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CollegeStudentsontheJobMarket（adbcadbequipmentinyouroffice,available,atemporaryofficeorequipment.47.答案Thereareadvantagesanddisadvantagesinbeinglazy.48.答案theyaredistrustfuloftheirfellowworkers49答案Lazinesscanactuallybehelpfulsometimes.50答案theymaybethinking，resting，orplanningtheirnextwork.51答案delusions.Bcccd,ccdcc.babca,ccacd,bcacd,bcdcb82.答案arefreshmenpermittedtotakemake-uptests.83.答案noneotherthanthefamousscientist.84.答案therateofunemploymentinthatnationwillhaverisentoabout3%.85.答案agreatdealoftimeandenergywouldhavebeensaved.86.答案incasehehaddesignsonmyjob)WillElectronicMedicalRecordsImproveHealthCare?Electronichealthrecords(EHRs)havereceivedalotofattentionsincetheObamaadministrationcommitted$19billioninstimulusfundsearlierthisyeartoencouragehospitalsandhealthcarefacilitiestodigitizepatientdataandmakebetteruseofinformationtechnology.Thehealthcareindustryasawhole,however,hasbeenslowtoadoptinformationtechnologyandintegratecomputersystems,raisingthequestionofwhetherthepushtodigitizewillresultininformationthatempowersdoctorstomakebetter-informeddecisionsoramorassofdisconnecteddata.TheUniversityofPittsburghMedicalCenter(UPMC)knowsfirsthandhowdifficultitistoachievetheformer,andhoweasilyanEHRplancanfallintothelatter.UPMChasspentfiveyearsandmorethan$1billiononinformationtechnologysystemstogetaheadoftheEHRissue.Whilethatismorethanfivetimesasmuchasrecentestimatessayitshouldcostahospitalsystem,UPMCisamammothnetworkconsistingof20hospitalsaswellas400doctors’offices,outpatientsitesandlong-termcarefacilitiesemployingabout50,000people.UPMC’searlyattemptstocreateauniversalEHRsystem,suchasitsambulatoryelectronicmedicalrecordsrolledoutbetween2000and2005,weremetwithresistanceasdoctors,staffandotheruserseitheravoidedusingthenewtechnologyaltogetherorclungtoindividual,disconnectedsoftwareandsystemsthatUPMC’sITdepartmenthadimplementedovertheyears.OnthemendAlthoughUPMCbegandigitizingsomeofitsrecordsin1996,theturningpointinitseffortscamein2004withtherolloutofitseRecordsystemacrosstheentirehealthcarenetwork.eRecordnowcontainsmorethan3.6millionelectronicpatientrecords,includingimagesandCTscans,clinicallaboratoryinformation,radiologydata,andapicturearchivalandcommunicationsystemthatdigitizesimagesandmakesthemavailableonPCs.TheEHRsystemhas29,000users,includingmorethan5,000physiciansemployedbyoraffiliatedwithUPMC.IfUPMCmakesEHRsystemslookeasy,don’tbefooled,cautionsUPMCchiefmedicalinformationofficerDanMartich,whosaysthehealthcarenetwork’sITsystemsrequireahuge,ongoingefforttoensurethatthosesystemscancommunicatewithoneanother.OneofthemainreasonsisthatUPMC,likemanyotherhealthcareorganizations,usesanumberofdifferentvendorsforitsmedicalandITsystems,leavingtheintegrationlargelyuptotheITstaff.Sincedoctorstypicallydonotwanttochangethewaytheyworkforthesakeofacomputersystem,thesuccessofanEHRprogramisdictatednotonlybythepresenceofthetechnologybutalsobyhowwellthedoctorsaretrainedon,anduse,thetechnology.PhysiciansneedtoseethebenefitsofusingEHRsystemsbothpersistentlyandconsistently,saysLouisBaverso,chiefinformationofficeratUPMC’sMagee-Women’sHospital.Butthesebenefitsmightnotbeobviousatfirst,hesays,adding,Whatdoctorsseeinthebeginningisthatthey’relosingtheirabilitytoworkwithpaperdocuments,whichhasbeensovaluabletothemupuntilnow.OpportunitiesandcostsGiventhelackofEHRadoptionthroughoutthehealthcareworld,therearealotofopportunitiestogetthisright(orwrong).Lessthan10percentofU.S.hospitalshaveadoptedelectronicmedicalrecordseveninthemostbasicway,accordingtoastudyauthoredbyAshishJha,associateprofessorofhealthpolicyandmanagementatHarvardSchoolofPublicHealth.Only1.5percenthaveadoptedacomprehensivesystemofelectronicrecordsthatincludesphysicians’notesandordersanddecisionsupportsystemsthatalertdoctorsofpotentialdruginteractionsorotherproblemsthatmightresultfromtheirintendedorders.CostistheprimaryfactorstallingEHRsystems,followedbyresistancefromphysiciansunwillingtoadoptnewtechnologiesandalackofstaffwithadequateITexpertise,accordingtoJha.Heindicatedthatahospitalcouldspendfrom$20millionto$200milliontoimplementanelectronicrecordsystemoverseveralyears,dependingonthesizeofthehospital.Atypicaldoctor’sofficewouldcostanestimated$50,000tooutfitwithanEHRsystem.TheupsideofEHRsystemsismoredifficulttoquantify.Althoughsomeestimatessaythathospitalsanddoctor’sofficescouldsaveasmuchas$100millionannuallybymovingtoEHRs,themereactofimplementingthetechnologyguaranteesneithercostsavingsnorimprovementsincare,JhasaidduringaHarvardSchoolofPublicHealthcommunityforumonSeptember17.AnotherHarvardstudyofhospitalcomputerizationlikewisedeterminedthatcuttingcostsandimprovingcarethroughhealthITasitexiststodayiswishfulthinking.ThisstudywasledbyDavidHimmelstein,associateprofessoratHarvardMedicalSchool.ThecostofgettingitwrongThedifferencebetweentheprojectedcostsavingsandtherealityofthesituationstemsfromthefactthattheEHRtechnologiesimplementedtodatehavenotbeendesignedtosavemoneyorimprovepatientcare,saysLeonardD’Avolio,associatecenterdirectorofBiomedicalInformaticsattheMassachusettsVeteransEpidemiologyResearcha