Key Breast Health Tips For Every Stage of Your Life

Breast health is becoming increasingly important as more and more women risk developing breast cancer each year. Fortunately there are some informative breast health tips that you can follow to ensure that your breasts remain as healthy as possible throughout your lifetime. Some of these tips can help to catch breast cancer in the earliest stages, ensuring it can be treated quickly, some may even help to prevent breast cancer altogether.

Self Examine Your Breasts

One of the most useful breast health tips is to self examine your breasts at least one per month. This is a fairly easy process that can be done by yourself or a partner in the comfort of your home. Follow these simple steps to complete a breast exam of your own.

Observe your breasts in the mirror as you stand with your hands at your side. Look for any bumps or variations in their normal shape.
While standing place one hand behind your head, and begin to feel firmly around the breast with your fingertips. You can do this in a circular motion, an up and down motion, or in a wedge motion, but you need to remember to do it the same way each month.
Squeeze the nipple of each breast. If you notice any discharge and you are not breastfeeding, report it to your doctor right away.
Lie down and place a pillow behind your right shoulder. Extend your right arm behind your head and use your left hand to check your entire breast and arm pit area. Then reposition the pillow and do the same thing for your other breast.
Report any abnormalities that you may encounter during your exam to your doctor right away.
Correct Breast Feeding
Using proper breast feeding techniques will not only make the whole process more enjoyable,
but it can lower your risk of developing breast cancer as well.

The following, useful breast health tips will help you understand how to correctly breast feed.

To help eliminate enlargement of the breasts, breast feed more frequently and be sure to pump your breast milk if you ever miss a scheduled feed.
Be sure to properly position the baby while breast feeding. Whether you choose the cradle, football, or side lying position, ensure that the baby is in the proper position.
After each feeding apply lanolin oil to your breasts. This will help to prevent your breasts from cracking and drying out.
Feed every one and a half to two hours in the first few months after your baby is born to keep your breasts from becoming engorged, and to discourage the formation of blocked milk ducts.
Breast Health during Menopause
During menopause you have a lot to worry about. To make matters worse, your
chance of developing breast cancer greatly increases during these years. However, there
are several breast health tips that you can follow to help reduce the rick of breast cancer.

Arrange an annual mammogram screening.
Regularly perform a breast self examine once per month
Try to exercise daily and avoid gaining excess weight.
Try to reduce your alcohol consumption or limit it within health guidelines.
Be sure to get your daily dose of folic acid vitamin D.
At all stages of your life, no matter what age you are, it is important to take steps to keep your breasts healthy and cancer free. The breast health tips above are just a few of the ways that you can keep your breasts healthy. By investing a little time and discussing breast health with your doctor you can minimize any risks involved during the key times in your life.
some more tips :1. Give more attention to your well-being. Women generally have plenty of responsibilities, but it is important to remember your health and take care of it as well. You should ensure that you exercise, eat right and enjoy enough sleep. Time might seem too precious to have time for this, but when you have a schedule in place, you can manage to do it all.

2. Fight off the stereotypes. If there is one thing that can bring a woman down and promote bad habits that can ruin health, then it is dealing with stereotypes and going through abuse, violence, discrimination and inequality. If you are facing any of these damaging issues at your workplace or home, make a point to stand your ground and defend your rights. You can actually make a bold move to move away or cut your connections with such people who do not give you peace.

3. Keep your physical and mental health in check. Alcoholism, anxiety, depression and stress are some of the issues that can get real serious in women. Get help as soon as any of them start disturbing you to keep off the greater risks they come with. A health care provider can guide you through such issues and make recommendations that will help bounce you back to good health.

4. Find out about all health issues that common in females. They include things such as UTIs, incontinence, overactive bladder, joint pains and others. Ensure that you know everything about health as far as family history goes and make a point of having regular checks just to get assurance that all is well. Such checks can help manage underlying issues before they come out in full force. It also helps to know your risks for stroke and heart disease because women tend to be at higher risks.

5. Keep your weight healthy. Maintaining a healthy weight is very important in keeping your health and general well-being in check. Remember that women have less muscle but more fats compared to men, hence you should keep your calories in check. Keep your BMI within the right healthy range, engage in physical activities and exercise and always eat a balanced diet. There are so many healthy foods low in calorie that you can still enjoy and maintain a healthy weight.

6. Remember your reproductive health. Sexual health is usually neglected yet it plays an important role in your overall health. Taking care of it is one of the best ways of how to stay healthy. Talk to your healthcare provider about prevention of STDs, safe sex and even screening procedures that can help you out. Reproduction covers female cancers, menstruation, contraception, pregnancy and breastfeeding, breast health, menopause and infertility.

Five Simple Health Tips to Jump Start A New You

Creating a heather lifestyle doesn't have to be complicated but it does require commitment. It takes 21 days to create a new habit, and 6 months for that habit to become ingrained in your routine. Since life can get in the way, I recommend small changes one step at a time. The list below represents five simple health tips that you can incorporate into your life and make a huge impact on your health, energy, and vitality. Choose one item at a time and do it for at least 3 weeks before adding another component to your lifestyle. When you are doing it without having to constantly remind yourself, then you are ready to move on to the next item.

1) Drink half your "ideal" weight in ounces of water per day. If your ideal weight (not your actual weight) is 120 pounds, you should drink 60 ounces of water per day. Even mild dehydration will cause a 3% drop in your baseline metabolism. That means you will gain 1 pound of fat every 6 months! Drinking water minimizes bloating and water retention in women. These symptoms are often a result of lack of hydration. Drinking plenty of water is how you flush the fat and toxins stored in your fat cells, and also how you can prevent muscle cramps. When muscle cells don't have adequate fluids, they don't work as well and performance can suffer. When exercising, you should try to drink 3-5 ounces of water every 20 minutes. Downing your 8-10 glasses of water all in one sitting doesn't cut it. For maximum effectiveness, staying "evenly" hydrated throughout the day is how our bodies metabolize fat. Also, proper hydration keeps our kidneys and bowel function healthy. Getting the proper hydration also gives you more youthful looking skin. Symptoms associated with mild dehydration are weakness, muscle cramps, headaches, irritability, fatigue, trouble concentrating, heart palpitations, and anxiety.

2) Get your Vitamin D levels tested. Over 80% of Americans are Vitamin D deficient. This is especially prevalent during the winter months. Research shows that proper levels of vitamin D can boost your immune system and decrease your risk for cancer. You can buy Vitamin D3 in a supplement form or you can spend some time in the sun, although your body can only generate vitamin D from UVB rays and during certain times of the day. There is an app for smartphones called Dminder. This app will let you know what time of day, based on your geographic location, the sun is at the proper angle and generating UVB rays so your body can create Vitamin D. In some geographic areas there will be times of the year that you cannot generate vitamin D from sun exposure and will need to get it in the form of supplementation or special tanning beds. This app takes all of the scientific data into account plus your personal profile which includes skin pigmentation, weight, and age. When you are ready to begin your sun exposure, input the type of clothing you are wearing and start the timer. When you've maximized your Vitamin D production for the day, an alarm will sound to end your session. For those of you who don't enjoy the outdoors or live in a location where you can't generate Vitamin D, there are plenty of Vitamin D supplements. Look for Vitamin D in the form of D3. The daily recommended amount is controversial, but generally, 1000-5000mg is recommended. For more info on this topic visit mercola.com

3) Get to bed before 10pm. Since I know this is going to be challenging, start with going to bed just a little earlier each night and work your way to 10pm over a three week period. The latest sleep studies indicate that the deepest and most regenerative sleep occurs between 10 p.m. - 2 a.m. If your body is chronically deprived of "regenerative sleep" between 10 p.m. - 2 a.m., then you may still feel tired and have difficulty getting up in the morning. At 10 p.m., your body goes through a series of transformations following the rise in melatonin production. Melatonin not only helps regulate your sleep/wake cycle but is also responsible for the repair and restoration of your body. A reduction of your mental and physical activity is necessary for this 10 p.m. shift to occur. Watching television, reading from an electronic device, or bright LED clocks all impact melatonin production and the subsequent chain reaction that leads your body into deep sleep. This is one good reason to buy paperback books and a book light! You can also listen to relaxing music. Getting a good night's sleep can create longevity and health. Deep rest during the night helps you fight stress, maintain a healthy weight, and keeps your energy levels high. A simple health tip for those wanting to lose weight: get a minimum of 5 hours of sleep per night.

4) Eat more fruits and vegetables. When we eat a diet high in whole foods, we feed our bodies thousands of micronutrients which stabilize our blood sugar and cholesterol, decrease weight, boost the immune system, reverse heart disease and prevent cancer. An apple a day may keep the doctor away but a mushroom a day will help keep cancer away! The micronutrients found in fruits and vegetables are very powerful antioxidants. Micronutrients create many cell protecting compounds. Many of these compounds such as polyphenols, flavonoids, carotenoids, and phytoestrogens have significant health benefits and are an essential component to optimal health. Micronutrients high in carotenoids are found in carrots, tomatoes, pumpkin, broccoli and spinach. Vegetables that are deep red, purple or black provide rich sources of polyphenols. Flavanoids are found in nuts, seeds, grains, green tea, red wine, kale, and lemons. Phytoestrogens are found in soybeans and flaxseeds. If you do not have access to a fresh variety of produce, then supplement your diet with a good whole food concentrate formula. It's important to incorporate both raw and cooked vegetables into your diet. A simple health tip is that roasting vegetables is easy, quick, and delicious! Cut your vegetables into bite size pieces, drizzle them in olive oil, add salt, pepper and a little cayenne. Roast at 420 degrees for about 20 minutes. To change it up, add raw nuts or dried cranberries in the last five minutes of cooking. You can squeeze fresh lemon juice or shake some parmesan cheese over the top for added flavor.

5) Exercise for 20 minutes a day. It is not necessary to kill yourself at the gym for hours at time. You can get tremendous benefit from just 20 minutes of activity per day, and even walking the dog counts! If you can think of exercise as a play-date, then it can be something to look forward to rather than something to get done! Find something you enjoy doing, and do it. It could be tennis, swimming, hiking, jogging, weightlifting, Zumba aerobics, dancing, pole-dancing, kickboxing, boxing, cardio barre, Nia, yoga, biking, jump rope, hula hooping, climbing stairs, or even just shooting baskets. Think about something you used to love doing and then do it again! If you can commit to anything physical for 20 minutes a day you can make a big impact on your health and really boost your metabolism! Running on a treadmill for 20 minutes a day at 4 mph will take 26 days for you to lose 1 pound of fat. That's a total of 14 pounds of fat in one year from this simple health tip. That's a lot of pant sizes! There are so many fun ways to lose weight and get in shape while improving your heart health, reducing stress, increasing endorphins and building muscle.

None of these simple health tips are rocket science. In fact I bet you knew most of this stuff already, you just don't do them. I spent years looking for complicated diets and supplements to get myself into optimal shape. The best medicine I had, I already knew - I just didn't do it. Make your New Years Resolution a lifestyle change to incorporate healthy habits three weeks at a time!

Daily Health Tips to Stay Fit Forever

Health should be the first and foremost priority of every individual. As with good health only you can feel energetic and fresh all the time. Healthy mind and body boost up your morale to work more efficiently. You cannot perform well without a healthy body.

Maintaining a good health is not at all an easy job to do. You need to take out time to focus on your health like by doing exercises, proper diet, gym etc.

You can find plenty of websites available on the internet that keep you updated with daily health tips. These sites provide you plenty of information about how to keep your body fit all the time. You just need to search the internet carefully to grab best information which you can follow on regular basis.

There are some tips which can be useful for you to keep your health in tone that is, drink as much water as you can. Much of our body and brain is made up by water. So, it is necessary to keep hydrated and flush out toxins. Exercise is very important factor or tip to keep your body in shape and energetic. The various types of physical exercises generate flexibility and strength in the body. One should eat well. Fresh fruits and vegetables are the most important foods to eat to keep your body healthy. A proper diet plan should be from breakfast to dinner which should contain a balanced diet.

Sleeping is also one of the important tips to relax your body and mind from hectic schedule. When you sleep your muscles relax and grow. It is essential to sleep at least 6 hours at night. You are suggested to sleep well and do not take tension at all if you want a healthy body.

A regular adherence to these tips may increase your chances of living a healthy and enjoyable life.

Daily health tips providing sites work 24X7 for the welfare of the people. You can ask all your health related queries anytime and these sites also offer you expert approval guidance. These daily tips are not bound with any age group. No matter whether you are an adolescent or old aged, everyone can find numerous health tips daily. They understand the stress of work on your life; likewise they suggest you some exercises or technique which you can obtain while sitting at office only.

The experts from these sites guide you with best healthy vitamins and other pills available in the market which suits your body. So, start taking your health seriously to stay fit forever.

Occupational Health - Workplace Health Management

Workplace Health Management (WHM) There are four key components of workplace health management:

Occupational Health and Safety
Workplace Health Promotion
Social and lifestyle determinants of health
Environmental Health Management
In the past policy was frequently driven solely by compliance with legislation. In the new approach to workplace health management, policy development is driven by both legislative requirements and by health targets set on a voluntary basis by the working community within each industry. In order to be effective Workplace Health Management needs to be based on knowledge, experience and practice accumulated in three disciplines: occupational health, workplace health promotion and environmental health. It is important to see WHM as a process not only for continuous improvement and health gain within the company, but also as framework for involvement between various agencies in the community. It offers a platform for co-operation between the local authorities and business leaders on community development through the improvement of public and environmental health.

The Healthy Workplace setting - a cornerstone of the Community Action Plan.

The Luxembourg Declaration of the European Union Network for Workplace Health Promotion defined WHP as the combined effort of employers, employees and society to improve the health and well-being of people at work

This can be achieved through a combination of:

Improving the work organization and the working environment
Promoting active participation of employees in health activities
Encouraging personal development
Workplace health promotion is seen in the EU network Luxembourg Declaration as a modern corporate strategy which aims at preventing ill-health at work and enhancing health promoting potential and well-being in the workforce. Documented benefits for workplace programs include decreased absenteeism, reduced cardiovascular risk, reduced health care claims, decreased staff turnover, decreased musculoskeletal injuries, increased productivity, increased organizational effectiveness and the potential of a return on investment (Mossinik, Licher1998 - Oxenburgh 1991).

However, many of these improvements require the sustained involvement of employees, employers and society in the activities required to make a difference. This is achieved through the empowerment of employees enabling them to make decisions about their own health. Occupational Health Advisors (OHA) are well placed to carry out needs assessment for health promotion initiatives with the working populations they serve, to prioritize these initiatives alongside other occupational health and safety initiatives which may be underway, and to coordinate the activities at the enterprise level to ensure that initiatives which are planned are delivered. In the past occupational health services have been involved in the assessment of fitness to work and in assessing levels of disability for insurance purposes for many years.

The concept of maintaining working ability, in the otherwise healthy working population, has been developed by some innovative occupational health services. In some cases these efforts have been developed in response to the growing challenge caused by the aging workforce and the ever-increasing cost of social security. OHA's have often been at the forefront of these developments.

There is a need to develop further the focus of all occupational health services to include efforts to maintain work ability and to prevent non-occupational workplace preventable conditions by interventions at the workplace. This will require some occupational health services to become more pro-actively involved in workplace health promotion, without reducing the attention paid to preventing occupational accidents and diseases. OHA's, with their close contact with employees, sometimes over many years, are in a good position to plan, deliver and evaluate health promotion and maintenance of work ability interventions at the workplace.

Health promotion at work has grown in importance over the last decade as employers and employees recognize the respective benefits. Working people spend about half of their non-sleeping day at work and this provides an ideal opportunity for employees to share and receive various health messages and for employers to create healthy working environments. The scope of health promotion depends upon the needs of each group.

Some of the most common health promotion activities are smoking reducing activities, healthy nutrition or physical exercise programs, prevention and abatement of drug and alcohol abuse.

However, health promotion may also be directed towards other social, cultural and environmental health determinants, if the people within the company consider that these factors are important for the improvement of their health, well-being and quality of life. In this case factors such as improving work organization, motivation, reducing stress and burnout, introducing flexible working hours, personal development plans and career enhancement may also help to contribute to overall health and well-being of the working community.

The Healthy Community setting In addition to occupational health and workplace health promotion there is also another important aspect to Workplace Health Management. It is related to the impact that each company may have on the surrounding ambient environment, and through pollutants or products or services provided to others, its impact on distant environments. Remember how far the effects of the Chernobyl Nuclear accident in 1986 affected whole neighbouring countries.

Although the environmental health impact of companies is controlled by different legislation to that which applies to Health and Safety at work, there is a strong relationship between safeguarding the working environment, improving work organization and working culture within the company, and its approach to environmental health management.

Many leading companies already combine occupational health and safety with environmental health management to optimally use the available human resources within the company and to avoid duplication of effort. Occupational health nurses can make a contribution towards environmental health management, particularly in those companies that do not employ environmental health specialists.

Health Care Reform Made Simple

This blog is a forum for talking "honestly" about:

1. Where health care in America is going?

2. Why it is going there?

3. What can we expect from tomorrow's health care system compared to what we have become used to?

4. What we can do to the best of our ability to use less of it (think preventive health strategies)?

5. How we should think about and help those unfortunate individuals, young and old, who need more of it than we do?

6. How can we help to make sure those who need health care get access to good health care when they need it?

7. What can we do to increase the chances that state of the art health care will be there when we need it and at a price we can afford?

I will also provide education as to how the health care system works from the various perspectives of the stakeholders. It is vital that we understand these perspectives, what drives them and the many conflicts that exist. Areas to cover will be:

1. What is happening to hospitals and physicians in this changing health care landscape?

2. What is happening to the development of innovative future medical technologies and pharmaceuticals?

3. Where is Medicare policy going with regard to payments to physicians and hospitals and other care settings?

4. What is the future of employer-sponsored health insurance plans?

5. Where is changing with regard to private health care insurance companies?

6. What will happen to patient costs?

7. What can I do to avoid premature, unnecessary or unproven health care interventions?

8. What role will "evidence and data" play in the future in giving us more information from which to make personal or family member health care decisions?

I would like this to be the place that you can visit when you hear politicians or anyone else for that matter promising something from health care that just doesn't make sense. We all know the feeling we get when we hear an "it's too good to be true" story. When we hear such fantastic promises, we better check it out and this will be a place where you can do that. So, bring your concerns and questions and I will do my best to help you to check them out!

Have you heard this one; "under my health plan, you need not to worry. Your costs will remain reasonable, you can keep your doctor and you will have access to state of the art health care". Or, "it is every ones right to access the very best in health care, young and old, rich and poor no matter your ability to pay." This would be nice but it is simply not reality and it is time that we talk about these things and deal with them with our rose-colored glasses removed. So, no matter what your point of view on this subject I encourage you to visit ask and comment. We need a grass-roots effort aimed at understanding health care and in particular we need to talk about its funding limits and what we can do to assure that those who need it - get it, and at a level of quality and at a manageable cost such that we can afford it as a nation. If we don't do this it is highly likely that health care as we have known it America will not be available when we face our own or a family members serious and costly illness.

The fundamental flaw in our individual approach to health care is the notion that we have no responsibility for it except to expect it to be there, with no delay, and at state of the art levels of care. And that for the most part it should be paid for by someone else. Most politicians right now are not leveling with us. They don't want to address the areas that I have addressed even in this my first edition health care blog. Well, I think that we are better than that! I think with the right information we can manage through the changes that are coming. We want to do the right thing but to do so we have to be informed as to how stretched the health care system is and what we can do to unburden this precious resource.

First, we can stretch health care dollars and resources by taking better care of ourselves. The goal is to do what "we" can do in terms of learning about and practicing preventive disease strategies, thereby reducing the amount and cost of health care interventions we need. By behaving this way we free up our local health care systems funding and limited physical capacity to treat those who are truly in need. Every one of us that invests in preventive disease strategies will find that the beneficiary is you, your family, and your finances. Pretty tangible benefits wouldn't you say? Perhaps bigger than that is what this behavior and better health for yourself and the avoidance of chronic diseases such as high blood pressure, heart disease, pulmonary (breathing) conditions, diabetes and a host of other conditions can do to unburden the nation's health care system. We need to preserve it, both in terms of resources and dollars, for those who are less fortunate and have to access the system for serious health problems. How good would that feel?

Some would say that America is a scary place to be these days. The events of 9/11, the Iraq and Afghanistan wars, continued threats from terrorism, the housing and subsequent financial meltdowns, the political infighting that gets us nowhere, and yes the health care crisis. These all create the tendency to make us want to "wring our hands" instead of "wringing the necks of politicians" that refuse to provide the leadership that we need.

I have come to a conclusion. I have seen enough to know that the leadership we need has to come from us, the individuals who make up the electorate. Waiting around for politicians to act means we don't understand the world of politics. Politicians only move in one direction or another when an exercised and voting electorate (that's us) frames the issues and leads the way to a solution. It is almost never the other way around.

Bringing it back to health care and the question of what one individual can do to improve things, it starts with one individual and another until we have millions pulling in the same direction. If we manage our health to the best of our ability (and I want to emphasize, truly to the best of our ability) and access the health care system only when we need it, paying a little more out-of-pocket for the incidental and non-life threatening ills and spills we all experience, the system could accommodate us all when we really need it.

So there it is in a nut shell - I have spelled out what I believe is our responsibility; that if we all pulled in the same direction as described above (think of disease prevention and what this can do for you and those who do need to access the health care system) we would dramatically and permanently free up this precious and finite resource and it would be there for others in need and, when we need it and in most cases at far less cost. We are all in this together folks, rich and poor, the older among us and the younger and if we just act responsibly and for the good of others in this matter, we would solve the problem. And then, we could work on the next challenge and the next one after that until we see clearly the power of teamwork - "all for one and one for all". That kind of thinking and behavior can work wonders. We all know it deep down - so let's just do it!

Look for a weekly newsletter and articles that will deal with everything about health care in America. Look for weekly newsletters that discuss changes coming to employer sponsored health care benefits, changes coming to Medicare and Medicaid plans, new technologies that should be of interest, and articles and commentary with regard to state and national healthcare policies as they develop in the months and years to come. Any kind of question you have about health care I can help to point you to resources that will answer these questions. The specifics about your employer sponsored insurance plan, Medicare, Medicaid and how you can incorporate disease prevention strategies into your life with their big benefits. Ask away and if I don't know or can't find the answer, maybe one of this blogs participant's will know. We are all in this together and as long as we believe that and look out for each other - everything will be alright!

Rebuilding the Tower of Babel - A CEO's Perspective on Health Information Exchanges

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.

One piece of the puzzle often overlooked is the patient investment in a functional EHR. In order to bring together all the pieces of the HIE puzzle patients will need to play a more active role in their healthcare. Many patients do not know what medicines they take every day or whether they have a living will. Several versions of patient EHR's like Memitech's 911medical id card exist, but very few patients know or carry them.23 One way to combat this lack of awareness is to use the hospital as a catch-all and discharge each patient with a fully loaded USB card via case managers. This strategy also might lead to better compliance with post in patient therapies to reduce readmissions.

The implementation of connecting qualified organizations began earlier this year. To fully support organizations to move toward qualification the Office of National Coordinator for HIE (ONC) has designated regional education centers (TN rec) who assist providers with educational initiatives in areas like HIT, ICD9 to ICD10 training and EMR transition. Qsource, a non-profit health consulting firm, has been chosen to oversee TNrec. To ensure sustainability it is critical that Tennessee build a network of private funding so that what happened with Carespark won't happen to HIP TN. The eHealth Initiatives 2011Survey Report states that of the 196 HIE initiatives, 115 act independently of federal funding and of those independent HIE's, break even through operational revenue. Some of these exchanges were in existence well before the American Recovery and Reinvestment Act in 2009. Startup funding from grants is only meant to get the car going so to speak, the sustainable fuel, as observed in the case of Carespark, has to come from value that can be monetized. KLAS research reports that 54% of public HIE's were concerned about future sustainability while only 35% of private HIE's shared this concern.

Hospital Implications of HIP TN (A Call to Action)

From a Financial perspective, taking our hospital into the future with EMR and an integrated statewide network has profound implications. In the short term the cost to find a vendor, establish EMR in and outpatient will be an expensive proposition. The transition will not be easy or finite and will involve constant evolution as HIP TN integrates with other state HIE's. To get a realistic idea of the benefits and costs associated with health information integration. we can look to HealthInfoNet in Portland, ME, a statewide HIE that expects to save 37 million dollars in avoided services and 15 million in productivity reduction. Specific areas of savings include paper or fax costs $5 versus $0.25 electronically, virtual health record savings of $50 per referral, $26 saved per ED visit and $17.41 per patient/year due to redundant lab tests which amounts to $52 million for a population of 3 million patients. In Grand Junction Colorado Quality Health Network lowered their per capita Medicare spending to 24% below the national average, gaining recognition by President Obama in 2009. The Santa Cruz Health Information Exchange (SCHIE) with 600 doctors and two hospitals achieved sustainability in the first year of operation and uses a subscription fee for all the organizations who interact with them. In terms of government dollars available, meaningful use incentives exist to encourage hospitals to meet twenty of twenty five objectives in the first phase (2011-2012) and adopting and implement an approved EHR vendor. ARRA specified three ways for EHR to be utilized to obtain Medicare reimbursement. These include e-prescribing, health information exchange and submission of clinical quality measures. The objectives for phase two in 2013 will expand on this baseline. Implementation of EHR and Hospital HIE costs are usually charged by bed or by the number of physicians. Fees can range from $1500 for a smaller hospital up to $12,000 per month for a larger hospital.

Perhaps the most compelling argument to building a functional Health Information Exchange is patient and community safety. The Healthbridge reduction in disease outbreak detection of 3-5 days is a perfect example of this safety benefit. Imagine the implications in the case of a rampant virus like avian or swine flu. The goal is to avoid a repeat of the 1918 influenza outbreak and ultimately save the lives of our most at risk. Rick Krohn of Healthsense makes the case for a socially responsible HIE that serves those who are chronically ill, uninsured and homeless. As the taxpayers ultimately bear the societal burden for our country's healthcare coverage, the need to reduce redundancies, increase efficiency and provide healthcare worthy of the United States is imperative. Right now our healthcare is in the Critical Care Unit it's time to stabilize it through operational excellence starting with our hospital. Let's rebuild the Tower of Babel and enhance communication to provide our patients the healthcare they deserve!

Ten Tips for Comparing Health Care Policies

Australians already know that health coverage can provide security for individuals and families when a medical need arises. Many, however, do not know how to find the best value when comparing health insurance policies.

Below are 10 tips everyone should read before shopping for private health coverage.

1. Choose coverage that concentrates on your specific health needs, or potential health needs.

The first thing you should do before comparing your health plan options is determine which policy features best fit your needs. A 30-year-old accountant, for instance, is going to need very different coverage than a 55year-old pro golfer, or a 75-year-old retired veterinarian. By understanding the health needs that most often correspond to people in your age and activity level group - your life stage - you can save money by purchasing only the coverage you need and avoid unnecessary services that aren't relevant. For instance, a young family with two small children isn't going to need coverage for joint replacement or cataract surgery. A 60-year-old school teacher isn't going to need pregnancy and birth control-related services.

Whether it's high level comprehensive care you're after, or the least expensive option to exempt you from the Medical Levy Surcharge while providing basic care coverage, always make sure you're comparing health insurance policies with only those services that make sense for you and your family.

2. Consider options such as Excess or Co-payment to reduce your premium costs.

When you agree to pay for a specified out-of-pocket amount in the event you are hospitalized, you sign an Excess or Co-payment option that will reduce your health insurance premium.

If you choose the Excess option, you agree to pay a predetermined, specific amount when you go to hospital, no matter how long your stay lasts. With a Co-payment option, you agree to pay a daily sum up to a pre-agreed amount. For example, if Joanne has an Excess of $250 on her medical coverage policy and is admitted to hospital, regardless of how long her stay turns out to be, she will pay $250 of the final bill. If Andrew has signed a $75x4 Co-payment with his provider, he will pay $75 per day for just the first the first four days of his hospitalization.

For younger individuals who are healthy and fit with no reason to expect to land in hospital any time soon, either of these options are great ways to reduce the monthly cost of your medical insurance premiums.
Keep in mind that different private insurers have their own rules when it comes to Excess and Co-payments, including how many payments you will need to make annually on either option. It is important to read the policy thoroughly and ask questions in advance in order to have a clear understanding of what you are paying for, and what you can expect coverage-wise in the event that you are hospitalized. Also, make sure you choose an Excess option greater than $500 if you're purchasing an individual policy, or $1,000 for family coverage, in order to be exempted from the Medicare Levy Surcharge.

3. Pay your health insurance premium in advance before the cost increases.

Each year insurance providers increase their premiums by approximately five percent sometime around the first of April, a practice approved by the Minister of Health. By instituting these annual increases, your health insurance provider retains the ability to fulfill their obligations to policyholders despite increasing medical costs.

Most private medical policy providers allow policy holders to pay for one year's premium in advance, which locks them into the previous year's rate for an additional 12 months - a great way to save money. In order to take advantage of the savings offered, most insurers require payment in full be made within the first quarter of the year, between January and March.

4. Lock in to low cost health insurance at an early age.

The most obvious advantage any Australian can take when it comes to saving money on your insurance premiums is to buy in early to the least expensive rate available. And by early, we mean before age 31. Everyone who is eligible for Medicare will receive at least a 30 percent rebate from the government on the price of their health care premium, no matter what age you are. However, by purchasing hospital coverage before the July first following your 31st birthday, you can be ensured the lowest premium rate available.

After age 31, your health insurance rate is subjected to a two percent penalty rate increase for every year after age 30 that you did not have health insurance. Therefore, if you wait to purchase private health coverage until you're age 35, you will pay 10 percent more annually than you would have if you had purchased it at age 30.

There are exemptions for some people who were overseas when they turned 30, or for new immigrants, and certain others under special exception status. However, if you purchased private insurance after age 30 and are paying an age loading penalty on your health coverage, you will be relieved of the excess penalty after 10 years of continual coverage.

The earlier in life that you lock in to a private health plan, the more money you will save both immediately and over your lifetime.

5. Choose a health care provider who already works with your health fund.

Determine which hospital you prefer if and when the need for treatment does arise, and seek out those health insurance providers that have an agreement with your hospital of choice before making a decision on your health insurance purchase.

It's a good idea to also find out if your insurer has a list of "preferred providers," which would include those physicians and practitioners who also have made arrangements with the health funds regarding their charges for services. Request this information from every provider when comparing health insurance policies. This way you can be sure you'll receive the full gamut of benefits available at the lowest possible cost. These preferred providers often have "no gap" cover - special rates that reduce or eliminate out-of-pocket expenses to policyholders.

6. Double check your health insurance policy before you schedule any treatment or procedures to make sure you have coverage.

Any time you are headed to a private hospital for treatment, first check to see if the hospital and your health insurance provider have an agreement to be absolutely sure you have adequate coverage. At the same time, check with your insurance provider, physician and the hospital to see if there is a Gap between their fees and the government's Medicare Benefits. This is extremely important because if your physician charges more than Medicare covers and you do not have a "no Gap" plan set up, you could find yourself responsible for a considerable bill. Simply contact your doctor and your insurance company to double check on these items, and avoid being saddled with an out-of-pocket expense your weren't expecting.

7. File your expense claims promptly.

When you have a health insurance membership card, you can file a claim against your benefits at the time of treatment with no additional paperwork or filing to worry about, at least in most cases. Sometimes, you may still need to file a claim with your insurance provider. When that happens, make sure to file your claim promptly. The typical cut off for insurers to pay health care claims is two years. You can file your health insurance claim directly with your provider or at your area Medicare office, which has a reciprocal agreement in place with most insurance providers.

8. Whenever you travel overseas, suspend your health coverage.

Anytime you travel overseas for more than a few weeks but less than 24 months, certain medical insurance providers allow policyholders to suspend their memberships for the time they're out of the country, freeing the policyholders from paying premiums during that time period. While your insurance policy is suspended, your Lifetime Health Cover status remains intact, so you do not have to worry about age loading added when you return home. Contact your health insurance provider to make sure of their policy and rules regarding waiting periods and re-activation.

Remember too that Australia has reciprocal arrangements in certain countries, including New Zealand, Finland, Ireland, Italy, Malta, the Netherlands, Sweden and the U.K.

9. Review your policy benefits annually.

Lifestyles change, individuals get married, have children, age - children grow up and move out on their own, couples separate. A lot can happen in the span of 12 months, which is why the Private Health Insurance Ombudsman recommends that everyone review their policy benefits once every year to make sure your coverage still fits your needs.

Regardless of your life changes, your Lifetime Health Cover status remains protected, and waiting periods for benefits that equal your current coverage are waived in compliance with the Private Health Insurance Act of 2007. This means you will be able to file claims related to features you had before you made any changes without interruption in benefits.

10. Compare policies to get the best price and the coverage you need.