure every global citizen has access to the treatment in the order of priority needed. HIMSS CEO Hal Wolf agreed, saying that such tracking can be used specifically to highlight how different social determinants of health may affect treatment access and efficacy."We could have adverse or different effects based upon the environment in which it's put into," he said, pointing out that some of the treatments require storage in ultracold conditions (prompting a recent uptick in dry ice demand, for example)."To be honest, there are going to be times when you're relying on the distribution capabilities of someone who wouldn't normally be in the supply chain. It may be leveraging the delivery capabilities of a local business."Chris Hale, KountableBefore treatments are given to individuals, however, doses have to physically make their how to deal with a dog on lasix way from manufacturers to healthcare providers.

"What we're really talking about is a governance risk and compliance functionality that relies on relative real-time data, coordination and transparency," said Chris Hale, CEO and co-founder of the global procurement company Kountable. "When you put those things together, there's not a lot of solutions that how to deal with a dog on lasix will work that don't involve technology." Logistically speaking, "what you really have to do is start at the end consumer, in this case the patient, and work backwards," said Hale. "If you start at the supplier, it's a fairly easy journey and a fairly developed journey – until it breaks. You have how to deal with a dog on lasix to finish the job. It's the person in the last position who matters most." Given the size of the demand and the relatively unconnected nature of some parts of the world – including the rural United States – Hale said unconventional thinking could prove necessary.

"To be honest, there are going to be how to deal with a dog on lasix times when you're relying on the distribution capabilities of someone who wouldn't normally be in the supply chain," he said. "It may be leveraging the delivery capabilities of a local business." Hale also said that the processes should be nimble, with the potential to shift if circumstances prove necessary. "There's sort of different degrees of success that how to deal with a dog on lasix need to be tracked independently. Did the treatments get the right place at the right time in the right condition?. That's a supply how to deal with a dog on lasix chain problem.

Were they distributed to patients and administered effectively?. Did they how to deal with a dog on lasix work?. What happens after?. " he said how to deal with a dog on lasix. "There's going to be a very real need for continuous improvement business processes applied to the full chain," he added.

"It's a question of vectors how to deal with a dog on lasix. 'Is it working and improving?. ' rather than 'did it how to deal with a dog on lasix work?. '" It's important to work the kinks out sooner rather than later, he said, especially as demand grows. "It's not tomorrow's problem, but it's not next year's either," he how to deal with a dog on lasix said.

"The entire thing is going to be driven by availability of supply … We're still going to be making allocation decisions for years to come." Hale said he feared that treatment access in the longer term would follow the trajectory of personal protective equipment, with huge shortages in some jurisdictions. "I hope it doesn't look how to deal with a dog on lasix and feel like PPE," he said. "Each state has different communities, different geography, different challenges to address."Dr. Rhonda Medows, Providence"I will tell you that I'm disappointed in the federal response" to hypertension medications as a whole, how to deal with a dog on lasix said Dr. Rhonda Medows, president of population health at Providence, one of the largest nonprofit health systems in the United States.

When it how to deal with a dog on lasix came to assessment, surveillance and testing, she said, "we were delayed, we were slow … and now the plan is to distribute treatments based on state population size. Not population risk for hypertension medications, but state population size. That's not what we were expecting or anticipating."Given the plan in place, she said she hopes state governors how to deal with a dog on lasix make allocation decisions with public health in mind. "The volume of treatments they're getting is really small," she said. "I don't know how else to emphasize it how to deal with a dog on lasix.

You need to prioritize within the priority groups. Vaccinate and protect your front how to deal with a dog on lasix line and first responders. One, for their benefit and well-being and two, because we need them. Second is to vaccinate and protect the people who will how to deal with a dog on lasix suffer the highest degree of morbidity and mortality from the agent. Nursing homes, elderly, those with chronic conditions." With that prioritization in mind, she said the organization has been planning the best ways to distribute doses efficiently."Providence has already done the work of registering with each state health entity" as a distributor, she said.

"We've registered each of our hospitals, ERs, individual physicians and clinicians … We've ordered the special how to deal with a dog on lasix freezers for the Pfizer one, then we have the regular freezers for the other treatments. We've already stocked the facilities for the ancillary things we need how to deal with a dog on lasix to go along with the treatment. The supply chain has been accumulating supplies just in case. Our facilities, with that part of the logistics, are fine." Providence has been relying on how to deal with a dog on lasix advanced analytics as part of its treatment preparations, she said, including patient population assessments across all care settings, and logistics and personnel planning. She noted that the initial volume of treatment to be distributed "will not even be adequate" for the group of clinicians and providers who are most exposed to the lasix."Even within those groups, we're going to be forced to sub-prioritize," she said.

"We've done the logistics of figuring out healthcare how to deal with a dog on lasix professionals at the highest risk from day-to-day work, including doctors, maintenance sanitation employees, those doing food delivery to other sites. It's a full health professional suite." Once more treatments are available, she said, a challenge will be reaching patients in more rural areas, who might struggle with the freezer requirements or facility access. "Each state has different communities, different geography, different how to deal with a dog on lasix challenges to address," she said. "In those communities where there's already not great physical access space could we retrofit mobile vans with the deep freeze requirements?. " "We know that we have some facilities or clinics that could be a [distribution] site, but then there's a whole world of people, so to speak, in the communities" who how to deal with a dog on lasix will be lower on the treatment priority list.

Medows noted the importance of centering the needs of groups especially affected by hypertension medications, such as Black, Latino, and Native people. A recent Commonwealth how to deal with a dog on lasix Fund study showed that systemic and medical racism is likely to affect vaccination rates, with distrust among many people of color stemming in large part "from institutional experiences with racism and unethical medical experimentation." treatments are also linked to coverage and financial barriers that reflect a legacy of racial inequity, wrote Commonwealth researchers. Hale, too, said that he feared that uncontrolled or unregulated supply chains would lead to a replication of inequity. "Unfortunately this kind of complexity also … how to deal with a dog on lasix creates economic distortions," he said. And given the nature of the disease – which spreads regardless of political borders and disproportionately impacts already underserved people – it's imperative to address these potential gaps from the get-go, said experts.

"When one individual is vulnerable, we are how to deal with a dog on lasix literally all vulnerable," said Wolf. Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.Cleveland Clinic, DigitalC, TransDigm Group and The Lubrizol Foundation have come together to help provide affordable high-speed internet to residents of the Fairfax neighborhood in Cleveland. Installation should be complete for Fairfax residents by the second quarter of 2021.WHY IT MATTERSThe effort aims to help impact disparities in internet coverage in the local community, which can affect access to education, healthcare and economic opportunities.

According to 2019 Census Bureau data, Cleveland is the worst-connected large city, with nearly 50,000 households not having reliable broadband. HIMSS20 Digital Learn on-demand, earn credit, find products and solutions. Get Started >>. Especially during a global lasix, access to the internet affects a person’s ability to search and apply for jobs, use healthcare and telehealth services, fully participate in their education and virtually connect with friends, family and colleagues.Broadband for the households covered in this program will be provided by EmpowerCLE, a wireless internet service provider founded by and operating within DigitalC. DigitalC is a nonprofit organization focused on improving Cleveland’s digital equity and providing residents with an affordable, high-speed internet connection.EmpowerCLE has installed equipment on the rooftops of two Cleveland Clinic main campus buildings in order to expand its coverage in the Fairfax community.

EmpowerCLE brand ambassadors and technicians will visit local households to offer the connection and install the necessary equipment to begin service.While DigitalC and EmpowerCLE provide affordable internet services, in order to further lower the cost for Fairfax residents, Cleveland Clinic has brought together additional partners with an interest in connecting underserved areas. TransDigm and The Lubrizol Foundation have agreed to contribute significant funds to further reduce the monthly subscription fee and help subsidize the cost of equipment.THE LARGER TRENDIn addition to working with DigitalC, earlier this year, Cleveland Clinic signed on to the American Connection Project Broadband Coalition, which advocates to bring high-speed internet to rural and under-connected areas.Connecting underserved areas with reliable high-speed internet is one way Cleveland Clinic aims to positively impact social determinants of health in communities. Social determinants of health are factors such as food security, housing, infant mortality, chronic diseases, education quality and access, and economic opportunity that affect a person’s health and wellbeing.According to the National Academy of Medicine, medical care is estimated to account for only 20% of a person’s health – social determinants of health can make up the other 80%.ON THE RECORD“The hypertension medications lasix has further illuminated the crucial role internet access plays in the overall health and well-being of a population, and it is critical that we work to overcome digital inequities,” said Dr. Tom Mihaljevic, president and CEO of Cleveland Clinic.“Social determinants of health lay the foundation of a person’s overall health and have a lifelong impact on their health outcomes,” said Dr. Adam Myers, director of Cleveland Clinic Community Care.

€œBy identifying areas we can help, such as providing broadband connection, and engaging with like-minded partners, we can make a difference in creating a better, healthier community for everyone.”Twitter. @SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.SUNY Upstate Medical University in Syracuse, New York, has 35 operating rooms across multiple locations including academic and community facilities. As with most traditional perioperative departments, it was facing three major issues.THE PROBLEMFirst, low OR utilization despite demand for time. SUNY Upstate was not hitting its desired utilization targets and did not have actionable data for department chairs and administration to take the right actions for improvement.

At the same time, it had surgeons and departments wanting more access to OR time. HIMSS20 Digital Learn on-demand, earn credit, find products and solutions. Get Started >>. Second, standardizing systemwide decision making based on objective data. The provider organization needed to unify decision making in key areas – block policy to allocate time, block release times, areas for operational improvement – across the academic and community settings to ensure shared best practices and goals while maintaining a high level of visibility into decision making.Decisions were questioned often because of the lack of objective data, clearly defined and understood across the various stakeholders.And third, visibility into the performance metrics that matter.

SUNY Upstate had various reporting sources that were in conflict with each other, creating a distrust in data presented during operational and committee meetings.PROPOSALTo solve its problems, SUNY Upstate Medical University turned to LeanTaaS, which markets software that combines lean principles, predictive analytics and machine learning to transform hospital and infusion center operations.LeanTaaS’ technology, iQueue for Operating Rooms, promised several attractive outcomes, said Dr. William Marx, medical director of perioperative services at SUNY Upstate Medical University.“LeanTaaS’ technology predicts when blocks will be underutilized and enables surgeon offices to release them sooner than auto release deadlines so a large pool of shared open time can be created,” said Marx. €œLike OpenTable makes it easy to book restaurant tables, their tools would make it really simple to see open OR time anytime, anywhere and ask for it.”This aspect of the tool would help SUNY do more cases, thereby improving three key metrics. Prime time utilization, staffed room utilization and case volume, he added."The data availability and transparency to everyone involved in meeting our goals has been critical in our collaboration efforts in policy writing and adoption."Dr. William Marx, SUNY Upstate Medical UniversityTransparency was another attractive promised outcome for Marx.“It would provide cloud-based mobile and web tools that showed the right metrics to the right user on demand,” he explained.

€œThis would alleviate the lack of transparency into data between surgeons and operations and also create a single source of truth to eliminate discrepancies in reports arising from competing sources of information. The transparency has been the best feature as we have introduced the product to our leadership and surgical staff.”Yet another aspect he liked was what the vendor called “actionability.”“The tools promised ready access to actionable data to department chairs across SUNY Upstate Medical University so we could hold ourselves accountable, measure what’s important and make decisions, not just debate the numbers,” he said. €œOne specific such metric is what they call ‘collectable time,’ which is far more actionable than ‘block utilization,’ the traditional metric all ORs have used to right-size blocks, which is far less actionable and defensible.”Marx was also interested in data hygiene.“Over the years we knew we had made decisions and used logic in our EHR that had errors, for example, assigned overlapping block times given to different surgeons. We just weren’t sure how to identify them systematically, and LeanTaaS’ implementation process promised to ferret those out,” he noted.MEETING THE CHALLENGELaunched in July 2020, iQueue is being used across SUNY Upstate facilities by OR scheduling, clinic scheduling, surgery chairs and surgeons themselves. It integrates easily with the organization’s Epic EHR and provides a cloud-based add-on the provider can access on any browser whether mobile or web.“We send iQueue a nightly feed from our data warehouse and a real time feed in HL7, so the integration is relatively light,” Marx said.

€œiQueue provides a few powerful tools by using this data in real time.”One of these tools is OpenTable for Open OR Time. This is actually a set of tools that streamline how the OR can advertise open time, enable and encourage clinics to release time ahead of auto releases, and request it 24/7 when needed. This has led to what Marx called a “mentality of plenty” instead of one of “scarcity” where everyone felt they were competing for the same limited OR time.Another tool is deep on-demand analytics.“There is a comprehensive set of daily refreshed metrics that help us look at over a dozen powerful metrics – utilization rated, volume, trends, opportunities for improvement in delay, and turnover times,” Marx explained. €œThe tool allows very easy sharing across campuses improving data transparency and credibility across all stakeholders.”Surgeons get personalized weekly texts and messages pushed to them to keep them abreast of their performance. SUNY Upstate has been able to shift cases from one campus to another and improve utilization of others.

It also has seen how some surgeons have actually had duplicate blocks on the same day. The on-demand analytics has helped to redesign block scheduling patterns so they coincide with surgeon and OR availability.Then there is data-driven accountability, Marx said.“We have been able to adopt a new way of looking at how to measure usage of block time and hold ourselves accountable – ‘collectable time’ – this has made the conversations in our decision making bodies like the OR committee a lot lore data-driven and actionable,” he said. €œThere has been strong adoption and engagement from leadership, which continued to expand to all levels. Business office, surgeons and MSG schedulers.”By cultivating a strong partnership between SUNY Leadership and the LeanTasS team, SUNY Upstate has seen continued active user growth and engagement, he added.“We now have a Tiger Team at SUNY Upstate Medical University, assembled from key stakeholder groups, relying on iQueue to provide real-time data to the team to assess progress and drive improvements in efficiency,” Marx noted. €œThe data availability and transparency to everyone involved in meeting our goals has been critical in our collaboration efforts in policy writing and adoption.”RESULTSIn just a few months (the tools went live in early July), SUNY Upstate has been able to see significant success.

The key results achieved with iQueue include:Absorbed significantly higher case volume during business hours. €œWe have seen a 3.4% increase in weekly volume of cases done within existing capacity and in business hours,” Marx explained. €œThis is hugely important for any system since OR volume is a key driver of hospital performance.”Increases usage of OR minutes during business hours. Correspondingly, SUNY Upstate has experienced a 5.5% increase in the number of OR minutes used during business hours. Since business hours are when ORs are staffed, that also means the organization is using its fixed and variable costs better instead of doing cases into the night.

Since costs are fixed, improving OR utilization has helped reduce non-productive time.Increase utilization across the board. SUNY Upstate has seen a positive impact on key utilization metrics including prime time and staffed room utilization with a 2% and 1% improvement, respectively, in under 3 months.Increase “release proactivity.” Before iQueue, offices were releasing time on an average of two days ahead of EHR auto release. With iQueue, the organization increased its block release time to five days and block release has actually increased to 12 days ahead of auto release across the health system. This is very important, Marx said, because now offices that need time have a lot more runway to plan for cases and get patients access into the OR sooner to get cases done.Data/EHR hygiene. Increased visibility of the data stored in the EHR has led to improved EHR hygiene, which was an unexpected benefit, Marx noted.“As a result of all this, we have been able to collaborate across the system to adopt a systemwide block policy with stretch goals.

Our goal is to improve block utilization from around 50% to 70% by January 1, 2021, and we are well on our way to getting there,” he said. €œThis will be a big forward step for us.”ADVICE FOR OTHERSMarx has three pieces of advice for his peers who may be exploring this kind of technology.“Math works,” he stated. €œPredictive analytics- and machine learning-based systems are going to be instrumental in taking healthcare from making decisions based on ‘tribal rules set by committees’ or gut feel supported by ad-hoc analytics to a data-driven approach that makes useful predictions and prescribes the right actions.”Surgery has to move to adopting more objective data and 21st century tools to make critical operational and clinical decisions, he added.“Fear of change is natural but the status quo is worse,” he continued. €œWe have all seen what has happened to industries like retail, banking, airlines, transportation – those players that use data win and others that don’t fall behind.”Healthcare has to embrace innovation and change, and there are excellent options out there to work with organizations that truly get healthcare problems and will work with executives to solve them, he said. Data transparency has assuaged some of the anxiety that surgeons have about access, he added.“And hypertension medications can accelerate your thinking and decision making,” he concluded.

€œTelemedicine is a great example of how such shocks to the system can accelerate the pace of adopting new tools. Use that to your advantage and take action.“Because no matter what happens in Washington, reimbursement levels aren’t about to go up and surgical volumes aren’t going to come down,” he added. €œSo we all need tools that help us do more with less – increase patient access, improve the patient experience and lower unit delivery costs.”Without such tools, he said, healthcare executives and clinicians are shooting in the dark and making sub-optimal decisions every day.Twitter. @SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.New research published this week in the Journal of the American Medical Informatics Association found that chatbots and other conversational agents can be used to provide up-to-date facts about hypertension medications.Researchers from IBM Watson Health and Vanderbilt University Medical Center explored the ways governmental agencies, employers, provider organizations and health plans used the Watson Assistant platform to deliver hypertension medications-related information to users."Given the enormous demand for information about hypertension medications, many stakeholders have leveraged emerging conversational technologies to automate responses to common hypertension medications related questions and information needs specific to their organizations," wrote the team.WHY IT MATTERSAs the researchers noted, chatbots have been used in healthcare to aid in performing specific tasks, determining social needs, and prompting behavior change.But in response to the rapidly evolving information – and disinformation – landscape around the novel hypertension throughout 2020, many organizations turned to natural language processing tools as part of public-awareness strategies.As of August 10, 101 organizations had used Watson Assistant to develop a conversational agent related to hypertension medications, with usage data available for 37.

Those organizations used their chatbots to provide a wide range of information, including:hypertension medications symptoms.Testing information.Information on preventative behaviors.Local and national information about the disease.Response initiatives.Availability of services and how to access them.Guidelines, restrictions, closures and reopening information.Course and exam information.Unemployment benefits and information.Stimulus payments. Business assistance.Volunteering opportunities.A total of 6,872,021 messages were sent in conversations about hypertension medications using the platform between March 30 and August 10, with conversational turns (meaning pairs of interactions between users and agents) highest among provider organizations and lowest for health plans."Yet, across organizations, the number of conversational turns is not reflective of highly complex conversations," researchers wrote. "Due to the novel and rapidly evolving context in the early stages of a lasix, most users probably asked simple, transactional types of questions such as 'Is the hospital open?. ' and 'What is hypertension medications?. '"This trend is likely to change as the lasix evolves," they continued.

"For example, in the later weeks of this study, conversational length among employers spiked. We hypothesize that as workers returned to work, more complex conversations around workplace safety and reopening policies occurred."THE LARGER TRENDAs with many other tools, chatbots are an inherently neutral technology, with the potential to either help or hurt patients in a healthcare setting.For example, as a viewpoint piece in the Journal of the American Medical Association outlined this summer, a chatbot's response to a user's declaration of wanting to harm themselves can cause confusion or even danger. It is important, said the authors of that piece, for the operators of chatbots to be nimble and ready to intervene personally if necessary.At the same time, chatbots can be used to ease user anxiety about seeking medical care, particularly at hours when humans aren't available. "Chatbots are scalable, so they can meet an unexpected surge in demand when there is a shortage of qualified human agents," wrote the authors of a different JAMIA piece published in July. "Chatbots can provide around-the-clock service at a low operational cost."ON THE RECORD"We have demonstrated the ability of a wide variety of organizations including governments, employers, providers, and payers to use conversational technologies to provide current information related to hypertension medications to their citizens, employees, patients, and beneficiaries," read the December JAMIA study.

"The WA platform enabled rapid implementation of a set of conversational agents for a wide variety of use cases, and usage data show demand for and adoption of these technologies during a rapidly evolving public health crisis," the researchers added. Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail. Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication..

As Pfizer and where to buy lasix online Moderna wait http://twistedspaces.com/cost-of-cialis-at-cvs/ for the U.S. Federal and Drug Administration to where to buy lasix online issue an emergency use authorization for their respective treatments, the importance of a seamless – or at least well-connected – supply chain has become increasingly clear.According to the U.S. Department of Health and Human Services, the first rollout of the treatment is likely to be very limited, with state governors and public health departments directing allocation of the first available doses.

But if plans to produce tens of millions of where to buy lasix online doses by the end of 2020 see fruition, professionals say logistics will play an increasingly vital role in getting those doses to people who need them. "This is a phenomenally critical issue that every health system is going to have to manage and figure out the way forward," said Anne Snowdon, executive director of clinical research at HIMSS (parent company of Healthcare IT News). Snowdon – who created HIMSS Analytics' Clinically Integrated Supply Outcomes Model, which signifies digital health maturity in a system's supply chain where to buy lasix online processes – called the question of treatment rollout the "classic supply chain strategy" in a recent HIMSS TV interview.

"If you are tracking every patient who receives every dose of treatment, and with the simple scan of a barcode or QR code or RFID tag – or however it's labeled – can identify what lot number, what site was it manufactured, when was that manufactured, and now you track that to every individual citizen who receives that dose, you now have an ability to know who had side effects, who had a great response to that treatment, who didn't, and now you've got a data set to work from," said Snowdon. Such data, said Snowdon, can be used to ensure where to buy lasix online every global citizen has access to the treatment in the order of priority needed. HIMSS CEO Hal Wolf agreed, saying that such tracking can be used specifically to highlight how different social determinants of health may affect treatment access and efficacy."We could have adverse or different effects based upon the environment in which it's put into," he said, pointing out that some of the treatments require storage in ultracold conditions (prompting a recent uptick in dry ice demand, for example)."To be honest, there are going to be times when you're relying on the distribution capabilities of someone who wouldn't normally be in the supply chain.

It may be leveraging the delivery capabilities of a local business."Chris Hale, KountableBefore treatments are given to individuals, however, doses have to physically make their way from manufacturers to healthcare where to buy lasix online providers. "What we're really talking about is a governance risk and compliance functionality that relies on relative real-time data, coordination and transparency," said Chris Hale, CEO and co-founder of the global procurement company Kountable. "When you put those things together, there's not a lot of solutions that will work that don't involve technology." Logistically speaking, "what you really have to do is start at the end consumer, in this case the patient, and work backwards," where to buy lasix online said Hale.

"If you start at the supplier, it's a fairly easy journey and a fairly developed journey – until it breaks. You have to finish the job where to buy lasix online. It's the person in the last position who matters most." Given the size of the demand and the relatively unconnected nature of some parts of the world – including the rural United States – Hale said unconventional thinking could prove necessary.

"To be honest, there are going to be times when you're relying on the distribution where to buy lasix online capabilities of someone who wouldn't normally be in the supply chain," he said. "It may be leveraging the delivery capabilities of a local business." Hale also said that the processes should be nimble, with the potential to shift if circumstances prove necessary. "There's sort of different degrees of success that need to be where to buy lasix online tracked independently.

Did the treatments get the right place at the right time in the right condition?. That's a supply where to buy lasix online chain problem. Were they distributed to patients and administered effectively?.

Did where to buy lasix online they work?. What happens after?. " he said where to buy lasix online.

"There's going to be a very real need for continuous improvement business processes applied to the full chain," he added. "It's a question where to buy lasix online of vectors. 'Is it working and improving?.

' rather than 'did where to buy lasix online it work?. '" It's important to work the kinks out sooner rather than later, he said, especially as demand grows. "It's not where to buy lasix online tomorrow's problem, but it's not next year's either," he said.

"The entire thing is going to be driven by availability of supply … We're still going to be making allocation decisions for years to come." Hale said he feared that treatment access in the longer term would follow the trajectory of personal protective equipment, with huge shortages in some jurisdictions. "I hope it doesn't where to buy lasix online look and feel like PPE," he said. "Each state has different communities, different geography, different challenges to address."Dr.

Rhonda Medows, Providence"I where to buy lasix online will tell you that I'm disappointed in the federal response" to hypertension medications as a whole, said Dr. Rhonda Medows, president of population health at Providence, one of the largest nonprofit health systems in the United States. When it came to assessment, where to buy lasix online surveillance and testing, she said, "we were delayed, we were slow … and now the plan is to distribute treatments based on state population size.

Not population risk for hypertension medications, but state population size. That's not what we were expecting or anticipating."Given the plan in place, she said she hopes state governors make where to buy lasix online allocation decisions with public health in mind. "The volume of treatments they're getting is really small," she said.

"I don't know how else where to buy lasix online to emphasize it. You need to prioritize within the priority groups. Vaccinate and protect your front line and first responders where to buy lasix online.

One, for their benefit and well-being and two, because we need them. Second is to vaccinate and protect the people who will suffer the highest degree of morbidity where to buy lasix online and mortality from the agent. Nursing homes, elderly, those with chronic conditions." With that prioritization in mind, she said the organization has been planning the best ways to distribute doses efficiently."Providence has already done the work of registering with each state health entity" as a distributor, she said.

"We've registered each of our hospitals, ERs, individual physicians and where to buy lasix online clinicians … We've ordered the special freezers for the Pfizer one, then we have the regular freezers for the other treatments. We've already stocked the facilities for the ancillary things we need to where to buy lasix online go along with the treatment. The supply chain has been accumulating supplies just in case.

Our facilities, with that part of the logistics, are fine." Providence has been relying on advanced analytics as part of its treatment preparations, she where to buy lasix online said, including patient population assessments across all care settings, and logistics and personnel planning. She noted that the initial volume of treatment to be distributed "will not even be adequate" for the group of clinicians and providers who are most exposed to the lasix."Even within those groups, we're going to be forced to sub-prioritize," she said. "We've done the logistics of figuring out healthcare professionals at the highest risk from day-to-day work, including doctors, maintenance sanitation employees, where to buy lasix online those doing food delivery to other sites.

It's a full health professional suite." Once more treatments are available, she said, a challenge will be reaching patients in more rural areas, who might struggle with the freezer requirements or facility access. "Each state has different communities, different geography, different where to buy lasix online challenges to address," she said. "In those communities where there's already not great physical access space could we retrofit mobile vans with the deep freeze requirements?.

" "We know that we have some facilities or clinics that could be a [distribution] site, but then there's a whole where to buy lasix online world of people, so to speak, in the communities" who will be lower on the treatment priority list. Medows noted the importance of centering the needs of groups especially affected by hypertension medications, such as Black, Latino, and Native people. A recent Commonwealth Fund study showed that systemic and medical racism is likely to affect vaccination rates, with distrust among many people of color stemming in large part "from institutional experiences where to buy lasix online with racism and unethical medical experimentation." treatments are also linked to coverage and financial barriers that reflect a legacy of racial inequity, wrote Commonwealth researchers.

Hale, too, said that he feared that uncontrolled or unregulated supply chains would lead to a replication of inequity. "Unfortunately this kind of complexity also … creates economic distortions," where to buy lasix online he said. And given the nature of the disease – which spreads regardless of political borders and disproportionately impacts already underserved people – it's imperative to address these potential gaps from the get-go, said experts.

"When one individual is vulnerable, we are literally all vulnerable," said Wolf where to buy lasix online. Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail.

Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication.Cleveland Clinic, DigitalC, TransDigm Group and The Lubrizol Foundation have come together to help provide affordable high-speed internet to residents of the Fairfax neighborhood in Cleveland. Installation should be complete for Fairfax residents by the second quarter of 2021.WHY IT MATTERSThe effort aims to help impact disparities in internet coverage in the local community, which can affect access to education, healthcare and economic opportunities. According to 2019 Census Bureau data, Cleveland is the worst-connected large city, with nearly 50,000 households not having reliable broadband.

HIMSS20 Digital Learn on-demand, earn credit, find products and solutions. Get Started >>. Especially during a global lasix, access to the internet affects a person’s ability to search and apply for jobs, use healthcare and telehealth services, fully participate in their education and virtually connect with friends, family and colleagues.Broadband for the households covered in this program will be provided by EmpowerCLE, a wireless internet service provider founded by and operating within DigitalC.

DigitalC is a nonprofit organization focused on improving Cleveland’s digital equity and providing residents with an affordable, high-speed internet connection.EmpowerCLE has installed equipment on the rooftops of two Cleveland Clinic main campus buildings in order to expand its coverage in the Fairfax community. EmpowerCLE brand ambassadors and technicians will visit local households to offer the connection and install the necessary equipment to begin service.While DigitalC and EmpowerCLE provide affordable internet services, in order to further lower the cost for Fairfax residents, Cleveland Clinic has brought together additional partners with an interest in connecting underserved areas. TransDigm and The Lubrizol Foundation have agreed to contribute significant funds to further reduce the monthly subscription fee and help subsidize the cost of equipment.THE LARGER TRENDIn addition to working with DigitalC, earlier this year, Cleveland Clinic signed on to the American Connection Project Broadband Coalition, which advocates to bring high-speed internet to rural and under-connected areas.Connecting underserved areas with reliable high-speed internet is one way Cleveland Clinic aims to positively impact social determinants of health in communities.

Social determinants of health are factors such as food security, housing, infant mortality, chronic diseases, education quality and access, and economic opportunity that affect a person’s health and wellbeing.According to the National Academy of Medicine, medical care is estimated to account for only 20% of a person’s health – social determinants of health can make up the other 80%.ON THE RECORD“The hypertension medications lasix has further illuminated the crucial role internet access plays in the overall health and well-being of a population, and it is critical that we work to overcome digital inequities,” said Dr. Tom Mihaljevic, president and CEO of Cleveland Clinic.“Social determinants of health lay the foundation of a person’s overall health and have a lifelong impact on their health outcomes,” said Dr. Adam Myers, director of Cleveland Clinic Community Care.

€œBy identifying areas we can help, such as providing broadband connection, and engaging with like-minded partners, we can make a difference in creating a better, healthier community for everyone.”Twitter. @SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.SUNY Upstate Medical University in Syracuse, New York, has 35 operating rooms across multiple locations including academic and community facilities.

As with most traditional perioperative departments, it was facing three major issues.THE PROBLEMFirst, low OR utilization despite demand for time. SUNY Upstate was not hitting its desired utilization targets and did not have actionable data for department chairs and administration to take the right actions for improvement. At the same time, it had surgeons and departments wanting more access to OR time.

HIMSS20 Digital Learn on-demand, earn credit, find products and solutions. Get Started >>. Second, standardizing systemwide decision making based on objective data.

The provider organization needed to unify decision making in key areas – block policy to allocate time, block release times, areas for operational improvement – across the academic and community settings to ensure shared best practices and goals while maintaining a high level of visibility into decision making.Decisions were questioned often because of the lack of objective data, clearly defined and understood across the various stakeholders.And third, visibility into the performance metrics that matter. SUNY Upstate had various reporting sources that were in conflict with each other, creating a distrust in data presented during operational and committee meetings.PROPOSALTo solve its problems, SUNY Upstate Medical University turned to LeanTaaS, which markets software that combines lean principles, predictive analytics and machine learning to transform hospital and infusion center operations.LeanTaaS’ technology, iQueue for Operating Rooms, promised several attractive outcomes, said Dr. William Marx, medical director of perioperative services at SUNY Upstate Medical University.“LeanTaaS’ technology predicts when blocks will be underutilized and enables surgeon offices to release them sooner than auto release deadlines so a large pool of shared open time can be created,” said Marx.

€œLike OpenTable makes it easy to book restaurant tables, their tools would make it really simple to see open OR time anytime, anywhere and ask for it.”This aspect of the tool would help SUNY do more cases, thereby improving three key metrics. Prime time utilization, staffed room utilization and case volume, he added."The data availability and transparency to everyone involved in meeting our goals has been critical in our collaboration efforts in policy writing and adoption."Dr. William Marx, SUNY Upstate Medical UniversityTransparency was another attractive promised outcome for Marx.“It would provide cloud-based mobile and web tools that showed the right metrics to the right user on demand,” he explained.

€œThis would alleviate the lack of transparency into data between surgeons and operations and also create a single source of truth to eliminate discrepancies in reports arising from competing sources of information. The transparency has been the best feature as we have introduced the product to our leadership and surgical staff.”Yet another aspect he liked was what the vendor called “actionability.”“The tools promised ready access to actionable data to department chairs across SUNY Upstate Medical University so we could hold ourselves accountable, measure what’s important and make decisions, not just debate the numbers,” he said. €œOne specific such metric is what they call ‘collectable time,’ which is far more actionable than ‘block utilization,’ the traditional metric all ORs have used to right-size blocks, which is far less actionable and defensible.”Marx was also interested in data hygiene.“Over the years we knew we had made decisions and used logic in our EHR that had errors, for example, assigned overlapping block times given to different surgeons.

We just weren’t sure how to identify them systematically, and LeanTaaS’ implementation process promised to ferret those out,” he noted.MEETING THE CHALLENGELaunched in July 2020, iQueue is being used across SUNY Upstate facilities by OR scheduling, clinic scheduling, surgery chairs and surgeons themselves. It integrates easily with the organization’s Epic EHR and provides a cloud-based add-on the provider can access on any browser whether mobile or web.“We send iQueue a nightly feed from our data warehouse and a real time feed in HL7, so the integration is relatively light,” Marx said. €œiQueue provides a few powerful tools by using this data in real time.”One of these tools is OpenTable for Open OR Time.

This is actually a set of tools that streamline how the OR can advertise open time, enable and encourage clinics to release time ahead of auto releases, and request it 24/7 when needed. This has led to what Marx called a “mentality of plenty” instead of one of “scarcity” where everyone felt they were competing for the same limited OR time.Another tool is deep on-demand analytics.“There is a comprehensive set of daily refreshed metrics that help us look at over a dozen powerful metrics – utilization rated, volume, trends, opportunities for improvement in delay, and turnover times,” Marx explained. €œThe tool allows very easy sharing across campuses improving data transparency and credibility across all stakeholders.”Surgeons get personalized weekly texts and messages pushed to them to keep them abreast of their performance.

SUNY Upstate has been able to shift cases from one campus to another and improve utilization of others. It also has seen how some surgeons have actually had duplicate blocks on the same day. The on-demand analytics has helped to redesign block scheduling patterns so they coincide with surgeon and OR availability.Then there is data-driven accountability, Marx said.“We have been able to adopt a new way of looking at how to measure usage of block time and hold ourselves accountable – ‘collectable time’ – this has made the conversations in our decision making bodies like the OR committee a lot lore data-driven and actionable,” he said.

€œThere has been strong adoption and engagement from leadership, which continued to expand to all levels. Business office, surgeons and MSG schedulers.”By cultivating a strong partnership between SUNY Leadership and the LeanTasS team, SUNY Upstate has seen continued active user growth and engagement, he added.“We now have a Tiger Team at SUNY Upstate Medical University, assembled from key stakeholder groups, relying on iQueue to provide real-time data to the team to assess progress and drive improvements in efficiency,” Marx noted. €œThe data availability and transparency to everyone involved in meeting our goals has been critical in our collaboration efforts in policy writing and adoption.”RESULTSIn just a few months (the tools went live in early July), SUNY Upstate has been able to see significant success.

The key results achieved with iQueue include:Absorbed significantly higher case volume during business hours. €œWe have seen a 3.4% increase in weekly volume of cases done within existing capacity and in business hours,” Marx explained. €œThis is hugely important for any system since OR volume is a key driver of hospital performance.”Increases usage of OR minutes during business hours.

Correspondingly, SUNY Upstate has experienced a 5.5% increase in the number of OR minutes used during business hours. Since business hours are when ORs are staffed, that also means the organization is using its fixed and variable costs better instead of doing cases into the night. Since costs are fixed, improving OR utilization has helped reduce non-productive time.Increase utilization across the board.

SUNY Upstate has seen a positive impact on key utilization metrics including prime time and staffed room utilization with a 2% and 1% improvement, respectively, in under 3 months.Increase “release proactivity.” Before iQueue, offices were releasing time on an average of two days ahead of EHR auto release. With iQueue, the organization increased its block release time to five days and block release has actually increased to 12 days ahead of auto release across the health system. This is very important, Marx said, because now offices that need time have a lot more runway to plan for cases and get patients access into the OR sooner to get cases done.Data/EHR hygiene.

Increased visibility of the data stored in the EHR has led to improved EHR hygiene, which was an unexpected benefit, Marx noted.“As a result of all this, we have been able to collaborate across the system to adopt a systemwide block policy with stretch goals. Our goal is to improve block utilization from around 50% to 70% by January 1, 2021, and we are well on our way to getting there,” he said. €œThis will be a big forward step for us.”ADVICE FOR OTHERSMarx has three pieces of advice for his peers who may be exploring this kind of technology.“Math works,” he stated.

€œPredictive analytics- and machine learning-based systems are going to be instrumental in taking healthcare from making decisions based on ‘tribal rules set by committees’ or gut feel supported by ad-hoc analytics to a data-driven approach that makes useful predictions and prescribes the right actions.”Surgery has to move to adopting more objective data and 21st century tools to make critical operational and clinical decisions, he added.“Fear of change is natural but the status quo is worse,” he continued. €œWe have all seen what has happened to industries like retail, banking, airlines, transportation – those players that use data win and others that don’t fall behind.”Healthcare has to embrace innovation and change, and there are excellent options out there to work with organizations that truly get healthcare problems and will work with executives to solve them, he said. Data transparency has assuaged some of the anxiety that surgeons have about access, he added.“And hypertension medications can accelerate your thinking and decision making,” he concluded.

€œTelemedicine is a great example of how such shocks to the system can accelerate the pace of adopting new tools. Use that to your advantage and take action.“Because no matter what happens in Washington, reimbursement levels aren’t about to go up and surgical volumes aren’t going to come down,” he added. €œSo we all need tools that help us do more with less – increase patient access, improve the patient experience and lower unit delivery costs.”Without such tools, he said, healthcare executives and clinicians are shooting in the dark and making sub-optimal decisions every day.Twitter.

@SiwickiHealthITEmail the writer. Bsiwicki@himss.orgHealthcare IT News is a HIMSS Media publication.New research published this week in the Journal of the American Medical Informatics Association found that chatbots and other conversational agents can be used to provide up-to-date facts about hypertension medications.Researchers from IBM Watson Health and Vanderbilt University Medical Center explored the ways governmental agencies, employers, provider organizations and health plans used the Watson Assistant platform to deliver hypertension medications-related information to users."Given the enormous demand for information about hypertension medications, many stakeholders have leveraged emerging conversational technologies to automate responses to common hypertension medications related questions and information needs specific to their organizations," wrote the team.WHY IT MATTERSAs the researchers noted, chatbots have been used in healthcare to aid in performing specific tasks, determining social needs, and prompting behavior change.But in response to the rapidly evolving information – and disinformation – landscape around the novel hypertension throughout 2020, many organizations turned to natural language processing tools as part of public-awareness strategies.As of August 10, 101 organizations had used Watson Assistant to develop a conversational agent related to hypertension medications, with usage data available for 37. Those organizations used their chatbots to provide a wide range of information, including:hypertension medications symptoms.Testing information.Information on preventative behaviors.Local and national information about the disease.Response initiatives.Availability of services and how to access them.Guidelines, restrictions, closures and reopening information.Course and exam information.Unemployment benefits and information.Stimulus payments.

Business assistance.Volunteering opportunities.A total of 6,872,021 messages were sent in conversations about hypertension medications using the platform between March 30 and August 10, with conversational turns (meaning pairs of interactions between users and agents) highest among provider organizations and lowest for health plans."Yet, across organizations, the number of conversational turns is not reflective of highly complex conversations," researchers wrote. "Due to the novel and rapidly evolving context in the early stages of a lasix, most users probably asked simple, transactional types of questions such as 'Is the hospital open?. ' and 'What is hypertension medications?.

'"This trend is likely to change as the lasix evolves," they continued. "For example, in the later weeks of this study, conversational length among employers spiked. We hypothesize that as workers returned to work, more complex conversations around workplace safety and reopening policies occurred."THE LARGER TRENDAs with many other tools, chatbots are an inherently neutral technology, with the potential to either help or hurt patients in a healthcare setting.For example, as a viewpoint piece in the Journal of the American Medical Association outlined this summer, a chatbot's response to a user's declaration of wanting to harm themselves can cause confusion or even danger.

It is important, said the authors of that piece, for the operators of chatbots to be nimble and ready to intervene personally if necessary.At the same time, chatbots can be used to ease user anxiety about seeking medical care, particularly at hours when humans aren't available. "Chatbots are scalable, so they can meet an unexpected surge in demand when there is a shortage of qualified human agents," wrote the authors of a different JAMIA piece published in July. "Chatbots can provide around-the-clock service at a low operational cost."ON THE RECORD"We have demonstrated the ability of a wide variety of organizations including governments, employers, providers, and payers to use conversational technologies to provide current information related to hypertension medications to their citizens, employees, patients, and beneficiaries," read the December JAMIA study.

"The WA platform enabled rapid implementation of a set of conversational agents for a wide variety of use cases, and usage data show demand for and adoption of these technologies during a rapidly evolving public health crisis," the researchers added. Kat Jercich is senior editor of Healthcare IT News.Twitter. @kjercichEmail.

Kjercich@himss.orgHealthcare IT News is a HIMSS Media publication..

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