Defining a Health Information Exchange

The United States is facing the largest shortage of healthcare practitioners in our country’s history which is compounded by an ever increasing geriatric population. In 2005 there existed one geriatrician for every 5,000 US residents over 65 and only nine of the 145 medical schools trained geriatricians. By 2020 the industry is estimated to be short 200,000 physicians and over a million nurses. Never, in the history of US healthcare, has so much been demanded with so few personnel. Because of this shortage combined with the geriatric population increase, the medical community has to find a way to provide timely, accurate information to those who need it in a uniform fashion. Imagine if flight controllers spoke the native language of their country instead of the current international flight language, English. This example captures the urgency and critical nature of our need for standardized communication in healthcare. A healthy information exchange can help improve safety, reduce length of hospital stays, cut down on medication errors, reduce redundancies in lab testing or procedures and make the health system faster, leaner and more productive. The aging US population along with those impacted by chronic disease like diabetes, cardiovascular disease and asthma will need to see more specialists who will have to find a way to communicate with primary care providers effectively and efficiently.

This efficiency can only be attained by standardizing the manner in which the communication takes place. Healthbridge, a Cincinnati based HIE and one of the largest community based networks, was able to reduce their potential disease outbreaks from 5 to 8 days down to 48 hours with a regional health information exchange. Regarding standardization, one author noted, “Interoperability without standards is like language without grammar. In both cases communication can be achieved but the process is cumbersome and often ineffective.”

United States retailers transitioned over twenty years ago in order to automate inventory, sales, accounting controls which all improve efficiency and effectiveness. While uncomfortable to think of patients as inventory, perhaps this has been part of the reason for the lack of transition in the primary care setting to automation of patient records and data. Imagine a Mom & Pop hardware store on any square in mid America packed with inventory on shelves, ordering duplicate widgets based on lack of information regarding current inventory. Visualize any Home Depot or Lowes and you get a glimpse of how automation has changed the retail sector in terms of scalability and efficiency. Perhaps the “art of medicine” is a barrier to more productive, efficient and smarter medicine. Standards in information exchange have existed since 1989, but recent interfaces have evolved more rapidly thanks to increases in standardization of regional and state health information exchanges.

History of Health Information Exchanges

Major urban centers in Canada and Australia were the first to successfully implement HIE’s. The success of these early networks was linked to an integration with primary care EHR systems already in place. Health Level 7 (HL7) represents the first health language standardization system in the United States, beginning with a meeting at the University of Pennsylvania in 1987. HL7 has been successful in replacing antiquated interactions like faxing, mail and direct provider communication, which often represent duplication and inefficiency. Process interoperability increases human understanding across networks health systems to integrate and communicate. Standardization will ultimately impact how effective that communication functions in the same way that grammar standards foster better communication. The United States National Health Information Network (NHIN) sets the standards that foster this delivery of communication between health networks. HL7 is now on it’s third version which was published in 2004. The goals of HL7 are to increase interoperability, develop coherent standards, educate the industry on standardization and collaborate with other sanctioning bodies like ANSI and ISO who are also concerned with process improvement.

In the United States one of the earliest HIE’s started in Portland Maine. HealthInfoNet is a public-private partnership and is believed to be the largest statewide HIE. The goals of the network are to improve patient safety, enhance the quality of clinical care, increase efficiency, reduce service duplication, identify public threats more quickly and expand patient record access. The four founding groups the Maine Health Access Foundation, Maine CDC, The Maine Quality Forum and Maine Health Information Center (Onpoint Health Data) began their efforts in 2004.

In Tennessee Regional Health Information Organizations (RHIO’s) initiated in Memphis and the Tri Cities region. Carespark, a 501(3)c, in the Tri Cities region was considered a direct project where clinicians interact directly with each other using Carespark’s HL7 compliant system as an intermediary to translate the data bi-directionally. Veterans Affairs (VA) clinics also played a crucial role in the early stages of building this network. In the delta the midsouth eHealth Alliance is a RHIO connecting Memphis hospitals like Baptist Memorial (5 sites), Methodist Systems, Lebonheur Healthcare, Memphis Children’s Clinic, St. Francis Health System, St Jude, The Regional Medical Center and UT Medical. These regional networks allow practitioners to share medical records, lab values medicines and other reports in a more efficient manner.

Seventeen US communities have been designated as Beacon Communities across the United States based on their development of HIE’s. These communities’ health focus varies based on the patient population and prevalence of chronic disease states i.e. cvd, diabetes, asthma. The communities focus on specific and measurable improvements in quality, safety and efficiency due to health information exchange improvements. The closest geographical Beacon community to Tennessee, in Byhalia, Mississippi, just south of Memphis, was granted a $100,000 grant by the department of Health and Human Services in September 2011.

A healthcare model for Nashville to emulate is located in Indianapolis, IN based on geographic proximity, city size and population demographics. Four Beacon awards have been granted to communities in and around Indianapolis, Health and Hospital Corporation of Marion County, Indiana Health Centers Inc, Raphael Health Center and Shalom Health Care Center Inc. In addition, Indiana Health Information Technology Inc has received over 23 million dollars in grants through the State HIE Cooperative Agreement and 2011 HIE Challenge Grant Supplement programs through the federal government. These awards were based on the following criteria:1) Achieving health goals through health information exchange 2) Improving long term and post acute care transitions 3) Consumer mediated information exchange 4) Enabling enhanced query for patient care 5) Fostering distributed population-level analytics.

Regulatory Aspects of Health Information Exchanges and Healthcare Reform

The department of Health and Human Services (HHS) is the regulatory agency that oversees health concerns for all Americans. The HHS is divided into ten regions and Tennessee is part of Region IV headquartered out of Atlanta. The Regional Director, Anton J. Gunn is the first African American elected to serve as regional director and brings a wealth of experience to his role based on his public service specifically regarding underserved healthcare patients and health information exchanges. This experience will serve him well as he encounters societal and demographic challenges for underserved and chronically ill patients throughout the southeast area.

The National Health Information Network (NHIN) is a division of HHS that guides the standards of exchange and governs regulatory aspects of health reform. The NHIN collaboration includes departments like the Center for Disease Control (CDC), social security administration, Beacon communities and state HIE’s (ONC).11 The Office of National Coordinator for Health Information Exchange (ONC) has awarded $16 million in additional grants to encourage innovation at the state level. Innovation at the state level will ultimately lead to better patient care through reductions in replicated tests, bridges to care programs for chronic patients leading to continuity and finally timely public health alerts through agencies like the CDC based on this information.12 The Health Information Technology for Economic and Clinical Health (HITECH) Act is funded by dollars from the American Reinvestment and Recovery Act of 2009. HITECH’s goals are to invest dollars in community, regional and state health information exchanges to build effective networks which are connected nationally. Beacon communities and the Statewide Health Information Exchange Cooperative Agreement were initiated through HITECH and ARRA. To date 56 states have received grant awards through these programs totaling 548 million dollars.

History of Health Information Partnership TN (HIPTN)

In Tennessee the Health Information Exchange has been slower to progress than places like Maine and Indiana based in part on the diversity of our state. The delta has a vastly different patient population and health network than that of middle Tennessee, which differs from eastern Tennessee’s Appalachian region. In August of 2009 the first steps were taken to build a statewide HIE consisting of a non-profit named HIP TN. A board was established at this time with an operations council formed in December. HIP TN’s first initiatives involved connecting the work through Carespark in northeast Tennessee’s s tri-cities region to the Midsouth ehealth Alliance in Memphis. State officials estimated a cost of over 200 million dollars from 2010-2015. The venture involves stakeholders from medical, technical, legal and business backgrounds. The governor in 2010, Phil Bredesen, provided 15 million to match federal funds in addition to issuing an Executive Order establishing the office of eHealth initiatives with oversight by the Office of Administration and Finance and sixteen board members. By March 2010 four workgroups were established to focus on areas like technology, clinical, privacy and security and sustainability.

By May of 2010 data sharing agreements were in place and a production pilot for the statewide HIE was initiated in June 2011 along with a Request for Proposal (RFP) which was sent out to over forty vendors. In July 2010 a fifth workgroup,the consumer advisory group, was added and in September 2010 Tennessee was notified that they were one of the first states to have their plans approved after a release of Program Information Notice (PIN). Over fifty stakeholders came together to evaluate the vendor demonstrations and a contract was signed with the chosen vendor Axolotl on September 30th, 2010. At that time a production goal of July 15th, 2011 was agreed upon and in January 2011 Keith Cox was hired as HIP TN’s CEO. Keith brings twenty six years of tenure in healthcare IT to the collaborative. His previous endeavors include Microsoft, Bellsouth and several entrepreneurial efforts. HIP TN’s mission is to improve access to health information through a statewide collaborative process and provide the infrastructure for security in that exchange. The vision for HIP TN is to be recognized as a state and national leader who support measurable improvements in clinical quality and efficiency to patients, providers and payors with secure HIE. Robert S. Gordon, the board chair for HIPTN states the vision well, “We share the view that while technology is a critical tool, the primary focus is not technology itself, but improving health”. HIP TN is a non profit, 501(c)3, that is solely reliant on state government funding. It is a combination of centralized and decentralized architecture. The key vendors are Axolotl, which acts as the umbrella network, ICA for Memphis and Nashville, with CGI as the vendor in northeast Tennessee.15 Future HIP TN goals include a gateway to the National Health Institute planned for late 2011 and a clinician index in early 2012. Carespark, one of the original regional health exchange networks voted to cease operations on July 11, 2011 based on lack of financial support for it’s new infrastructure. The data sharing agreements included 38 health organizations, nine communities and 250 volunteers.16 Carespark’s closure clarifies the need to build a network that is not solely reliant on public grants to fund it’s efforts, which we will discuss in the final section of this paper.

Current Status of Healthcare Information Exchange and HIPTN

Ten grants were awarded in 2011 by the HIE challenge grant supplement. These included initiatives in eight states and serve as communities we can look to for guidance as HIP TN evolves. As previously mentioned one of the most awarded communities lies less than five hours away in Indianapolis, IN. Based on the similarities in our health communities, patient populations and demographics, Indianapolis would provide an excellent mentor for Nashville and the hospital systems who serve patients in TN. The Indiana Health Information Exchange has been recognized nationally for it’s Docs for Docs program and the manner in which collaboration has taken place since it’s conception in 2004. Kathleen Sebelius, Secretary of HHS commented, “The Central Indiana Beacon Community has a level of collaboration and the ability to organize quality efforts in an effective manner from its history of building long standing relationships. We are thrilled to be working with a community that is far ahead in the use of health information to bring positive change to patient care.” Beacon communities that could act as guides for our community include the Health and Hospital Corporation of Marion County and the Indiana Health Centers based on their recent awards of $100,000 each by HHS.

A local model of excellence in practice EMR conversion is Old Harding Pediatric Associates (OHPA) which has two clinics and fourteen physicians who handle a patient population of 23,000 and over 72,000 patient encounters per year. OHPA’s conversion to electronic records in early 2000 occurred as a result of the pursuit of excellence in patient care and the desire to use technology in a way that benefitted their patient population. OHPA established a cross functional work team to improve their practices in the areas of facilities, personnel, communication, technology and external influences. Noteworthy was chosen as the EMR vendor based on user friendliness and the similarity to a standard patient chart with tabs for files. The software was customized to the pediatric environment complete with patient growth charts. Windows was used as the operating system based on provider familiarity. Within four days OHPA had 100% compliance and use of their EMR system.

The Future of HIP TN and HIE in Tennessee

Tennessee has received close to twelve million dollars in grant money from The State Health Information Exchange Cooperative Agreement Program.20 Regional Health Information Organizations (RHIO) need to be full scalable to allow hospitals to grow their systems without compromising integrity as they grow.21and the systems located in Nashville will play an integral role in this nationwide scaling with companies like HCA, CHS, Iasis, Lifepoint and Vanguard. The HIE will act as a data repository for all patients information that can be accessed from anywhere and contains a full history of the patients medical record, lab tests, physician network and medicine list. To entice providers to enroll in the statewide HIE tangible value to their practice has to be shown with better safer care. In a 2011 HIMSS editor’s report Richard Lang states that instead of a top down approach “A more practical idea may be for states to support local community HIE development first. Once established, these local networks can feed regional HIE’s and then connect to a central HIE/data repository backbone. States should use a portion of the stimulus funds to support local HIE development.”22 Mr. Lang also believes the primary care physician has to be the foundation for the entire system since they are the main point of contact for the patient.

What do you do when what you’re trying to sell from your website isn’t selling? You’ve written what you think is great sales copy, you’re all excited…but when you post it online and start getting visitors…NOTHING. They ain’t buyin’ it!

This article will shed some light on a high-powered web content secret that will have you selling like crazy…just like the most successful online marketers.

So how do you go from no sales to plenty of sales with just a bunch of words?

ANSWER: Write a Review…

If you’ve been in e-commerce for any length of time, you probably know that when most people want to buy something, they will go to a search engine and type in “NAME OF PRODUCT + review” to find out if the product is worth buying or not.

And it makes sense, doesn’t it? An online sales letter or product description is just a self-serving pitch. But a third person review has a lot more credibility and honesty.

That’s been my experience: I’ve bought a ton of stuff online after reading a decent review. I’d head to the seller’s sales or landing page and think, “Ugh. This is awful!” And yet, despite of a crappy sales page, I would buy the product just based on the third-party review.

However, there is a right way and a wrong way to create a selling review. Get it right, and you’ll make a mint. Get it wrong, and you’ll be laughed off the Internet (and not make a penny).

Although there are so many different ways to put together a review, I’ve found the following structure to be incredibly persuasive.

The Structure of a Selling Review:

1. What was the problem that caused you to search?

Give a brief story of what caused you (or someone else) to look for a solution. What pain were you in?

2. How did you come across the product?

This could be through a search engine, a blog post, a recommendation on a forum, even thumbing through a magazine at the dentist’s office.

3. What are the problems that are typical for this TYPE of product?

Why haven’t other solutions turn out not to be solutions? What do people usually complain about in this category of products?

4. Now introduce the product. What is its name? What are the main promises of the product? What are some of its features and benefits? How would you describe it?

You might want to create a list of these before you start writing and then reference it as you write your review.

5. What is the downside to this product?

Nothing is perfect. And a review that sounds to good to be true, doesn’t sell crap. You’ll be gaining trust and credibility if you tell the readers about some minor imperfections or what it can’t do.

6. How are you going to wrap up the review?

Here you will state the main promises and how the product will help you reach them (or has helped you reach them). This is where you also make your recommendation and include a link to the sales page.

Should you create a review for your own product? I wouldn’t. Besides being unethical (like homemade testimonials), it has a good chance of sounding stilted or contrived. It would be far better to get some friends (or a professional copywriter) to try out your product. Hand them the above questions and let them come up with something that is honest and interesting (and you could always tweak it a bit to make it flow better).

How you use the review depends on your situation. It could be placed on a blog. It can have its own web page. It can be placed on a website that is specifically designed for product reviews.

BONUS TIP: You can get some practice with writing reviews AND make some money at the same time. How? By creating reviews for products that you have liked and becoming an affiliate for that product.

If you don’t have any reviews of your products, you will face an uphill battle of trying to make decent money. On the other hand, get a good review up and online and you’ll have a steady stream of customers for years to come!

When you sell your luxury Athens home, you want to get the best price you can. The first step is to prepare the property for sale. Spruce it up and do any necessary maintenance and repairs. A well presented property can fetch a higher price. Attractive gardens and street appeal are important to create a good first impression.

Luxury home buyers are discerning and expect excellent quality. You don’t need to spend a lot of money to achieve a fresh look. Be careful not to overcapitalize.

Check if interiors need a new coat of paint. Skillful use of accessories such as cushions and vases can be effective in giving your home a lift. Declutter to accentuate a sense of spaciousness and get rid of shabby furniture and curtains. You can even hire furniture and plants until you sell.

When the home and gardens are in order, approach a real estate agency. One who specializes in luxury real estate in Athens would be ideal. Check their reputation and track record. Don’t settle on the first real estate agent you meet. Decide if you are going with a sole agent or if you will list your property with a number of agents.

Find out what strategies they propose for marketing your property. You want someone who is proactive and who has a strong network of contacts. Research current values in your area and settle on a realistic asking price.

You may be able to arrange an independent appraisal to give you a starting point. The aim is to start higher so you have room to come down in price. Find out what the agent’s fees are. These are often negotiable, especially on a luxury property.

Discuss whether it’s best to auction the property, put it on the open market or if there are other options. You need to be guided by the real estate agent who is the industry professional, but choose someone you feel you can work with. Set ground rules for communication and inspections but allow some flexibility as well.

When your luxury property is officially for sale, keep in touch with the real estate agent. Discuss any offers. If there are no offers or if you need to sell, review your position. Be clear on your bottom line. Continue to maintain the property so it is ready for inspection by prospective buyers.

Being savvy about selling your will get you a better price. It will also make the selling process less stressful and ensure a smoother process for all concerned.

In the past few decades there has been a revolution in computing and communications, and all indications are that technological progress and use of information technology will continue at a rapid pace. Accompanying and supporting the dramatic increases in the power and use of new information technologies has been the declining cost of communications as a result of both technological improvements and increased competition. According to Moore’s law the processing power of microchips is doubling every 18 months. These advances present many significant opportunities but also pose major challenges. Today, innovations in information technology are having wide-ranging effects across numerous domains of society, and policy makers are acting on issues involving economic productivity, intellectual property rights, privacy protection, and affordability of and access to information. Choices made now will have long lasting consequences, and attention must be paid to their social and economic impacts.

One of the most significant outcomes of the progress of information technology is probably electronic commerce over the Internet, a new way of conducting business. Though only a few years old, it may radically alter economic activities and the social environment. Already, it affects such large sectors as communications, finance and retail trade and might expand to areas such as education and health services. It implies the seamless application of information and communication technology along the entire value chain of a business that is conducted electronically.

The impacts of information technology and electronic commerce on business models, commerce, market structure, workplace, labour market, education, private life and society as a whole.

1. Business Models, Commerce and Market Structure

One important way in which information technology is affecting work is by reducing the importance of distance. In many industries, the geographic distribution of work is changing significantly. For instance, some software firms have found that they can overcome the tight local market for software engineers by sending projects to India or other nations where the wages are much lower. Furthermore, such arrangements can take advantage of the time differences so that critical projects can be worked on nearly around the clock. Firms can outsource their manufacturing to other nations and rely on telecommunications to keep marketing, R&D, and distribution teams in close contact with the manufacturing groups. Thus the technology can enable a finer division of labour among countries, which in turn affects the relative demand for various skills in each nation. The technology enables various types of work and employment to be decoupled from one another. Firms have greater freedom to locate their economic activities, creating greater competition among regions in infrastructure, labour, capital, and other resource markets. It also opens the door for regulatory arbitrage: firms can increasingly choose which tax authority and other regulations apply.

Computers and communication technologies also promote more market-like forms of production and distribution. An infrastructure of computing and communication technology, providing 24-hour access at low cost to almost any kind of price and product information desired by buyers, will reduce the informational barriers to efficient market operation. This infrastructure might also provide the means for effecting real-time transactions and make intermediaries such as sales clerks, stock brokers and travel agents, whose function is to provide an essential information link between buyers and sellers, redundant. Removal of intermediaries would reduce the costs in the production and distribution value chain. The information technologies have facilitated the evolution of enhanced mail order retailing, in which goods can be ordered quickly by using telephones or computer networks and then dispatched by suppliers through integrated transport companies that rely extensively on computers and communication technologies to control their operations. Nonphysical goods, such as software, can be shipped electronically, eliminating the entire transport channel. Payments can be done in new ways. The result is disintermediation throughout the distribution channel, with cost reduction, lower end-consumer prices, and higher profit margins.

The impact of information technology on the firms’ cost structure can be best illustrated on the electronic commerce example. The key areas of cost reduction when carrying out a sale via electronic commerce rather than in a traditional store involve physical establishment, order placement and execution, customer support, strong, inventory carrying, and distribution. Although setting up and maintaining an e-commerce web site might be expensive, it is certainly less expensive to maintain such a storefront than a physical one because it is always open, can be accessed by millions around the globe, and has few variable costs, so that it can scale up to meet the demand. By maintaining one ‘store’ instead of several, duplicate inventory costs are eliminated. In addition, e-commerce is very effective at reducing the costs of attracting new customers, because advertising is typically cheaper than for other media and more targeted. Moreover, the electronic interface allows e-commerce merchants to check that an order is internally consistent and that the order, receipt, and invoice match. Through e-commerce, firms are able to move much of their customer support on line so that customers can access databases or manuals directly. This significantly cuts costs while generally improving the quality of service. E-commerce shops require far fewer, but high-skilled, employees. E-commerce also permits savings in inventory carrying costs. The faster the input can be ordered and delivered, the less the need for a large inventory. The impact on costs associated with decreased inventories is most pronounced in industries where the product has a limited shelf life (e.g. bananas), is subject to fast technological obsolescence or price declines (e.g. computers), or where there is a rapid flow of new products (e.g. books, music). Although shipping costs can increase the cost of many products purchased via electronic commerce and add substantially to the final price, distribution costs are significantly reduced for digital products such as financial services, software, and travel, which are important e-commerce segments.

Although electronic commerce causes the disintermediation of some intermediaries, it creates greater dependency on others and also some entirely new intermediary functions. Among the intermediary services that could add costs to e-commerce transactions are advertising, secure online payment, and delivery. The relative ease of becoming an e-commerce merchant and setting up stores results in such a huge number of offerings that consumers can easily be overwhelmed. This increases the importance of using advertising to establish a brand name and thus generate consumer familiarity and trust. For new e-commerce start-ups, this process can be expensive and represents a significant transaction cost. The openness, global reach, and lack of physical clues that are inherent characteristics of e-commerce also make it vulnerable to fraud and thus increase certain costs for e-commerce merchants as compared to traditional stores. New techniques are being developed to protect the use of credit cards in e-commerce transactions, but the need for greater security and user verification leads to increased costs. A key feature of e-commerce is the convenience of having purchases delivered directly. In the case of tangibles, such as books, this incurs delivery costs, which cause prices to rise in most cases, thereby negating many of the savings associated with e-commerce and substantially adding to transaction costs.

With the Internet, e-commerce is rapidly expanding into a fast-moving, open global market with an ever-increasing number of participants. The open and global nature of e-commerce is likely to increase market size and change market structure, both in terms of the number and size of players and the way in which players compete on international markets. Digitized products can cross the border in real time, consumers can shop 24 hours a day, seven days a week, and firms are increasingly faced with international online competition. The Internet is helping to enlarge existing markets by cutting through many of the distribution and marketing barriers that can prevent firms from gaining access to foreign markets. E-commerce lowers information and transaction costs for operating on overseas markets and provides a cheap and efficient way to strengthen customer-supplier relations. It also encourages companies to develop innovative ways of advertising, delivering and supporting their product and services. While e-commerce on the Internet offers the potential for global markets, certain factors, such as language, transport costs, local reputation, as well as differences in the cost and ease of access to networks, attenuate this potential to a greater or lesser extent.

2. Workplace and Labour Market

Computers and communication technologies allow individuals to communicate with one another in ways complementary to traditional face-to-face, telephonic, and written modes. They enable collaborative work involving distributed communities of actors who seldom, if ever, meet physically. These technologies utilize communication infrastructures that are both global and always up, thus enabling 24-hour activity and asynchronous as well as synchronous interactions among individuals, groups, and organizations. Social interaction in organizations will be affected by use of computers and communication technologies. Peer-to-peer relations across department lines will be enhanced through sharing of information and coordination of activities. Interaction between superiors and subordinates will become more tense because of social control issues raised by the use of computerized monitoring systems, but on the other hand, the use of e-mail will lower the barriers to communications across different status levels, resulting in more uninhibited communications between supervisor and subordinates.

That the importance of distance will be reduced by computers and communication technology also favours telecommuting, and thus, has implications for the residence patterns of the citizens. As workers find that they can do most of their work at home rather than in a centralized workplace, the demand for homes in climatically and physically attractive regions would increase. The consequences of such a shift in employment from the suburbs to more remote areas would be profound. Property values would rise in the favoured destinations and fall in the suburbs. Rural, historical, or charming aspects of life and the environment in the newly attractive areas would be threatened. Since most telecommuters would be among the better educated and higher paid, the demand in these areas for high-income and high-status services like gourmet restaurants and clothing boutiques would increase. Also would there be an expansion of services of all types, creating and expanding job opportunities for the local population.

By reducing the fixed cost of employment, widespread telecommuting should make it easier for individuals to work on flexible schedules, to work part time, to share jobs, or to hold two or more jobs simultaneously. Since changing employers would not necessarily require changing one’s place of residence, telecommuting should increase job mobility and speed career advancement. This increased flexibility might also reduce job stress and increase job satisfaction. Since job stress is a major factor governing health there may be additional benefits in the form of reduced health costs and mortality rates. On the other hand one might also argue that technologies, by expanding the number of different tasks that are expected of workers and the array of skills needed to perform these tasks, might speed up work and increase the level of stress and time pressure on workers.

A question that is more difficult to be answered is about the impacts that computers and communications might have on employment. The ability of computers and communications to perform routine tasks such as bookkeeping more rapidly than humans leads to concern that people will be replaced by computers and communications. The response to this argument is that even if computers and communications lead to the elimination of some workers, other jobs will be created, particularly for computer professionals, and that growth in output will increase overall employment. It is more likely that computers and communications will lead to changes in the types of workers needed for different occupations rather than to changes in total employment.

A number of industries are affected by electronic commerce. The distribution sector is directly affected, as e-commerce is a way of supplying and delivering goods and services. Other industries, indirectly affected, are those related to information and communication technology (the infrastructure that enables e-commerce), content-related industries (entertainment, software), transactions-related industries (financial sector, advertising, travel, transport). eCommerce might also create new markets or extend market reach beyond traditional borders. Enlarging the market will have a positive effect on jobs. Another important issue relates to inter linkages among activities affected by e-commerce. Expenditure for e-commerce-related intermediate goods and services will create jobs indirectly, on the basis of the volume of electronic transactions and their effect on prices, costs and productivity. The convergence of media, telecommunication and computing technologies is creating a new integrated supply chain for the production and delivery of multimedia and information content. Most of the employment related to e-commerce around the content industries and communication infrastructure such as the Internet.

Jobs are both created and destroyed by technology, trade, and organizational change. These processes also underlie changes in the skill composition of employment. Beyond the net employment gains or losses brought about by these factors, it is apparent that workers with different skill levels will be affected differently. E-commerce is certainly driving the demand for IT professionals but it also requires IT expertise to be coupled with strong business application skills, thereby generating demand for a flexible, multi-skilled work force. There is a growing need for increased integration of Internet front-end applications with enterprise operations, applications and back-end databases. Many of the IT skill requirements needed for Internet support can be met by low-paid IT workers who can deal with the organizational services needed for basic web page programming. However, wide area networks, competitive web sites, and complex network applications require much more skill than a platform-specific IT job. Since the skills required for e-commerce are rare and in high demand, e-commerce might accelerate the up skilling trend in many countries by requiring high-skilled computer scientists to replace low-skilled information clerks, cashiers and market salespersons.

3. Education

Advances in information technology will affect the craft of teaching by complementing rather than eliminating traditional classroom instruction. Indeed the effective instructor acts in a mixture of roles. In one role the instructor is a supplier of services to the students, who might be regarded as its customers. But the effective instructor occupies another role as well, as a supervisor of students, and plays a role in motivating, encouraging, evaluating, and developing students. For any topic there will always be a small percentage of students with the necessary background, motivation, and self-discipline to learn from self-paced workbooks or computer assisted instruction. For the majority of students, however, the presence of a live instructor will continue to be far more effective than a computer assisted counterpart in facilitating positive educational outcomes. The greatest potential for new information technology lies in improving the productivity of time spent outside the classroom. Making solutions to problem sets and assigned reading materials available on the Internet offers a lot of convenience. E-mail vastly simplifies communication between students and faculty and among students who may be engaged in group projects. Advances in information technology will affect the craft of teaching by complementing rather than eliminating traditional classroom instruction. Indeed the effective instructor acts in a mixture of roles. In one role the instructor is a supplier of services to the students, who might be regarded as its customers. But the effective instructor occupies another role as well, as a supervisor of students, and plays a role in motivating, encouraging, evaluating, and developing students. For any topic there will always be a small percentage of students with the necessary background, motivation, and self-discipline to learn from self-paced workbooks or computer assisted instruction. For the majority of students, however, the presence of a live instructor will continue to be far more effective than a computer assisted counterpart in facilitating positive educational outcomes. The greatest potential for new information technology lies in improving the productivity of time spent outside the classroom. Making solutions to problem sets and assigned reading materials available on the Internet offers a lot of convenience. E-mail vastly simplifies communication between students and faculty and among students who may be engaged in group projects.

Although distance learning has existed for some time, the Internet makes possible a large expansion in coverage and better delivery of instruction. Text can be combined with audio/ video, and students can interact in real time via e-mail and discussion groups. Such technical improvements coincide with a general demand for retraining by those who, due to work and family demands, cannot attend traditional courses. Distance learning via the Internet is likely to complement existing schools for children and university students, but it could have more of a substitution effect for continuing education programmes. For some degree programmes, high-prestige institutions could use their reputation to attract students who would otherwise attend a local facility. Owing to the Internet’s ease of access and convenience for distance learning, overall demand for such programmes will probably expand, leading to growth in this segment of e-commerce.

As shown in the previous section, high level skills are vital in a technology-based and knowledge intensive economy. Changes associated with rapid technological advances in industry have made continual upgrading of professional skills an economic necessity. The goal of lifelong learning can only be accomplished by reinforcing and adapting existing systems of learning, both in public and private sectors. The demand for education and training concerns the full range of modern technology. Information technologies are uniquely capable of providing ways to meet this demand. Online training via the Internet ranges from accessing self-study courses to complete electronic classrooms. These computer-based training programmes provide flexibility in skills acquisition and are more affordable and relevant than more traditional seminars and courses.

4. Private Life and Society

Increasing representation of a wide variety of content in digital form results in easier and cheaper duplication and distribution of information. This has a mixed effect on the provision of content. On the one hand, content can be distributed at a lower unit cost. On the other hand, distribution of content outside of channels that respect intellectual property rights can reduce the incentives of creators and distributors to produce and make content available in the first place. Information technology raises a host of questions about intellectual property protection and new tools and regulations have to be developed in order to solve this problem.

Many issues also surround free speech and regulation of content on the Internet, and there continue to be calls for mechanisms to control objectionable content. However it is very difficult to find a sensible solution. Dealing with indecent material involves understanding not only the views on such topics but also their evolution over time. Furthermore, the same technology that allows for content altering with respect to decency can be used to filter political speech and to restrict access to political material. Thus, if censorship does not appear to be an option, a possible solution might be labelling. The idea is that consumers will be better informed in their decisions to avoid objectionable content.

The rapid increase in computing and communications power has raised considerable concern about privacy both in the public and private sector. Decreases in the cost of data storage and information processing make it likely that it will become practicable for both government and private data-mining enterprises to collect detailed dossiers on all citizens. Nobody knows who currently collects data about individuals, how this data is used and shared or how this data might be misused. These concerns lower the consumers’ trust in online institutions and communication and, thus, inhibit the development of electronic commerce. A technological approach to protecting privacy might by cryptography although it might be claimed that cryptography presents a serious barrier to criminal investigations.

It is popular wisdom that people today suffer information overload. A lot of the information available on the Internet is incomplete and even incorrect. People spend more and more of their time absorbing irrelevant information just because it is available and they think they should know about it. Therefore, it must be studied how people assign credibility to the information they collect in order to invent and develop new credibility systems to help consumers to manage the information overload.

Technological progress inevitably creates dependence on technology. Indeed the creation of vital infrastructure ensures dependence on that infrastructure. As surely as the world is now dependent on its transport, telephone, and other infrastructures, it will be dependent on the emerging information infrastructure. Dependence on technology can bring risks. Failures in the technological infrastructure can cause the collapse of economic and social functionality. Blackouts of long-distance telephone service, credit data systems, and electronic funds transfer systems, and other such vital communications and information processing services would undoubtedly cause widespread economic disruption. However, it is probably impossible to avoid technological dependence. Therefore, what must be considered is the exposure brought from dependence on technologies with a recognizable probability of failure, no workable substitute at hand, and high costs as a result of failure.

The ongoing computing and communications revolution has numerous economic and social impacts on modern society and requires serious social science investigation in order to manage its risks and dangers. Such work would be valuable for both social policy and technology design. Decisions have to be taken carefully. Many choices being made now will be costly or difficult to modify in the future.

Since the economic downturn starting back in 2007, the price of gold has steadily increased coinciding with catastrophic collapse of several markets: bank, housing, mortgage, and government. The increase in gold price has translated in to the increase of gold buying and selling from public, private, and government sectors, yet this increase in buyers has created a great confusion for sellers amongst all the choices, how to choose the best buyer that will create the greatest benefit. It is a healthy decision to sell gold and can come in hand a time of great need, the following will attempt to provide you with a basis for finding a reputable gold buyer and increase your confidence to sell gold.

Since the creation and popularity of the internet has eliminated barriers to entry for businesses and sole proprietors, there has been an increased level of competition. This allows for business to greatly compete on basis of price, quality of goods, and customer service. There are also many options to gather customer feedback or referrals. In order to sell gold, as a seller it is important to evaluate a gold buyer on the basis of each of these aspects. A buyer that does not provide some type of information on their prices, estimated transaction time, shipping carrier speeds and insurance, communication before the customer decides to sell, reviews, and overall level of transparency.

Out of the several options to sell gold whether online through the mail or locally in person, there are certainly trustworthy positive experiences to be had. The requirements necessary to create this experience are common sense and a basis for any successful transaction. Additional attention and care is needed with precious metals transactions since this industry is heavily enforced and small volume can translate to very high prices.

By taking the time to investigate the information provided by such businesses you will prevent yourself from being taken advantage of or not receiving a fair percentage of cash for gold.

Verizon FiOS TV (fiber-optic television) is the fastest and largest growing network in the United States! And it keeps spreading becoming even more popular as people stand in the showrooms to find out just how well FiOS stands up against regular television.

People are discovering how clear and close to life Verizon FiOS TV really is. Once you see it for yourself, you will never want to go back to your old TV service providers. The perfectly clear picture is not the only great thing about Verizon FiOS; you get over 200 all digital channels and a very unique home media DVR that offers multi room functions.

The one DVR can record a movie while the family watches TV, then you can set it up at a later date to play the movie in any room in the house. This will save you a lot of money because you only have to have one DVR. You will be able to watch 3 different recorded shows on three different TV sets at once. The plus to having the DVR is that you can record 80 hours of SD programming and 20 hours of High Definition programming. You can also choose the HD Receiver, which allows you to access Verizon FiOS TV’s HD programming. Or you could choose the SD Receiver as an option as well.

You can also view over 14,000 movies every month with the On Demand Options. If you are tired of watching the same old boring TV stations that you see over and over, the On Demand will allow you to watch movies 24/7 if you choose to.

When it comes to the installation, you are treated with the utmost respect and the skilled technicians will be more than happy to set up your entire home and they will not leave until you are completely satisfied. They will explain the process of the installations and everything that you get with it, all for no extra charge.

Verizon FiOS TV gives you several convenient plans, plus you can customize a package to meet your desire. If you prefer, or are unsure what sort of programming you want, you can start with the basic package and customize it at any time in the future. The bundled package include the Verizon FiOS Triple Play and Double Play where you package more than 1 service up to get a better discount. These FiOS packages are most popular because of the maximum savings you will achieve!

Why wait to have the greatest TV set in town, join the rest of the Verizon FiOS community. You can be the talk of your town with your big screen TV and FiOS – which make a great combo. Get the thrill of your life. You will be glad you did. Check to see if you can get Verizon FiOS in your area right now.

So, you want to get into the HD scene and don’t know where to start? First, you’ll need to make sure you have an “HD-ready” television set to go with the service, that way you’ll actually be able to see the beautiful views and awesome sounds that HDTV will provide you with. You’ll most likely have to check your TV’s manual to find out if it supports 720p, 1080i, or 1080p, 720p and 1080i are the same, but most TV makers put 1080i to attempt to fool you, so watch out for that.

Now, you’ll need to decide which TV service you would like, Direct TV, Dish TV, or cable. With cable, you’ll get about 55 HD channels depending on which cable provider, with satellite TV, you’ll get 73 HD channels, and with Direct TV, you’ll receive 92 of your favorite HD channels, whereas with cable and Dish TV, nearly half of the HD channels you’ll be getting will be ones you’ve probably never heard of and if you have they are ones that you want and feel you need for the total HD experience.

For example, have you ever heard of Treasure HD, or Equator HD? No, no one has, and no one watches those channels either, so in fact, many people are paying extra for tons of channels that they have never heard of and will never watch. With Direct TV, you’ll be getting all the HD movies you could ever want with channels like Universal HD, Sony, Warner Brothers, and the traditional movie channels in HD, such as HBO and Starz. Direct TV also offers local High-Def channels, unlike what the cable companies would like to tell you on their commercials and DirecTV adds more HD programs all the time so there is little worry of tiring of these movie stations. Direct TV offers as many local HD channels as cable does, such as ABC, NBC, CBS, and Fox. Of course, like cable, the availability depends on the region.

As with cable, you will also have to get a separate receiver for your HD channels with HDTV Direct TV. The basic HD Receiver for Direct TV will give you 1080i (720p) picture, while the Plus version will give you the full 1080p picture that is truly worth showing off on your new flatscreen. You’ll only pay a one-time fee, though, for most Direct TV boxes, while with Cable ones, you have to pay so much per month.

Many people do not realise how much media affects us in our daily lives. We are literally controlled by media: it determines the way we dress, what we eat and what lifestyle we pursue. Many people spend hours just flicking through channels till their bedtime.

Although we may not realise, it is media that makes us feel the way we feel, which is usually depressed, having no purpose in life and just feeling sad. The more you watch TV or listen to radio news, the more disasters you will hear, e.g. that someone was killed in your neighbourhood or that times are hard. Media forms the way we think and we let the media do this.

From my personal experience I can tell you that I have not watched TV for two years now. As soon as I stopped watching it, I instantly became happier. Instead of watching TV or flicking through newspapers I spent my time reading about how to acquire wealth, how to be healthy and positive. The absence of the influential media changed my life. I became a different person – I stopped gossiping, judging people, I became much more positive and happy. To tell you the truth, I did not have a bad day since I stopped being involved in the media.

But then many would argue that it is impossible to disengage from media as we would be not updated on current situation etc. But I would rather CHOOSE what I wish to be updated on by using on-line search engines, rather than just turn on the TV only to be bombarded by the depressing information.

Why do we always hear more negative than positive information on TV? Why do we feel sad, angry and insecure after watching news? Sometimes I think that society is kept in fear by such ways. Then common people are discouraged to achieve more, to start their own business because the media tells them that now the economic situation is disastrous and many businesses fail. I think it is ridiculous when people take everything that is told for granted.

The way many people live can be summed up in a few sentences: they work for someone else, they go home, eat, watch TV and sleep. Then on weekends they go shopping for cheap stuff to spend all their money in useless ways only to find themselves in debt after a few days of getting salaries. Then they go on vacation for a week or two once a year.

That is not life. That is a horrible loop they are stuck in. To break away from such life means to change habits. Change the habit of listening to media to doing something useful in that time. Reading is always good. Reading how to acquire wealth was my favourite pastime.

If yo do not like to read, buy educational tapes or DVDs, attend seminars. These are interactive and very useful ways to acquire knowledge and change your life. When you stop listening to the media, you will find yourself happier, healthier and wealthier. You will travel much more often, meet interesting people, maybe even start a new relationship. Things will change – I will guarantee you this. Get rid of this negative influence and you will change your life for good.

Do not hesitate to email me with your feedback on my articles! Thank you for taking time to read this post.

I am so happy I just discovered I can watch TV on my PC. Before television on my computer I was paying over $75 a month for cable. Canceling your cable service is a very pleasurable experience. The customer service representatives there sometimes say that getting tv on your PC isn’t possible. One only has to try the service for a minute to know this isn’t true.

There are several options out there. To get tv on your pc used to require additional equipment. This is no longer the case. If you have a PC and are online, then you are ready to go. All you need is a simply downloaded program. Some companies attempt to charge a monthly license fee for this software in an attempt to mimic the cable companies.

A few allow you to break the monthly payment cycle forever. Charging a one time fee only, you are perpetually able to receive satellite tv channels with no ongoing cost. Many think it sounds to good to be true. I admit I was one of them. However, seeing is believing. Not only does it work, but you would be astounded at the selection of programming.

Some programs offer up to 3000 channels. Yes, three thousand. That puts my old cable line up to shame. It is possible to receive channels from all over the globe. Watching live coverage from Rio one minute then Iraq the next is wild. It is as if a window has opened up to the world. Whether it be news, sports or movies the best of all countries becomes available right on your PC.

Friends who are rabid soccer fans are rushing to get this service now. Whatever the sport, many fans can not access their favorite games and team on regular cable television. Satellite TV on your computer allows for an incredible choice between events from all over the world. Never again will you utter that there is nothing good on to watch.

As I mentioned, the best part is that there is nothing left to pay after purchasing the initial software. Never. No ongoing monthly bills like all normal cable and satellite services entail. I read this software used to cost several hundred dollars. Some companies would charge comparable amounts to cable bills for its use each month. However, recently that has changed.

My timing was perfect because the most cutting edge package has now hit the market, and I can’t believe what a bargain it was. After confirming with the seller that it was 100% legal, the plunge was made. Download was as simple as downloading and installing any other software program.

Within minutes, I was able to watch TV on my PC. The best part is that home computers are now easily connected to televisions. Viewed this way, the amazing high def picture is fully experienced along with all sound effects. Nothing is missing except the bill. Added were several thousand channels. I wonder why anyone has cable anymore.