Many doctors ask: Why is EMR so expensive? This question as it appears can seem simple in nature. While exploring this topic, you can find so many variations in the EMR products’ features and functions. In most cases, a large or majority of the total cost of an EMR is in the training and implementation services, not in the software.

But in many cases products will include more features than one needs or the manufacturer of the product is generally focused on larger sized groups making it more expensive for smaller ones. Additionally, as a practice, the question of technical proficiencies needs to be addressed. If a product is more technically advanced than the user, the user will not receive the full usage of the application. If the product is not being used to its full functionality, nobody wins. If this happens, the practice is not satisfied, and the vendor now has an unsatisfied end user. This is why matching up the practice with the right EMR is so critical. The opposite effect can be just as frustrating.

Cost is a fact in the investment of an EMR. An entry level EMR can cost as little as $3,000, and advanced level EMRs can cost over $100,000, even for a solo physician practice. The word “expense” should be replaced with the word “investment”. Once a practice has converted to the EMR, they can now look back and understand the difference in those two, very different words. When the EMR is running at full functionality, the practice becomes very efficient. No more hunting for paper charts. A single “click” of the mouse, and the patient’s entire record is in the hands of the appropriate user. Multiple users can access the same record simultaneously as well; allowing for greater productivity. The investment now begins to pay dividends.

Which is better? An integrated EMR system or a modular EMR? Having a portion of the practice automated can be a benefit, just as it can be a challenge to overcome. There are many EMR vendors that have a Practice Management application built into their system. Many of these products can be a total replacement of existing applications, usually a older medical billing software. Be advised that not all EMR vendors have the capability to integrate with an existing software product. This is all very important to identify prior to committing to an EMR vendor. Running separate systems simultaneously can bring much unneeded frustration if not appropriately integrated in the beginning as you will need to deal with two different companies for technical support.

The number of modules that can be integrated can vary significantly from vendor to vendor. Consideration of the charge for an HL7 (as explained earlier in this document) interface should also be taken into account. The interface between your existing system and your new EMR can often cost as much as $5000 making it often more financially viable to purchase an integrated system from the beginning.

Blood pressure is the force of the blood pushing against the walls of the arteries. Each time the heart beats, it pumps blood through the arteries. Your blood pressure is at its highest when the heart beats, forcing blood into the arteries. This is called systolic pressure. When the heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure. Blood pressure is always given as two numbers, the systolic and diastolic pressures. Both are important.

The systolic pressure is the first or top number, and the diastolic pressure is the second or bottom number (for example, 120/80). If your blood pressure is 120/80, you say that it is “120 over 80″.

It is important to take steps to keep your blood pressure under control. The treatment goal is to keep blood pressure below 140/90, or even lower for people with other conditions, such as diabetes and kidney disease.

Adopting healthy lifestyle habits is an essential and effective first step in both preventing and controlling high blood pressure. However, if lifestyle changes alone are not effective in keeping your pressure controlled, it may be necessary to take blood pressure medications.

The following types of medications are available to treat high blood pressure:

1. Diuretics: Diuretics are sometimes called water pills because they work in the kidney and flush excess water and sodium from the body, lowering blood pressure.

2. Beta-blockers: Beta-blockers reduce nerve impulses to the heart and blood vessels. This makes the heart beat slower and with less force. As a result of these drugs, the blood pressure drops and the heart works less hard.

3. ACE inhibitors: Angiotensin converting enzyme (ACE) inhibitors prevent the formation of a hormone called angiotensin II, which normally causes blood vessels to narrow. The ACE inhibitors cause the vessels to relax and blood pressure goes down.

4. Angiotensin antagonists: Angiotensin antagonists shield blood vessels from angiotensin II. As a result, the vessels become wider and blood pressure goes down.

5. Calcium channel blockers (CCBs): CCBs keep calcium from entering the muscle cells of the heart and blood vessels. This causes the blood vessels to relax and pressure goes down.

6. Alpha-blockers: Alpha-blockers reduce nerve impulses to blood vessels, which allows blood to pass more easily, causing the blood pressure to go down.

7. Alpha-beta-blockers: Alpha-beta-blockers work the same way as alpha-blockers but also slow the heartbeat, as beta-blockers do. As a result of using these drugs, less blood is pumped through the vessels and the blood pressure goes down.

8. Nervous system inhibitors: Nervous system inhibitors relax blood vessels by controlling nerve impulses, and this causes the blood vessels to become wider and the blood pressure to go down.

9. Vasodilators: Vasodilators directly open blood vessels by relaxing the muscles in the vessel walls, causing the blood pressure to go down.

To find out if you have high blood pressure consult your doctor and have a blood pressure test. The test is quick and painless.

To determine which life style changes and medications are appropriate, consult your doctor.

Why would an article with such an esoteric title be of interest, of importance and relevancy to more than just Pain Management health care workers. Shouldn’t such an article be of more importance and interest in a Professional Journal than it would be to the educated general populous. What is behind the idea of publishing it on the Internet, situated so that many more than just medical minds would come across it by happenstance.

A large percentage of the general population is thought to either listen to, watch, or read any of the many ways the News Media bombards us with what their financial backers’ opinions would have us know. Therefore we must assume that this same population should, by now, understand how the median age of death, in our country as in others, has been prolonged. We attribute this increasing life expectancy, over the previous few centuries, by all of the many scientific advances, by the formation of and stabilization of standardized-religion, and by the many laws of behavior, in-acted to prevent man’s destruction of his/her fellow man/woman.

For these and other reasons, the percentage of the population living over the age of 65 increases with every passing decade and century. At this point I hope that you can begin to better understand the importance of pain control in chronic non-cancer patients. Since the percentage of the population over 65 is getting larger with each passing decade, it is becoming more common place to know or to know of an individual requiring pain control for a chronic non-cancerous problem.

Breakthrough pain in cancer patients is associated with poor outcomes, a greater incidence of hospitalization, more difficult to treat pain syndromes, and, of course, the inevitable patient dissatisfaction with therapy. None of the previous characteristics are found, in general, amongst the non-cancerous patients.

Breakthrough pain in non-cancerous patients is known to be prevalent, severe, and it shares several characteristics with cancer patients, such as that it is typically rapid in onset and frequently encountered. Studies have shown that nearly three quarters of patients with non-cancer pain have significant episodes of breakthrough pain.

For the general population, is not important what the actual treatments are for pain control in chronic non-cancerous patients. What is important for everyone to understand is that a growing part of our general population will be suffering with chronic non-cancerous pain. We need to start to modify and/or drop, when appropriate, our misconceptions of individuals (young and old) that complain of chronic pain that proves to be non-cancerous in origin. We must study how individuals on narcotic therapy do when attempting to continue with accepted normal daily functions. Such functions would include work, play, and care-giving. I feel that we will be surprised how much of a normal life these individuals can live if given the chance.