Again there has been just a heap of stuff arrive this week.
First we have:
A Road Map to Electronic Medical Record System Implementation
- May 1, 2009
Originally published - May 28, 2008
Today, health care organizations are looking to adopt time-saving technology. Electronic medical record (EMR) software uses online technology to deliver automated processes that can save health care organizations a lot of time and resources.
Not only does an EMR solution reduce the amount of paper used by a health care facility (because it no longer needs to make as many copies of documents), it helps the facility to save on resources too, including transcription and storage costs. In addition, nurses and doctors spend less time searching for patient data, because it is stored on servers in digital format, taking up a minuscule amount of space. This enables health care organizations to convert valuable space, previously occupied by file cabinets and paper storage systems, into areas for patient care and treatment.
All this helps to reduce patient waiting times, and physicians are able to see more patients daily.
This article lists and discusses the guidelines a health care organization should follow when implementing an EMR system. These guidelines will explain what health care organizations should expect, and they will help to ensure a smoother transition from manual to electronic processes. However, following these guidelines still cannot guarantee that your implementation will be a complete success; some problems are likely to arise regardless of the measures you take to avoid them, and should be expected.
More here (registration required):
This is a good review of the basics of implementing EHRs. How to select an EHR is covered here:
Second we have:
Predicting Flu With the Aid of (George) Washington
The best way to track the spread of swine flu across the United States in the coming weeks may be to imagine it riding a dollar bill.
The routes taken by millions of them are at the core of a computer model at Northwestern University that is predicting the epidemic’s future. Reassuringly, it foresees only about 2,000 cases by the end of this month, mostly in New York, Los Angeles, Miami and Houston.
In the past decade, the Internet has allowed health agencies to spot emerging viruses much sooner: local public health reports posted on the Web along with items from newspapers and radio stations are harvested by keyword-scanning programs. Now, in tandem with that, supercomputers are being enlisted to predict their spread.
Such models are too new to have established a track record, but last week two separate teams — the one at Northwestern and a friendly rival at Indiana University, using different algorithms — both made predictions that matched almost exactly: flu from Mexico, if left utterly unchecked, would infect only 2,000 to 2,500 people in the United States in four weeks.
Although the number of cases appears to be rising faster than the two models predicted, the Northwestern projection was “still in the ballpark” as of Sunday, said Dirk Brockmann, the engineering professor who leads the epidemic-modeling team at the Northwestern Institute on Complex Systems. The model projected 150 to 170 cases by Sunday, compared with the 226 confirmed by the Centers for Disease Control and Prevention.
“If it was an order of magnitude off, like 1,000 cases instead of 10,000, I’d be worried,” Dr. Brockmann said.
At the heart of his simulation are two immense sets of data: air traffic and commuter traffic patterns for the entire country, and the yield of a whimsical Web site, Where’s George?
Where’s George? was started more than 10 years ago by Hank Eskin, a programmer who marked each dollar bill he received with a note asking its next owner to enter its serial number and a ZIP code into the Web site, just for the fun of seeing how far and fast bills traveled. By 2006, the site had the histories of 100 million bills.
Much more here:
http://www.nytimes.com/2009/05/04/health/04model.html?_r=2
Good to see many angels are be being tried to keep tabs on how bad this might wind up being!
Third we have:
Friday, April 24, 2009
Halamka Warns That Move to EHRs Will Be Full of Challenges
At the SAS Healthcare and Life Sciences Executive Conference Thursday, John Halamka -- CIO of Harvard Medical School and chair of the Healthcare Information Technology Standards Panel -- emphasized that the transition to electronic health records will not be easy, the Triangle Business Journal reports.
In his keynote address, Halamka, however, said moving to EHRs would save millions of dollars, make the health care system more efficient and create as many as 50,000 new jobs.
To help the process along, Halamka said work developing health IT standards needs to continue so health care providers can share data. He also said that regional health IT centers that use "cloud computing" might be a more effective way to facilitate health IT adoption than installing "servers and exchanges" in physician offices.
Halamka also noted that physicians will have to use their own funds to cover the cost of new EHR systems because federal incentive payments included in the economic stimulus package for EHR use will be disbursed over five years.
Reporting continues here:
This is certainly true. I wonder if Ms Roxon has noticed the job creation possibilities. Probably no I guess!
Fourth we have:
Soon, cell phones to monitor heart patients
2 May 2009, 1820 hrs IST, ANI
In a bid to encourage heart patients to complete their rehabilitation programs after surgery, Australian scientists have come up with a new technique that will see nurses monitoring them via a mobile phone.
The trial, being run by the CSIRO's Australian E-Health Research Centre (AEHRC) and Queensland Health, uses a mobile phone to collect and send health-related information about patients'' activities at home to a central computer.
AEHRC chief executive officer Dr Phil Gurney said that less than 20 pct of the heart surgery patients complete their six-week rehabilitation program, following the need for patients to return regularly to the hospital for the rehab program.
"We are largely using technology that is available, but we have customised it to our purposes," ABC Science quoted Gurney as saying.
The mobile phones have an inbuilt accelerator that measures physical activity such as the number of steps walked.
More here:
Why on earth is this being reported in India and not made a fuss of here in OZ? We really are in a global village despite the GFC!
Fifth we have:
Critical access to IT
Because Medicare incentives under the federal stimulus law vary by type of hospital, rurals expect to see fewer dollars for health IT
By Jessica Zigmond
Posted: May 4, 2009 - 5:59 am EDT
Soon after Congress allocated upward of $19 billion in health information technology funding as part of the economic recovery package, a commentary from the Rural Wisconsin Health Cooperative of 35 free-standing facilities said that the law would leave rural hospitals to make “the best of a bad situation.”
That’s because, according to the report, the differences in Medicare incentives between prospective payment system hospitals and critical-access hospitals are “dramatic,” and the Congressional Budget Office estimates the incentives will result in only half of all critical-access hospitals reaching “meaningful user” status by 2019.
Other healthcare leaders, however, say the legislation’s structure is fair, and that this funding is only a down payment from the federal government for health IT, with additional funds to come later. According to the CBO, total IT funding via the stimulus pipeline could eventually top $34 billion.
Meanwhile, the rural health community continues to improve its IT capabilities—and, in some cases, with financial help from other federal funding sources.
“I think it provides a good benefit” to both types of hospitals, Don May, vice president for policy at the American Hospital Association, says of the health IT funding in the American Recovery and Reinvestment Act of 2009. “It is different and does structure it differently, but I think it provides good financial incentives for both types of hospitals. I think a lot of the reason that you may be hearing some concern is there are more unanswered questions than there are answered questions,” he says.
Some of those questions relate to the definition of terms included in the legislation. For example, the law stipulates that both PPS hospitals and critical-access hospitals are eligible for Medicare incentives if these facilities are able to demonstrate that they are meaningful users of certified electronic health-record technology.
Last week, the Healthcare Information and Management Systems Society, or HIMSS, published its definitions of “meaningful use of certified EHR technologies” as outlined in the stimulus law. It then sent two definitions—one for meaningful users of certified EHR technologies, which focuses on physicians, and one covering meaningful use for hospitals—to the Office of the National Coordinator for Health Information Technology and the acting CMS administrator. In both definitions, the recommendations call for use of an EHR certified by the Certification Commission for Healthcare Information Technology, or CCHIT.
Much more here (registration required):
http://www.modernhealthcare.com/article/20090504/REG/905019995
This is a good discussion of where thinking is up to with implementation of the US Health IT stimulus planning.
Sixth we have:
Monitoring Tools Can Boost E-Health Record Systems Performance
Federal stimulus money is pushing health care providers to implement e-medical record systems, but keeping the technology performing to doctors' satisfaction is the larger concern.
By Marianne Kolbasuk McGee, InformationWeek
May 5, 2009
With federal stimulus programs waving a $20 billion carrot in front of health care providers, it's a sure bet that many more hospitals and medical practices will be deploying e-medical record systems over the next several years. But many health-care organizations will likely discover that implementing these systems is one thing; keeping the technology performing to the satisfaction of clinicians is another.
E-medical record systems require doctors and nurses to make huge changes in the workflow habits involved with patient care. That in itself is a tough sell. But if systems performance problems prevent clinicians from accessing crucial patient data or ordering drugs or tests in a timely way, that can become a matter of life or death.
Performance monitoring tools that help IT staff quickly identify and diagnose application, infrastructure, and other systems performance problems before the trouble impacts users can greatly boost clinicians' satisfaction, say health care IT leaders who have deployed e-medical records and other health IT systems.
"It takes a lot to ask nurses and doctors to change their workflow and adopt computerized systems for patient care, they put all their trust that these systems will be reliable and high performing," said Barry Runyon," a health care analyst and VP of research at Garter.
More here:
http://www.informationweek.com/news/showArticle.jhtml?articleID=217300190
This is a very sensible article that explores some important issues.
Seventh we have:
NHS contract leaves BT with painful results
The government has handed the telecoms giant a £100m advance despite its dire record on delivering computer systems, reports Simon Bowers
- Simon Bowers
- The Observer, Sunday 3 May 2009
The Department of Health has handed BT almost £100m in advance payments for its work computerising patient records despite years of delays, system failures, and overspending on BT's £1bn NHS contract in London.
Industry insiders suggest the up-front sum is substantially above what such a contract ought to cost. Health minister Ben Bradshaw told parliament the payment was "in line with Treasury rules, and in return for a reduction in payments to be earned for future successful delivery".
The cash advance, revealed by Bradshaw in a parliamentary answer, comes just days ahead of BT's full-year results. These will next week include a painful writedown reflecting a catalogue of troubles that have dogged BT's work on IT upgrades for hospitals and GP surgeries in the capital.
The NHS-related writedown is expected to be larger than the £336m wiped off the combined value of 15 other BT Global Services IT contracts three months ago. The contract has been so costly and problematic that BT is thought to have discussed the possibility of quitting altogether as recently as March.
The government's £92.8m advance appears to largely relate to a bolt-on contract BT won in March, through which Global Services has taken over management of IT systems at eight major NHS trusts outside London abandoned by Fujitsu. The Japanese firm had quit as a health service contractor in a bitter legal row.
More here:
http://www.guardian.co.uk/business/2009/may/03/nhs-bt-contract-it-systems
The news from the NHS seems to be getting worse and with the UK economic situation one must be a little anxious about the ultimate fate of their plans. At least Scotland and Wales seem to have achieved well on a more limited budget.
Eighth we have:
What's Holding Back Online Appointment Booking?
Donatello Bianco - May 1, 2009
Have you ever asked yourself why you can use the Internet to book a flight, a hotel room, or even a seat at the theatre, but if you need to make an appointment with your doctor, you have to do it by phone? Do you ever find yourself on a Sunday morning or Tuesday evening wanting to arrange a check-up, but having to wait until the doctor's office opening hours before you can make the call? And when you finally make the call, have you ever wished you had more time or options to help you make the right choice? Have you wondered how much easier making appointments could be if only we had access to a dedicated online scheduling system?
I first asked myself these questions years ago and have since asked the same questions to about a hundred doctors, hospital and clinic directors and call centre managers. And their answer is always the same: "Yes, it would be good to overcome these problems", which was often followed by "but it's complicated" or "it's still too early".
Having been involved in several successful patient relationship management (PRM) implementations over the last few years, I have discovered that by avoiding some simple mistakes, an appointment scheduling system can actually be significantly less complex than generally perceived within the health industry. And it is certainly not too early, by any means, to implement one.
With a little effort, any hospital, clinic, doctor's office, or individual doctor can save a considerable amount of its own and its patients' time, make its services easy to use, and reduce non-attendance significantly.
Long full article here (registration required) :
This is an interesting article reviewing the range of barriers that need to be overcome to get improved patient booking systems in place.
Ninth we have:
Few hospitals go paperless using free VA software
Electronic record system helps W. Va.
By Lisa Wangsness, Globe Staff | May 4, 2009
WASHINGTON - In a country where just 1.5 percent of US hospitals have fully computerized records, one of the poorest and least technologically advanced states has created a paperless records system for its state-run hospitals and nursing homes serving the indigent elderly and mentally ill.
West Virginia did it on the cheap by using an electronic medical records system built by the Veterans Administration with taxpayer dollars, saving millions in software licensing fees charged by commercial software vendors. The VA software, known as VistA, is open-source software - its code is freely available to the public and is constantly being improved by users - and it includes important features, such as a bar-coding system to track drug dispensations, to help improve patient safety.
But very few US hospitals have taken advantage of it. Wealthier hospitals have opted to buy more expensive, custom systems from private vendors, while smaller and more rural hospitals often stick with paper records.
"I would think there would be a tremendous opportunity for using this as a platform, particularly for smaller hospitals that have a real challenge in coming up with the money for electronic medical records," said Dr. William Weeks, an associate professor at Dartmouth Institute for Health Policy and Clinical Practice and Veterans Administration psychiatrist in Vermont.
Much more here:
I suspect that as the financial incentives kick in we may see more use!
Tenth we have:
Apollo launches new technology to capture multimedia from legacy systems
May 01, 2009 | Eric Wicklund, Managing Editor
FALLS CHURCH, VA – When a doctor in a remote town needs help analyzing an X-ray of a child’s broken leg, the last thing he or she should worry about is whether the image can be read by a specialist thousands of miles away.
Apollo, a Falls Church, Va.-based developer of clinical multimedia solutions, seeks to solve this issue with the release of Apollo Enterprise Patient Media Manager (EPMM), a so called “device-agnostic” software platform that’s designed to collect distributed patient media into one unified record.
“It looks at the problem from a clinician’s perspective, bringing it all to the clinician’s desktop,” said Mark Newburger, the company’s CEO. “It really is a multimedia manager.”
Launched in 1993 as a telemedicine company, Apollo created digital pathology management and telepathology solutions for clinical and research laboratories before moving into the PACS market in 2003. Newburger said the company focuses on coordinating data from older, legacy systems so that it can be read easily and quickly – a critical issue at a time when hospitals and other healthcare providers don’t have the funding to purchase new hardware or software.
More here:
This looks like really useful work indeed.
Eleventh for the week we have:
Monday, May 4, 2009
Medical records software provides security
Lauren Whetzel
People underestimate how vulnerable their medical records are, even on paper, said Dr. Brian Wicks, an orthopedist who heads a Washington state medical practice.
"Just about anybody walking by the records room in a hospital, for example, could potentially get a hold of a patient chart …," said Dr. Wicks, president of the Doctors Clinic, practice that is making the transition to electronic health records at all of its locations.
Dr. Wicks says the chances of unauthorized personnel gaining access to a computer at a clinic would be small because electronic health records have a very high level of security and require passwords at every step.
Nigel Jones, director of the Cyber Security Knowledge Transfer Network in Britain, is less confident. "Nothing is 100 percent risk-free. Sensitive information always has the possibility of being released by an insider, an Internet hacking or accidentally.
"If I were someone giving medical details electronically," Mr. Jones says, "I want to know where the data is held, how it is stored and if it is being held in one place."
The question of electronic security has become more compelling as private companies, with big incentives from government, relentlessly push the technology in the medical and public health fields.
More here:
http://washingtontimes.com/news/2009/may/04/securing-medical-records/
A good discussion of the various ins and outs of medical record security.
Twelfth we have:
iSOFT wins A$ 5m (US$ 3.54m) deal in England for a hospital information system
May 4th, 2009
Sydney/Chennai, Monday, 4 May 2009: iSOFT, an IBA Health Group Company, today announced that it has won a contract for a hospital information system with a National Health Service (NHS) trust in southern England worth £2.4 million ( A$5 million) (US$3.54m) over five years.
The contract with Heatherwood and Wexham Park Hospitals NHS Foundation Trust is for iSOFT’s i.Patient Manager (i.PM) PAS and a technical refresh of an existing iSOFT clinical solution, i.Clinical Manager (i.CM). i.PM is replacing an outdated third-party system.
The trust elected to contract directly with iSOFT for a replacement PAS instead of waiting for a solution under England’s National Programme for IT. This is one of the first major deals in the Southern Cluster, which was formerly serviced by Fujitsu.
Jonathan Pearce, the Trust’s Director of Infrastructure, said: “We are delighted to be working with iSOFT on this very important programme for Heatherwood and Wexham Park Hospitals NHS Foundation Trust. We already have a strong working relationship with iSOFT as we already use its clinical information system, i.CM. We very much value our partnership with iSOFT and look forward to strengthening this and working with the company to deliver the new PAS solution to the trust.”
More here:
http://press-releases.techwhack.com/36100-isoft-7
It is interesting that some NHS trusts are going outside the NHS program to purchase their systems.
Thirteenth we have:
Industry Weighs in on Definition of Meaningful Use
Carrie Vaughan, for HealthLeaders Media, May 5, 2009
Healthcare providers are antsy to start working toward becoming "meaningful users" of electronic health record technology so that they can claim some of the American Recovery and Reinvestment Act's financial incentives when they become available in fiscal year 2011 and 2012. While providers wait for the government's definition of "meaningful use" of EHR technology, which ultimately is the only definition that matters, they did receive some guidance this past week as just about every association and industry group released their own definition of what meaningful use should include. Here's a breakdown of those recommendations.
Much more here:
This is an excellent summary of the view being offered by a large range of stakeholders.
Fourteenth we have:
The Downside of E-Health Records
By Gautham Nagesh 05/05/09 12:03 pm ET
With all the excitement surrounding electronic health records in the new administration, including the $19 billion in the stimulus bill set aside to further their adoption, it's easy to forget the potential risks of moving our health information online.
One striking example of the possible downside came to us on Monday from Wikileaks via the Washington Post's Security Fix blog:
Hackers last week broke into a Virginia state Web site used by pharmacists to track prescription drug abuse. They deleted records on more than 8 million patients and replaced the site's homepage with a ransom note demanding $10 million for the return of the records, according to a posting on Wikileaks.org, an online clearinghouse for leaked documents.
Wikileaks reports that the Web site for the Virginia Prescription Monitoring Program was defaced last week with a message claiming that the database of prescriptions had been bundled into an encrypted, password-protected file. Wikileaks also printed a copy of the ransom note:
I have your [expletive] In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh :(For $10 million, I will gladly send along the password.
The state discovered the attack on April 30 and soon after shut down the Web site. They are in the process of restoring the systems but no word yet on whether the attacker has been identified.
Much more here :
http://techinsider.nextgov.com/2009/05/the_downside_of_electronic_hea.php
This must have IT execs all over the country a bit nervous. It is certainly a pretty huge breech!
Fifteenth we have:
mbitious goals are not new, but they have proven difficult to achieve at the scale in the U.S.
By Archie Galbraith
"Necessity, who is mother of invention." -- Plato, The Republic, 380 BC.
In the past, the differences between health care ecosystems across the world have been large enough to make it difficult to share a range of patient-oriented software. This article questions whether the current pressures and emerging goals of the U.S. health system will increasingly result in breaching these barriers.at least to the extent that practical and low-cost applications and solutions from outside the U.S. might be worth considering.
Assume that the most effective health information technology is developed in response to the clinical and business requirements immediate to the developer. The question is whether the requirements of a hospital in Taiwan are close enough to those of a hospital in Tennessee to mean that the clinical or business systems developed for either might be relevant to both.
We are facing demands by a new administration for integrating care, disease management, visibility and cost containment. At the same time the resources which are being made available allocated across 6000 hospitals and 921,904 licensed physicians will be inadequate to achieve these goals across the hospitals, clinics and doctors' offices in the United States. This might be a good time to think differently.
More here:
http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=199065
A very good and interesting article from an obviously thoughtful Health CIO.
Sixteenth we have:
Connecting Stakeholders to Improve Care
The concept formally called the "patient-centered medical home" is gaining momentum.
Medical Home Connects Healthcare Stakeholders to Improve Care
Sathya Rangaswamy
With each passing day, a concept formally called the "patient-centered medical home" is gaining momentum. Under this concept, a primary care practice would be the patient's regular source of care or "medical home," with teams composed of primary care physicians (PCPs), registered nurses, nurse practitioners and physician assistants who coordinate services across the continuum of care. The goals are to improve outcomes and reduce overall costs by promoting preventive care; maintain patient health by leveraging information technology to foster clinical collaboration and data exchange; streamline follow-up visit requests and referrals to specialists, hospitals and other care settings; and empower patients to participate in and make better health care decisions.
Very much more here:
http://health-care-it.advanceweb.com/Editorial/Content/Editorial.aspx?CC=199070
A good article on current thinking in the “medical home” area.
Seventeenth we have:
GE Launches 'Healthymagination'; Will Commit $6 Billion to Enable Better Health
Created May 7 2009 - 12:45pm
WASHINGTON, DC - May 7, 2009 - GE announced today that it will spend $3 billion over the next six years on healthcare innovation that will help deliver better care to more people at lower cost. In addition, the company will commit $2 billion of financing and $1 billion in related GE technology and content to drive healthcare information technology and health in rural and underserved areas. These investments are the foundation of GE's healthymagination initiative, which is built on the global commitments of reducing costs, improving quality and expanding access for millions of people.
More here:
http://www.fiercehealthcare.com/node/35936/print
This is a long a detailed agenda that is really very encouraging indeed!
Fourth last we have:
"Star Trek" Scanner Tested
May 4, 2009
The National Space Biomedical Research Institute, federally created to develop treatments for those on long-duration missions, is working on a "Star Trek" type of scanning device to noninvasively conduct metabolic tests.
The sensor and portable monitor is called the "Venus prototype." Placed on the skin, it uses near infrared light (just beyond the visible spectrum) to take measurements.
More here:
As every year goes by we seem to get closer to the Rodenberry vision. Given he was imagining the 23rd Century we may get there more quickly than he imagined!
Third last we have:
Agency Urges Patients to Quiz Their Doctors
Tuesday, May 5, 2009
People are more likely to demand information about a restaurant entree or a cellphone deal than about a doctor's diagnosis. At least that's the opinion of the federal Agency for Healthcare Research and Quality, which recently launched a campaign aimed at getting Americans to research and ask questions of their health-care providers.
The public service announcements (one has a picture of a waiter captioned, "You'll ask him about the side dish," then a picture of a doctor that reads, "But you won't ask him about the side effects") are meant to prompt people not only to ask questions but also to think about what those questions might be ahead of time, says Carolyn Clancy, director of AHRQ. To help, the agency has a sort of menu that helps you create a list of questions based on the nature of your visit to the doctor. (At http://www.ahrq.gov/questionsaretheanswer, click "Do You Know?") The site offers nine categories, each with suggested questions for such encounters as getting a new prescription or getting a recommendation to have surgery.
More here (with links):
http://www.washingtonpost.com/wp-dyn/content/article/2009/05/01/AR2009050103218.html
All I can say is what a good idea!
Second last for the week we have:
Bury using SCR for end of life care
05 May 2009
The Summary Care Record will start to hold information on end of life plans in the next few months, according to NHS Connecting for Health.
The IT agency has set out its plans to develop the SCR for end of life care and the progress that has been made at NHS Bury, one of the early adopter primary care trusts for the SCR.
Writing in the European Journal of Palliative Care, Dr Gillian Braunold, clinical director of the SCR, and colleagues from CfH, said a National Audit Office report published last year highlighted ‘severe shortcomings’ in relation to end of life care.
One of the issues it highlighted was that the wishes of people approaching the end of their life were not always conveyed to those who needed to know them.
The authors said that the SCR could “easily be used to communicate patient wishes and end-of-life care plans” because any coded information and associated free text entered in the GP IT system could be sent as part of the ‘GP summary’ to the SCR.
Much more here:
http://www.ehiprimarycare.com/news/4810/bury_using_scr_for_end_of_life_care
This seems like a sensible use of a summary health record. As long, of course, if it is carefully kept up to date!
Last for this week we have:
NHS Evidence launches
01 May 2009
The National Institute for Health and Clinical Excellence has launched NHS Evidence, an online source of “fast, free, relevant and trustworthy” information for health and social care staff.
The new service was promised in the final report of Lord Darzi’s Next Stage Review of the NHS, High Quality Care for All and is being promoted as a way to spread innovation across the health service.
Speaking at the launch, Lord Darzi said: “in my strategy for the future of the NHS, I made it clear that if quality was to become the organising principle of the NHS, its staff and patients must have a way to access the latest authoritative clinical and non-clinical evidence and best practice.
“NHS Evidence will ensure that whatever you do within the NHS you will always have access to the best information you need to deliver the highest quality care to your patients.”
Much more here:
http://www.ehiprimarycare.com/news/4806/nhs_evidence_launches
What a pity we don’t have a similar service for Australian Health Professionals. That at least could be afforded in these CFC constrained times!
There is an amazing amount happening. Enjoy!
David.
Appreciate the recommendation. Will try it out.
ReplyDeleteYou should consider this too, one of the videos at the end is also worth a watch - https://medconfidential.org/2015/what-else-will-burn-in-the-bonfire-of-the-faxes/
ReplyDelete