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Electronic Aspirin Market Key Manufacturers, Development Trends And Competitive Analysis 2025

Electronic Aspirin Market Key Manufacturers, Development Trends And Competitive Analysis 2025 , 7 June 2019 — Electronic Aspirin Market Size, Status and Forecast to 2025With the changing lifestyle, recurrent headaches are common. In recent times, stress has increased significantly due to excess work. As a result, patients has resorted to self-medication of known analgesic drug brands. For headache, aspirin is the most common brand available worldwide. According to the world health organization (WHO), prevalence of headache among is about 50%. In addition, migraine is the third most prevalent disease with approximately one billion people being affected worldwide (Source: Migraine Research Foundation). Electronic aspirin is an advanced technology intended to benefit patients in terms of pain relief. For example, relief from cluster headache, migraine, and other continuing facial and head pains. As per the WHO, migraine is positioned in the top 20 causes of disability worldwide. View Report: https://www.transparencymarketresearch.com/electronic-aspirin-market.html In the treatment using electronic aspirin, a nerve-stimulated insert is placed in the patient’s gum area (in the superior part of gum area). It is placed near the part where the patient feels the most pain. The process to placing the device is quite simple and is conducted with negligible invasiveness. It has slight side-effects. The insert is positioned close to the SPG (sphenopalatine ganglion), a group of nerves located in deeper part of the bone cavity in the mid-face area. The permanently fixed insert has a pointed tip that is connected to the SPG group of nerves. When a patient first experiences a headache, he/she holds a remote controller device on the cheek area adjacent to the inserted device. The patient operates the hand-held remote controller device; a low electric charge stimulates, which blocks pain-causing neurotransmitters. The patient is in total controller of the device. He/she can turn it off or on, as per the requirement. At the beginning of 20th century, study of SPG blockage started for headache treatment, first it was initiated in 1908. Certain patients experience immediate reduction in pain. Normally, aspirin takes about 15 minutes to few hours to relieve the pain. As per a study, around 88% of the patients indicate that they need less medication or no medication for headache for ongoing relief. According to WHO report, most of the treatment of migraine is focused on the pain management. SPG-blocking aspirin such as electronic aspirin works to relieve symptoms. Increasing incidence of migraine caused by rising cigarette consumption and increasing prevalence of headache are the major drivers for the market for electronic aspirin. Moreover, increasing health care expenditure, technological advancements, rising awareness about migraine, and accelerated economic growth are factors driving the electronic aspirin market. However, regulatory challenges and high cost associated with electronic aspirin are major restraints for the market for electronic aspirin. //www.transparencymarketresearch.com/sample/sample.php?flag=B&rep_id=28577 The electronic aspirin market can be segmented by end-user and region. Based on end–user, the electronic aspirin market has been categorized into hospitals, ambulatory surgical centres (ASCs), and others. Based on region, the global electronic aspirin market has been divided into four regions such as North America, Latin America, Asia Pacific, and Demand for electronic aspirin is high in the regions with high prevalence of headache; for example, developed countries such as U.S., Canada, and certain European countries. On the other hand, the health care industry in Latin America, Asia Pacific, and Africa is in the developing phase. Hence, demand for implantable devices in these regions is rising at a sluggish pace. The rise of health tourism, increasing investments in research and development, and rising access to medical facilities in these countries are factors expected to increase the demand for electronic aspirin in these counties. Presently, Autonomic Technologies, Inc. (ATI) is the only company investing in the development of electronic aspirin. ATI is also a manufacturer of neurostimulation systems, which shows that the electronic aspirin device developed by the company would be able to treat the cluster headache effectively, thereby improving the overall quality of life.

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Helping you rest and also loosen up by treating your frustration/ migraine with some ASMR as well as realities!
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Disclaimer: *** This video clip is created for leisure, amusement and ASMR/tingles/chills causing functions just. To learn more about ASMR sensation please go here:
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Discover Energy Medicine Quick Tips for Headache Relief

Regularly I am asked about how Acupuncture as well as Energy Medicine can help alleviate frustrations. I recognize how uncomfortable and also in some cases disabling frustrations can be so I’m showing to you several of my preferred Energy Medicine acupressure points for migraine alleviation. Provide them a try and let us recognize just how they are benefiting you.

That implies one in every 6 people are experiencing a migraine of some kind and fifty percent of the grown-up population worldwide have had at the very least one migraine within the past year. If you endure from headaches, you can see you are not alone so read on to find out what you can do for headache relief.

To read even more regarding Energy Medicine for Headaches and the 4 W’s – Who, What When as well as Where: http://wellwithin.net/energymedicinetopics/energy_medicine_for_headaches/

For more information about Energy Medicine for Brain Health as well as devices to support the worried system, http://www.energymedicinestore.com/Energy-Mastery-for-Brain-Health-Online-Video-Series_p_239.html

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For our FREE eNewsletter and book “Energy Medicine: Your Personal Health as well as Wellness System for Today” http://www.wellwithin.net/

Inspired by Melanie Smith, Eden Energy Medicine Advanced Practitioner, Doctor of Oriental Medicine, as well as Acupuncture Physician as component of our Energy Medicine for Healthy Living ™ collection from Well Within Natural Medicine.

Power medicine can deal with physical health problem as well as psychological or psychological disorders, and also can likewise promote high-level health as well as optimal efficiency. By learning straightforward energy methods, you can enhance your health, hone your mind, and also raise your pleasure as well as vigor.

Be Well Within …

© 2016 Well Within Natural Medicine, Inc. www.wellwithin.net

Gout Pain Relief – Is Acupressure An Effective Pain Relief Gout Treatment?

pineapple and uric acid – Home Remedy for Gout- Naturally Cure Gout with Simple ???Natural Health’ Tips Home Remedy for Gout- Naturally Cure Gout with Simple ???Natural Health’ Tips Are you wondering what is best home remedy for gout ? Are you part of the millions who want to naturally cure gout but are wondering where to start?Unfortunately, this is the same thing that happens when a doctor treats gout. Because doctors will typically prescribe one of three types of medicinal treatments; Traditional treatments include Non-Steroidal Anti-Inflammatory Drugs (NSAIDs); Corticosteroids; and Colchicines. Though all of these treatments will numb the pain, none of the treatments will cure the cause of gout, high uric acid levels. To discover a list of major side-effects of traditional treatments, please visit our Home Remedy for Gout website. Try Goutezol for 60 Days People Said About Goutezol Gout Relief ” I was only 30 when I got a gout attack. Goutezol really helped me to get over the attack in just two days and the ebook helps me with watching what I’m eating. My uncle have had gout problems too, so I recommended your product. Thanks a lot! ” Matt, California 4. Maintain Healthy Weight! Every pound you shed gives you a better chance of leaving gout in the dust. Begin eating healthier with fruits, veggies, fresh foods, whole grains and low fat foods.And though gout is common today, you can cure gout by reversing the risk factors (alcohol and being overweight). Specifically, gout can naturally be cured by changing simple lifestyle habits. Treat It and Forget It! Blueberries, bananas, cherries, strawberries, barley, hawthorn and much, much more! Are you interested in a ‘treat it and forget it’ remedy cure? If you are serious about saying good-bye to gout forever, visit our Home Remedy for Gout website, and consider a 100% guaranteed (you are cured and completely satisfied-promise), medical doctor-approved, researched based Gout Remedy Report that has literally helped tens of thousands. Because your health is worth it! 4. Exercise, obviously! – I recently read an article of over 1,000 benefits from exercise. And can you believe it, they forgot to list that exercise will eventually help you cure gout. By lowering your Body Mass Index (BMI) and maintaining a healthy body weight, you can naturally cure gout !Imagine a man with a brain tumor who is always getting headaches. The man continues to take aspirin, prescribed by his doctor, to relieve the headache only to find out that his migraine returns. Though the doctor continues to prescribe aspirin; the pain reliever will NEVER cure the brain tumor. In fact, the brain tumor will only get worse if drastic measures are not taking. Did you know that gout has often been labeled the most painful types of arthritis? Unfortunately, you or either someone you know suffers from gout. Perhaps, you are grieving with the disease that makes sleep and life miserable. Heat, Pain, Redness, Stiffness, Swelling, Arthritis attacks are a common event in the life of gout suffers. But it doesn’t have to be this way? You can prevent gout attacks be making some simple lifestyle changes, lowering your uric acid levels and you can also cure gout attacks in minutes with even simpler gout home remedies! However, most of these home remedies are unknown by most sufferers. 4. Exercise, obviously! – I recently read an article of over 1,000 benefits from exercise. And can you believe it, they forgot to list that exercise will eventually help you cure gout. By lowering your Body Mass Index (BMI) and maintaining a healthy body weight, you can naturally cure gout ! 2. Limit Alcohol- Alcohol has also shown to raise the uric acid levels in the body. You should never drink more than 2 alcoholic drinks per day. The key is to keep the uric acid levels down.2. Take Vitamin C tablets! Vitamin C as well as fruit also lowers uric acid levels in the body thus preventing gout. 3. Apple cider vinegar – both ingested and applied to swollen area can help treat your symptoms. As a mixture you drink, it is thought that apple cider vinegar actually changes the pH of your blood which lowers uric acid levels.If you are intersted in finding more information about gout you can click on this website http://www.gout-info-center.com . Also you will find there valuable information about gout treatments and gout diet . Home Remedy for Gout Cure gout in hours, guaranteed! Allow Joe Barton and Barton Publishing to help you with a 100% guaranteed, research-based, doctor-approved Home Remedy for Gout! Visit us today for your toe’s sake! Treat It and Forget It! Blueberries, bananas, cherries, strawberries, barley, hawthorn and much, much more! Are you interested in a ‘treat it and forget it’ remedy cure? If you are serious about saying good-bye to gout forever, visit our Home Remedy for Gout website, and consider a 100% guaranteed (you are cured and completely satisfied-promise), medical doctor-approved, researched based Gout Remedy Report that has literally helped tens of thousands. Because your health is worth it! Natural Health Gout Tips 1. Avoid Animal Protein- Meat from animals typically contains a high number of purines which will cause your uric levels to shoot through the roof. In order to decrease the likelihood of an attack, avoid foods high in purines. Our Naturally Cure Gout website gives a list of foods to avoid and a list of foods you should eat! Simple Gout Prevention by Lowering Uric Acid Levels 1. Water has been known to be beneficial to almost every ailment, including gout. Drink 10-12 glasses of water each day will prevent uric acid crystals from forming and thus prevent gout!And though gout is common today, you can cure gout by reversing the risk factors (alcohol and being overweight). Specifically, gout can naturally be cured by changing simple lifestyle habits.You can have your gout treated, but it does not make any difference when it come to symptoms. The gout symptoms will actually go away in about one week, even if you do not treat your gout signs. Furthermore, there is always the chance that you will not suffer from another gout flare again. However, if you do suffer from other gout flares, this do not look so good for you. As time passes, the gout attacks become more painful. There is also the risk that if suffering from more than one gout attack, the duration of the attacks increases with time.However, by naturally curing gout with simple lifestyle habit changes, you can decrease uric acid levels (cause of gout) and naturally cure gout permanently. The following is a list our natural health medical doctor recommends to our customers. 5. Vitamins! It has been documented that Vitamin C has been shown to help reduce uric acid levels in the body. Thus, resulting in less gout acute attacks. We also recommend finding a quality multi-vitamin for supplementing.By choosing to take any of the following treatments, you can actually cause more harm to the affected joint and not even realize it. Though your brain might be telling you that ‘it doesn’t hurt’; your joint might be ‘screaming with pain’.By choosing to take any of the following treatments, you can actually cause more harm to the affected joint and not even realize it. Though your brain might be telling you that ‘it doesn’t hurt’; your joint might be ‘screaming with pain’.Unfortunately, this is the same thing that happens when a doctor treats gout. Because doctors will typically prescribe one of three types of medicinal treatments; Traditional treatments include Non-Steroidal Anti-Inflammatory Drugs (NSAIDs); Corticosteroids; and Colchicines. Though all of these treatments will numb the pain, none of the treatments will cure the cause of gout, high uric acid levels. To discover a list of major side-effects of traditional treatments, please visit our Home Remedy for Gout website.A gout attack strikes when you least expected it, that is to say at night. When you are sleeping peacefully, you suddenly feel some tenderness in the large joint of your big toe. That is a gout flare. That area suddenly becomes swollen, red and extremely painful. You might also develop a fever when suffering from a gout flare. The next 24 hours will also be very painful when having a gout.Are you wondering what is best home remedy for gout ? Are you part of the millions who want to naturally cure gout but are wondering where to start? People Said About Goutezol Gout Remedy ” week ago i couldnt walk and was in terible pain. i though my big toe was broken i would need a surgery, but doctor said it was gout. After taking some pain killer and goutezol for 2 days i can walk again. thank you ” Peter from Chicago 5. Vitamins! It has been documented that Vitamin C has been shown to help reduce uric acid levels in the body. Thus, resulting in less gout acute attacks. We also recommend finding a quality multi-vitamin for supplementing. To Cure Gout is to Reverse the Risk-factors Gout has been around for 3000 years and was even known as the ‘disease of kings’ because many kings would get the arthritis from their luxurious lifestyles. Being that gout is caused from being overweight and excessive alcohol consumption, it was no wonder most kings were stricken with gout. Though many treatments have been tried over the last 30 centuries, most treatments that WORK would be considered under the category of ‘natural health’. 3. Drink half your body weight- You should be drinking half your body weight in ounces of water per day. That means if you weigh 200 lbs. you should be drinking 100 ounces of water per day. That equates to 12 glasses of water per day. Water is a natural flusher and essential for optimal health!However, by naturally curing gout with simple lifestyle habit changes, you can decrease uric acid levels (cause of gout) and naturally cure gout permanently. The following is a list our natural health medical doctor recommends to our customers. Home Remedy for Gout 3. Drink half your body weight- You should be drinking half your body weight in ounces of water per day. That means if you weigh 200 lbs. you should be drinking 100 ounces of water per day. That equates to 12 glasses of water per day. Water is a natural flusher and essential for optimal health!You most likely have already seen a doctor about your arthritic condition? Though doctors might prescribe a ‘hefty’ pain medication, this is not a cure! Pain medications are meant to help you deal with the pain and will never fully treat or cure the gout problem you are dealing with. In fact, the only way to cure gout is to use simple, effective natural health tips that have been around since King David ruled. Seriously!When suffering from a gout, there are more factors of risk involved. However, one of those factors is the head of the list when talking about a gout attack. Elevated uric acid levels in your blood, also know as hyperuricemia is the main risk in a gout. All people who suffer from this condition are predisposed to having a gout flare. As your levels of acid rise in your blood, so does the risk of having a gout attack. Furthermore, this gout flare is very unpredictable. No one can say for sure when you are likely to have a gout attack. However, there are some factors that are thought to trigger the gout flare. Certain medicines, alcohol, stress and some other medical problems that you might suffer from may trigger a gout. Even if such factors are thought to be the ones responsible for a gout attack, there are many times that neither you nor your doctor can say for sure what was the cause of your gout flare. To predict the time of the chances of you having a gout attack can be done. This is not quite certain, but it may give you an idea. all you have to do is visit your doctor and have your levels of uric acid measured. This is the way to predict if you are likely to suffer from a gout attack in the future or not. Cure Your Gout Website Joe Barton writes for Barton Publishing Inc., a natural health company specializing in educating people of safe, affordable natural remedies. To see how you can naturally treat your gout in minutes… guaranteed! Click here: Cure Your Gout Website Naturally Cure Gout vs. a Doctor’s Prescription I am not completely opposed to prescription medications but in some cases prescriptions do more harm than good! Especially, when it comes to treating gout! But, I need immediate relief? You can also naturally have immediate relief for your gout attacks in hours. Believe it or not, you can be relieved of gout pain in hours if you take specific foods (at every grocery store) whenever your gout attacks occur. Imagine, being able to fall back to sleep and NOT being awake the rest of the night. Learn how thousands are naturally treating their gout and learning how to take back their life from gout’s symptoms. And finally, I want to urge you to consider a guaranteed natural remedy with no side-effects instead of the traditional medicinal approaches which carry numerous negative side effects. Besides having immediate relief, you will save hundreds from over-priced prescriptions and the hundred dollar hospital visit. Besides, with a 100% no-questions asked guarantee, what else could be stopping you? Please take some time to check out our website. 2. Limit Alcohol- Alcohol has also shown to raise the uric acid levels in the body. You should never drink more than 2 alcoholic drinks per day. The key is to keep the uric acid levels down. Home Remedy for Gout Cure gout in hours, guaranteed! Allow Joe Barton and Barton Publishing to help you with a 100% guaranteed, research-based, doctor-approved Home Remedy for Gout! Visit us today for your toe’s sake! Natural Health Gout Tips 1. Avoid Animal Protein- Meat from animals typically contains a high number of purines which will cause your uric levels to shoot through the roof. In order to decrease the likelihood of an attack, avoid foods high in purines. Our Naturally Cure Gout website gives a list of foods to avoid and a list of foods you should eat!Imagine a man with a brain tumor who is always getting headaches. The man continues to take aspirin, prescribed by his doctor, to relieve the headache only to find out that his migraine returns. Though the doctor continues to prescribe aspirin; the pain reliever will NEVER cure the brain tumor. In fact, the brain tumor will only get worse if drastic measures are not taking.5. Take a hike! Literally, go for a walk or a hike to get some exercise. You would be surprised how much better you will about yourself and your body! And you will also shed some extra pounds.You most likely have already seen a doctor about your arthritic condition? Though doctors might prescribe a ‘hefty’ pain medication, this is not a cure! Pain medications are meant to help you deal with the pain and will never fully treat or cure the gout problem you are dealing with. In fact, the only way to cure gout is to use simple, effective natural health tips that have been around since King David ruled. Seriously! Naturally Cure Gout vs. a Doctor’s Prescription I am not completely opposed to prescription medications but in some cases prescriptions do more harm than good! Especially, when it comes to treating gout!Almost ninety percent of all gout patients, suffer from flares in the big toe. However, gout attacks may happen in other joints, like the knee, fingers, wrist. The gout signs are the same no matter the location of the attack. To Cure Gout is to Reverse the Risk-factors Gout has been around for 3000 years and was even known as the ‘disease of kings’ because many kings would get the arthritis from their luxurious lifestyles. Being that gout is caused from being overweight and excessive alcohol consumption, it was no wonder most kings were stricken with gout. Though many treatments have been tried over the last 30 centuries, most treatments that WORK would be considered under the category of ‘natural health’.

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Migraine Relief Head Massage Trigger Point Therapy, Body Work Masters Gregory Gorey
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Death by a Thousand Clicks: Where Electronic Health Records Went Wrong

Stay Connected Death by a Thousand Clicks: Where Electronic Health Records Went Wrong The U.S. government claimed that turning American medical charts into electronic records would make health care better, safer, and cheaper. Ten years and $36 billion later, the system is an unholy mess: Inside a digital revolution gone wrong. A joint investigation by Fortune and Kaiser Health News. By Erika Fry and Fred Schulte March 18, 2019
The pain radiated from the top of Annette Monachelli’s head, and it got worse when she changed positions. It didn’t feel like her usual migraine. The 47-year-old Vermont attorney turned innkeeper visited her local doctor at the Stowe Family Practice twice about the problem in late November 2012, but got little relief.
Two months later, Monachelli was dead of a brain aneurysm, a condition that, despite the symptoms and the appointments, had never been tested for or diagnosed until she turned up in the emergency room days before her death.
Monachelli’s husband sued Stowe, the federally qualified health center the physician worked for. Owen Foster, a newly hired assistant U.S. attorney with the District of Vermont, was assigned to defend the government. Though it looked to be a standard medical malpractice case, Foster was on the cusp of discovering something much bigger—what his boss, U.S. Attorney Christina Nolan, calls the “frontier of health care fraud”—and prosecuting a first-of-its-kind case that landed the largest-ever financial recovery in Vermont’s history.
Foster began with Monachelli’s medical records, which offered a puzzle. Her doctor had considered the possibility of an aneurysm and, to rule it out, had ordered a head scan through the clinic’s software system, the government alleged in court filings. The test, in theory, would have caught the bleeding in Monachelli’s brain. But the order never made it to the lab; it had never been transmitted.
The software in question was an electronic health records system, or EHR, made by eClinicalWorks (eCW), one of the leading sellers of record-keeping software for physicians in America, currently used by 850,000 health professionals in the U.S. It didn’t take long for Foster to assemble a dossier of troubling reports —Better Business Bureau complaints, issues flagged on an eCW user board, and legal cases filed around the country—suggesting the company’s technology didn’t work quite like it said it did.
Until this point, Foster, like most Americans, knew next to nothing about electronic medical records, but he was quickly amassing clues that eCW’s software had major problems—some of which put patients, like Annette Monachelli, at risk.
Damning evidence came from a whistleblower claim filed in 2011 against the company. Brendan Delaney, a British cop turned EHR expert, was hired in 2010 by New York City to work on the eCW implementation at Rikers Island, a jail complex that then had more than 100,000 inmates. But soon after he was hired, Delaney noticed scores of troubling problems with the system, which became the basis for his lawsuit. The patient medication lists weren’t reliable; prescribed drugs would not show up, while discontinued drugs would appear as current, according to the complaint. The EHR would sometimes display one patient’s medication profile accompanied by the physician’s note for a different patient, making it easy to misdiagnose or prescribe a drug to the wrong individual. Prescriptions, some 30,000 of them in 2010, lacked proper start and stop dates, introducing the opportunity for under- or overmedication. The eCW system did not reliably track lab results, concluded Delaney, who tallied 1,884 tests for which they had never gotten outcomes.
The District of Vermont launched an official federal investigation in 2015. Photograph by The Voorhes for Fortune
eCW’s spaghetti code was so buggy that when one glitch got fixed, another would develop, the government found. The user interface offered a few ways to order a lab test or diagnostic image, for example, but not all of them seemed to function. The software would detect and warn users of dangerous drug interactions, but unbeknownst to physicians, the alerts stopped if the drug order was customized. “It would be like if I was driving with the radio on and the windshield wipers going and when I hit the turn signal, the brakes suddenly didn’t work,” says Foster.
The eCW system also failed to use the standard drug codes, and in some instances, lab and diagnosis codes as well, the government alleged.
The case never got to a jury. In May 2017, eCW paid a $155 million settlement to the government over alleged “false claims” and kickbacks—one physician made tens of thousands of dollars—to clients who promoted its product. Despite the record settlement, the company denied wrongdoing; eCW did not respond to numerous requests for comment.
If there is a kicker to this tale, it is this: The U.S. government bankrolled the adoption of this software—and continues to pay for it. Or we should say: You do.
Which brings us to the strange, sad, and aggravating story that unfolds below. It is not about one lawsuit or a piece of sloppy technology. Rather, it’s about a trouble-prone industry that intersects, in the most personal way, with every one of our lives. It’s about a $3.7-trillion-dollar health care system idling at the crossroads of progress. And it’s about a slew of unintended consequences—the surprising casualties of a big idea whose time had seemingly come. The Virtual Magic Bullet
Electronic health records were supposed to do a lot: make medicine safer, bring higher-quality care, empower patients, and yes, even save money. Boosters heralded an age when researchers could harness the big data within to reveal the most effective treatments for disease and sharply reduce medical errors. Patients, in turn, would have truly portable health records, being able to share their medical histories in a flash with doctors and hospitals anywhere in the country—essential when life-and-death decisions are being made in the ER.
But 10 years after President Barack Obama signed a law to accelerate the digitization of medical records—with the federal government, so far, sinking $36 billion into the effort—America has little to show for its investment. Kaiser Health News (KHN) and Fortune spoke with more than 100 physicians, patients, IT experts and administrators, health policy leaders, attorneys, top government officials, and representatives at more than a half-dozen EHR vendors, including the CEOs of two of the companies. The interviews reveal a tragic missed opportunity: Rather than an electronic ecosystem of information, the nation’s thousands of EHRs largely remain a sprawling, disconnected patchwork. Moreover, the effort has handcuffed health providers to technology they mostly can’t stand and has enriched and empowered the $13-billion-a-year industry that sells it. Joe Biden watches Barack Obama sign the American Recovery and Reinvestment Act in February 2009, which included a stimulus for electronic health records Charles Ommanney—Getty Images
By one measure, certainly, the effort has achieved what it set out to do: Today, 96% of hospitals have adopted EHRs, up from just 9% in 2008. But on most other counts, the newly installed technology has fallen well short. Physicians complain about clumsy, unintuitive systems and the number of hours spent clicking, typing, and trying to navigate them—which is more than the hours they spend with patients. Unlike, say, with the global network of ATMs, the proprietary EHR systems made by more than 700 vendors routinely don’t talk to one another, meaning that doctors still resort to transferring medical data via fax and CD-ROM. ­Patients, meanwhile, still struggle to access their own records—and, sometimes, just plain can’t.
Instead of reducing costs, many say EHRs, which were originally optimized for billing rather than for patient care, have instead made it easier to engage in “upcoding” or bill inflation (though some say the systems also make such fraud easier to catch).
More gravely still, a months-long joint investigation by KHN and Fortune has found that instead of streamlining medicine, the government’s EHR initiative has created a host of largely unacknowledged patient safety risks. Our investigation found that alarming reports of patient deaths, serious injuries, and near misses—thousands of them—tied to software glitches, user errors, or other flaws have piled up, largely unseen, in various government-funded and private repositories.
Compounding the problem are entrenched secrecy policies that continue to keep software failures out of public view. EHR vendors often impose contractual “gag clauses” that discourage buyers from speaking out about safety issues and disastrous software installations—though some customers have taken to the courts to air their grievances. Plaintiffs, moreover, say hospitals often fight to withhold records from injured patients or their families. Indeed, two doctors who spoke candidly about the problems they faced with EHRs later asked that their names not be used, adding that they were forbidden by their health care organizations to talk. Says Assistant U.S. Attorney Foster, the EHR vendors “are protected by a shield of silence.”
Though the software has reduced some types of clinical mistakes common in the era of handwritten notes, Raj Ratwani, a researcher at MedStar Health in Washington, D.C., has documented new patterns of medical errors tied to EHRs that he believes are both perilous and preventable. “The fact that we’re not able to broadcast that nationally and solve these issues immediately, and that another patient somewhere else may be harmed by the very same issue—that just can’t happen,” he says.
David Blumenthal, who, as Obama’s national coordinator for health information technology, was one of the architects of the EHR initiative, acknowledges to KHN and Fortune that electronic health records “have not fulfilled their potential. I think few would argue they have.” MedStar’s Raj Ratwani (standing) studies eyetracking with Dr. Zach Hettinger to see how doctors interact with EHRs Photograph by T.J. Kirkpatrick for Fortune
The former President has likewise singled out the effort as one of his most disappointing, bemoaning in a January 2017 interview with Vox “the fact that there are still just mountains of paperwork … and the doctors still have to input stuff, and the nurses are spending all their time on all this administrative work. We put a big slug of money into trying to encourage everyone to digitalize, to catch up with the rest of the world … that’s been harder than we expected.”
Seema Verma, the current chief of the Centers for Medicare and Medicaid Services (CMS), which oversees the EHR effort today, shudders at the billions of dollars spent building software that doesn’t share data—an electronic bridge to nowhere. “Providers developed their own systems that may or may not even have worked well for them,” she tells KHN and Fortune in an interview this February, “but we didn’t think about how all these systems connect with one another. That was the real missing piece.”
Perhaps none of the initiative’s former boosters is quite as frustrated as former Vice President Joe Biden. At a 2017 meeting with health care leaders in Washington, he railed against the infuriating challenge of getting his son Beau’s medical records from one hospital to another. “I was stunned when my son for a year was battling Stage 4 glioblastoma,” said Biden. “I couldn’t get his records. I’m the Vice President of the United States of America … It was an absolute nightmare. It was ridiculous, absolutely ridiculous, that we’re in that circumstance.”
A Bridge to Nowhere
As Biden will tell you , the original concept was a smart one. The wave of digitization had swept up virtually every industry, bringing both disruption and, in most cases, greater efficiency. And perhaps none of these industries was more deserving of digital liberation than medicine, where life-measuring and potentially lifesaving data was locked away in paper crypts—stack upon stack of file folders at doctors’ offices across the country.
Stowed in steel cabinets, the records were next to useless. Nobody—particularly at the dawn of the age of the iPhone—thought it was a good idea to leave them that way. The problem, say critics, was in the way that policy­makers set about to transform them.
“Every single idea was well-meaning and potentially of societal benefit, but the combined burden of all of them hitting clinicians simultaneously made office practice basically impossible,” says John Halamka, chief information officer at Beth Israel Deaconess Medical Center, who served on the EHR standards committees under both George W. Bush and Barack Obama. “In America, we have 11 minutes to see a patient, and, you know, you’re going to be empathetic, make eye contact, enter about 100 pieces of data, and never commit malpractice. It’s not possible!”
KHN and Fortune examined more than two dozen medical negligence cases that have alleged that EHRs either contributed to injuries, had been improperly altered, or were withheld from patients to conceal substandard care. In such cases, the suits typically settle prior to trial with strict confidentiality pledges, so it’s often not possible to determine the merits of the allegations. EHR vendors also frequently have contract stipulations, known as “hold harmless clauses,” that protect them from liability if hospitals are later sued for medical errors—even if they relate to an issue with the technology.
But lawsuits, like that filed by Fabian ­Ronisky, which do emerge from this veil, are quite telling.
Ronisky, according to his complaint, arrived by ambulance at Providence Saint John’s Health Center in Santa Monica on the afternoon of March 2, 2015. For two days, the young lawyer had been suffering from severe headaches while a disorienting fever left him struggling to tell the 911 operator his address.
Suspecting meningitis, a doctor at the hospital performed a spinal tap, and the next day an infectious disease specialist typed in an order for a critical lab test—a check of the spinal fluid for viruses, including herpes simplex—into the hospital’s EHR.
The multimillion-dollar system, manufactured by Epic Systems Corp. and considered by some to be the Cadillac of medical software, had been installed at the hospital about four months earlier. Although the order appeared on Epic’s screen, it was not sent to the lab. It turned out, Epic’s software didn’t fully “interface” with the lab’s software, according to a lawsuit Ronisky filed in February 2017 in Los Angeles County Superior Court. His results and diagnosis were delayed—by days, he claims—during which time he suffered irreversible brain damage from herpes encephalitis. The suit alleged the mishap delayed doctors from giving Ronisky a drug called acyclovir that may have minimized damage to his brain.
Epic denied any liability or defects in its software; the company said the doctor failed to push the right button to send the order and that the hospital, not Epic, had configured the interface with the lab. Epic, among the nation’s largest manufacturers of computerized health records and the leading provider to most of America’s most elite medical centers, quietly paid $1 million to settle the suit in July 2018, according to court records. The hospital and two doctors paid a total of $7.5 million, and a case against a third doctor is pending trial. Ronisky, 34, who is fighting to rebuild his life, declined to comment.
Incidents like that which happened to Ronisky—or to Annette Monachelli, for that matter—are surprisingly common, data shows. And the back-and-forth about where the fault lies in such cases is actually part of the problem: The systems are often so confusing (and training on them seldom sufficient) that errors frequently fall into a nether zone of responsibility. It can be hard to tell where human error begins and the technological short­comings end.
EHRs promised to put all of a patient’s records in one place, but often that’s the problem. Critical or time-sensitive information routinely gets buried in an endless scroll of data, where in the rush of medical decision-making—and amid the maze of pulldown menus—it can be missed.
Thirteen-year-old Brooke Dilliplaine, who was severely allergic to dairy, was given a probiotic containing milk. The two doses sent her into “complete respiratory distress” and resulted in a collapsed lung, according to a lawsuit filed by her mother. Rory Staunton, age 12, scraped his arm in gym class and then died of sepsis after ER doctors discharged the boy on the basis of lab results in the EHR that weren’t complete. And then there’s the case of Thomas Eric Duncan. The 42-year-old man was sent home in 2014 from a Dallas hospital infected with Ebola virus. Though a nurse had entered in the EHR his recent travel to Liberia, where an Ebola epidemic was then in full swing, the doctor never saw it. Duncan died a week later. Bobby and Tara Dilliplaine hold a photo of their late daughter Brooke, who suffered complications when she was given medication she was allergic to. (She later died of causes unrelated to the EHR issue.) Photograph by Heidi de Marco—KHN
Many such cases end up in court. Typically, doctors and nurses blame faulty technology in the medical-records systems. The EHR vendors blame human error. And meanwhile, the cases mount.
Quantros, a private health-care analytics firm, said it has logged 18,000 EHR-related safety events from 2007 through 2018, 3% of which resulted in patient harm, including seven deaths—a figure that a Quantros director says is “drastically underreported.”
A 2016 study by The Leapfrog Group, a patient-safety watchdog based in Washington, D.C., found that the medication-ordering function of hospital EHRs—a feature required by the government for certification but often configured differently in each system—failed to flag potentially harmful drug orders in 39% of cases in a test simulation. In 13% of those cases, the mistake could have been fatal.
The Pew Charitable Trusts has, for the past few years, run an EHR safety project, taking aim at issues like usability and patient matching—the process of linking the correct medical record to the correct patient—a seemingly basic task at which the systems, even when made by the same EHR vendor, often fail. At some institutions, according to Pew, such matching was accurate only 50% of the time. Patients have discovered mistakes as well: A January survey by the Kaiser Family Foundation found that one in five patients spotted an error in their electronic medical records.
The Joint Commission, which certifies hospitals, has sounded alarms about a number of issues, including false alarms—which account for between 85% and 99% of EHR and medical device alerts. (One study by researchers at Oregon Health & Science University estimated that the average clinician working in the intensive care unit may be exposed to up to 7,000 passive alerts per day.) Such over-warning can be dangerous. Between 2014 and 2018, the commission tallied 170 mostly voluntary reports of patient harm related to alarm management and alert fatigue—the phenomenon in which health workers, so overloaded with unnecessary warnings, ignore the occasional meaningful one. Of those 170 incidents, 101 resulted in patient deaths.
The Pennsylvania Patient Safety Authority, an independent state agency that collects information about adverse events and incidents, counted 775 “laboratory-test problems” related to health IT between January 2016 and December 2017.
To be sure, medical errors happened en masse in the age of paper medicine, when hospital staffers misinterpreted a physician’s scrawl or read the wrong chart to deadly consequence, for instance. But what is perhaps telling is how many doctors today opt for manual workarounds to their EHRs. Aaron Zachary Hettinger, an emergency medicine physician with MedStar Health in Washington, D.C., says that when he and fellow clinicians need to share critical patient information, they write it on a whiteboard or on a paper towel and leave it on their colleagues’ computer keyboards.
While the FDA doesn’t mandate reporting of EHR safety events—as it does for regulated medical devices—concerned posts have nonetheless proliferated in the FDA MAUDE database of adverse events, which now serves as an ad hoc bulletin board of warnings about the various systems.
Further complicating the picture is that health providers nearly always tailor their one-size-fits-all EHR systems to their own specifications. Such customization makes every one unique and often hard to compare with others—which, in turn, makes the source of mistakes difficult to determine.
Martin Makary, a surgical oncologist at Johns Hopkins and the coauthor of a much-cited 2016 study that identified medical errors as the third leading cause of death in America, credits EHRs for some safety improvements—including recent changes that have helped put electronic brakes on the opioid epidemic. But, he says, “we’ve swapped one set of problems for another. We used to struggle with handwriting and missing information. We now struggle with a lack of visual cues to know we’re writing and ordering on the correct patient.”
Joseph Schneider, a pediatrician at UT Southwestern Medical Center, compares the transition we’ve made, from paper records to electronic ones, to moving from horses to automobiles. But in this analogy, he adds, “Our cars have advanced to about the 1960s. They still don’t have seat belts or airbags.”
Schneider recalls one episode when his colleagues couldn’t understand why chunks of their notes would inexplicably disappear. They figured out the problem weeks later after intense study: Physicians had been inputting squiggly brackets—{}—the use of which, unbeknownst to even vendor representatives, deleted the text between them. (The EHR maker initially blamed the doctors, says Schneider.)
A broad coalition of actors, from National Nurses United to the Texas Medical Association to leaders within the FDA, has long called for oversight on electronic-record safety issues. Among the most outspoken is Ratwani, who directs MedStar Health’s National Center on Human Factors in Healthcare, a 30-­person institute focused on optimizing the safety and usability of medical technology. Ratwani spent his early career in the defense industry, studying things like the intuitiveness of information displays. When he got to MedStar in 2012, he was stunned by “the types of [digital] interfaces being used” in health care, he says.
In a study published last year in the journal Health Affairs , Ratwani and colleagues studied medication errors at three pediatric hospitals from 2012 to 2017. They discovered that 3,243 of them were owing in part to EHR “usability issues.” Roughly one in five of these could have resulted in patient harm, the researchers found. “Poor interface design and poor implementations can lead to errors and sometimes death, and that is just unbelievably bad as well as completely fixable,” he says. “We should not have patients harmed this way.”
Using eye-tracking technology, Ratwani has demonstrated on video just how easy it is to make mistakes when performing basic tasks on the nation’s two leading EHR systems. When emergency room doctors went to order Tylenol, for example, they saw a drop-down menu listing 86 options, many of which were irrelevant for the specified patient. They had to read the list carefully, so as not to click the wrong dosage or form—though many do that too: In roughly one out of 1,000 orders, physicians accidentally select the suppository (designated “PR”) rather than the tablet dose (“OR”), according to one estimate. That’s not an error that will harm a patient—though other medication mix-ups can and do.
Earlier this year, MedStar’s human-factors center launched a website and public awareness campaign with the American Medical Association to draw attention to such rampant mistakes—they use the letters “EHR” as an initialism for “Errors Happen Regularly”—and to petition Congress for action. Ratwani is pushing for a central database to track such errors and adverse events.
Others have turned to social media to vent. Mark Friedberg, a health-policy researcher with the RAND Corporation who is also a practicing primary care physician, champions the Twitter hashtag ­#EHRbuglist to encourage fellow health care workers to air their pain points. And last month, a scathing Epic parody account cropped up on Twitter, earning more than 8,000 followers in its first five days. Its maiden tweet, written in the mock voice of an Epic overlord, read: “I once saw a doctor make eye contact with a patient. This horror must stop.”
As much as EHR systems are blamed for sins of commission, it is often the sins of omission that trip up users even more.
Consider the case of Lynne Chauvin, who worked as a medical assistant at Ochsner Health System, in Louisiana. In a still-pending 2015 lawsuit, Chauvin alleges that Epic’s software failed to fire a critical medication warning; Chauvin suffered from conditions that heightened her risk for blood clots, and though that history was documented in her records, she was treated with drugs that restricted blood flow after a heart procedure at the hospital. She developed gangrene, which led to the amputation of her lower legs and forearm. (Ochsner Health System said that while it cannot comment on ongoing litigation, it “remains committed to patient safety which we strongly believe is optimized through the use of electronic health record technology.” Epic declined to comment.)
Echoing the complaints of many doctors, the suit argues that Epic software “is extremely complicated to view and understand,” owing to “significant repetition of data.” Chauvin says that her medical bills have topped $1 million and that she is permanently disabled. Her husband, Richard, has become her primary caregiver and had to retire early from his job with the city of Kenner to care for his wife, according to the suit. Each party declined to comment. An Epidemic of Burnout
The numbing repetition, the box-ticking, and the endless searching on pulldown menus are all part of what Ratwani calls the “cognitive burden” that’s wearing out today’s physicians and driving increasing numbers into early retirement.
In recent years, “physician burnout” has skyrocketed to the top of the agenda in medicine. A 2018 Merritt Hawkins survey found a staggering 78% of doctors suffered symptoms of burnout, and in January the Harvard School of Public Health and other institutions deemed it a “public health crisis.”
One of the coauthors of the Harvard study, Ashish Jha, pinned much of the blame on “the growth in poorly designed digital health records … that [have] required that physicians spend more and more time on tasks that don’t directly benefit patients.”
Few would deny that the swift digitization of America’s medical system has been transformative. With EHRs now nearly universal, the face and feel of medicine has changed. The doctor is now typing away, making more eye contact with the computer screen, perhaps, than with the patient. Patients don’t like that dynamic; for doctors, whose days increasingly begin and end with such fleeting encounters, the effect can be downright deadening.
“You’re sitting in front of a patient, and there are so many things you have to do, and you only have so much time to do it in—seven to 11 minutes, probably—so when do you really listen?” asks John-Henry Pfifferling, a medical anthropologist who counsels physicians suffering from burnout. “If you go into medicine because you care about interacting, and then you’re just a tool, it’s dehumanizing,” says Pfifferling, who has seen many physicians leave medicine over the shift to electronic records. “It’s a disaster,” he says.
Beyond complicating the physician-patient relationship, EHRs have in some ways made practicing medicine harder, says Hal Baker, a physician and the chief information officer at WellSpan, a Pennsylvania hospital system. “Physicians have to cognitively switch between focusing on the record and focusing on the patient,” he says. He points out how unusual—and potentially dangerous—this is: “Texting while you’re driving is not a good idea. And I have yet to see the CEO who, while running a board meeting, takes minutes, and certainly I’ve never heard of a judge who, during the trial, would also be the court stenographer. But in medicine … we’ve asked the physician to move from writing in pen to [entering a computer] record, and it’s a pretty complicated interface.”
Even if docs may be at the keyboard during visits, they report having to spend hours more outside that time—at lunch, late at night—in order to finish notes and keep up with electronic paperwork (sending referrals, corresponding with patients, resolving coding issues). That’s right. EHRs didn’t take away paperwork; the systems just moved it online. And there’s a lot of it: 44% of the roughly six hours a physician spends on the EHR each day is focused on clerical and administrative tasks, like billing and coding, according to a 2017 Annals of Family Medicine study. Fortune’s fourth annual Brainstorm Health conference will be held April 2–3 in San Diego. Please check out the incredible lineup of speakers and topics here .
For all that so-called pajama time—the average physician logs 1.4 hours per day on the EHR after work—they don’t get a cent.
Many doctors do recognize the value in the technology: 60% of participants in Stanford Medicine’s 2018 National Physician Poll said EHRs had led to improved patient care. At the same time, about as many (59%) said EHRs needed a “complete overhaul” and that the systems had detracted from their professional satisfaction (54%) as well as from their clinical effectiveness (49%).
In preliminary studies, Ratwani has found that doctors have a typical physiological reaction to using an EHR: stress. When he and his team shadow clinicians on the job, they use a range of sensors to monitor the doctors’ heart rate and other vital signs over the course of their shift. The physicians’ heart rates will spike—as high as 160 beats per minute—on two sorts of occasions: when they are interacting with patients and when they’re using the EHR.
“Everything is so cumbersome,” says Karla Dick, a family medicine doctor in Arlington, Texas. “It’s slow compared to a paper chart. You’re having to click and zoom in and zoom out to look for stuff.” With all the zooming in and out, she explains it’s easy to end up in the wrong record. “I can’t tell you how many times I’ve had to cancel an order because I was in the wrong chart.”
Among the daily frustrations for one emergency room physician in Rhode Island is ordering ibuprofen, a seemingly simple task that now requires many rounds of mouse clicking. Every time she prescribes the basic painkiller for a female patient, whether that patient is 9 or 68 years old, the prescription is blocked by a pop-up alert warning her that it may be dangerous to give the drug to a pregnant woman. The physician, whose institution does not allow her to comment on the systems, must then override the warning with yet more clicks. “That’s just the tiniest tip of the iceberg,” she says.
What worries the doctor most is the ease with which diligent, well-meaning physicians can make serious medical errors. She notes that the average ER doc will make 4,000 mouse clicks over the course of a shift, and that the odds of doing anything 4,000 times without an error is small. “The interfaces are just so confusing and clunky,” she adds. “They invite error … it’s not a negligence issue. This is a poor tool issue.”
Many of the EHR makers acknowledge physician burnout is real and say they’re doing what they can to lessen the burden and enhance user experience. Sam Butler, a pulmonary critical care specialist who started working at Epic in 2001, leads those efforts at the Wisconsin-based company. When doctors get more than 100 messages per week in their in-basket (akin to an email inbox), there’s a higher likelihood of burnout. Butler’s team has also analyzed doctors’ electronic notes—they’re twice as long as they were nine years ago, and three to four times as long as notes in the rest of the world. He says Epic uses such insights to improve the client experience. But coming up with fixes is difficult because doctors “have different viewpoints on everything,” he says. (KHN and Fortune made multiple requests to interview Epic CEO Judith Faulkner, but the company declined to make her available. In a trade interview in February, however, Faulkner said that EHRs were unfairly blamed for physician burnout and cited a study suggesting that there’s little correlation between burnout and EHR satisfaction. Executives at other vendors noted that they’re aware of usability issues and that they’re working on addressing them.)
“It’s not that we’re a bunch of Luddites who don’t know how to use technology,” says the Rhode Island ER doctor. “I have an iPhone and a computer and they work the way they’re supposed to work, and then we’re given these incredibly cumbersome and error-prone tools. This is something the government mandated. There really wasn’t the time to let the cream rise to the top; everyone had to jump in and pick something that worked and spend tens of millions of dollars on a system that is slowly killing us.” $36 Billion and Change
The effort to digitize America’s health records got its biggest push in a very low moment: the financial crisis of 2008. In early December of that year, Obama, barely four weeks after his election, pitched an ambitious economic recovery plan. “We will make sure that every doctor’s office and hospital in this country is using cutting-edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year,” he said in a radio address. The idea had already been a fashionable one in Washington. Former House Speaker Newt Gingrich was fond of saying it was easier to track a FedEx package than one’s medical records. Obama’s predecessor, President George W. Bush, had also pursued the idea of wiring up the country’s health system. He didn’t commit much money, but Bush did create an agency to do the job: the Office of the National Coordinator (ONC).
In the depths of recession, the EHR conceit looked like a shovel-ready project that only the paper lobby could hate. In February 2009 legislators passed the HITECH Act, which carved out a hefty chunk of the massive stimulus package for health information technology. The goal was not just to get hospitals and doctors to buy EHRs, but rather to get them using them in a way that would drive better care. So lawmakers devised a carrot-and-stick approach: Physicians would qualify for federal subsidies (a sum of up to nearly $64,000 over a period of years) only if they were “meaningful users” of a government-certified system. Vendors, for their part, had to develop systems that met the government’s requirements.
They didn’t have much time, though. The need to stimulate the economy, which meant getting providers to adopt EHRs quickly, “presented a tremendous conundrum,” says Farzad Mostashari, who joined the ONC as deputy director in 2009 and became its leader in 2011: The ideal—creating a useful, interoperable, nationwide records system—was “utterly infeasible to get to in a short time frame.”
That didn’t stop the federal planners from pursuing their grand ambitions. Everyone had big ideas for the EHRs. The FDA wanted the systems to track unique device identifiers for medical implants, the CDC wanted them to support disease surveillance, CMS wanted them to include quality metrics, and so on. “We had all the right ideas that were discussed and hashed out by the committee,” says Mostashari, “but they were all of the right ideas.”
Not everyone agreed, though, that they were the right ideas. Before long, “meaningful use” became pejorative shorthand to many for a burdensome government program—making doctors do things like check a box indicating a patient’s smoking status each and every visit.
The EHR vendor community, then a scrappy $2 billion industry, griped at the litany of requirements but stood to gain so much from the government’s $36 billion injection that it jumped in line. As Rusty Frantz, CEO of EHR vendor NextGen Healthcare, put it: “The industry was like, ‘I’ve got this check dangling in front of me, and I have to check these boxes to get there, and so I’m going to do that.’ ”
Halamka, who was an enthusiastic backer of the initiative in both the Bush and Obama administrations, blames the pressure for a speedy launch as much as the excessive wish list. “To go from a regulation to a highly usable product that is in the hands of doctors in 18 months, that’s too fast,” he says. “It’s like asking nine women to have a baby in a month.”
Several of those who worked on the project admit the rollout was not as easy or seamless as they’d anticipated, but they contend that was never the point. Aneesh Chopra, appointed by Obama in 2009 as the nation’s first chief technology officer, called the spending a “down payment” on a vision to fundamentally change American medicine—creating a digital infrastructure to support new ways to pay for health services based on their quality and outcomes.
Bob Kocher, a physician and star investor with venture capital firm Venrock, who served in the Obama administration from 2009 to 2011 as a health and economic policy adviser, not only defends the rollout then but also disputes the notion that the government initiative has been a failure at all. “EHRs have totally lived up to the hype and expectations,” he says, emphasizing that they also serve as a technology foundation to support innovation on everything from patients accessing their medical records on a smartphone to A.I.-driven medical sleuthing. Others note the systems’ value in aggregating medical data in ways that were never possible with paper—helping, for example, to figure out that contaminated water was poisoning children in Flint, Mich.
But Rusty Frantz heard a far different message about EHRs—and, more important, it was coming from his own customers.
The Stanford-trained engineer, who in 2015 became CEO of NextGen, a $500-million-a-year EHR heavyweight in the physician-office market, learned the hard way about how his product was being viewed. As he stood at the podium at his first meeting with thousands of NextGen customers at Las Vegas’s Mandalay Bay Resort, just four months after getting the job, he tells KHN and Fortune , “People were lining up at the microphones to yell at us: ‘We weren’t delivering stable software! The executive team was inaccessible! The service experience was terrible!’” (He now refers to the event as “Festivus: the airing of the grievances.”)
Frantz had bounced around the health care industry for much of his career, and from the nearby perch of a medical device company, he watched the EHR incentive bonanza with a mix of envy and slack-jawed awe. “The industry was moving along in a natural Darwinist way, and then along came the stimulus,” says Frantz, who blames the government’s ham-handed approach to regulation. “The software got slammed in, and the software wasn’t implemented in a way that supported care,” he says. “It was installed in a way that supported stimulus. This company, we were complicit in it too.”
Even that may be a generous description. KHN and Fortune found a trail of lawsuits against the company, stretching from White Sulphur Springs, Mont., to Neillsville, Wis. Mary Rutan Hospital in Bellefontaine, Ohio, sued NextGen (formerly called Quality Systems) in federal court in 2013, arguing that it experienced hundreds of problems with the “materially defective” software the company had installed in 2011.
A consultant hired by the hospital to evaluate the NextGen system, whose 60-page report was submitted to the court, identified “many functional defects” that he said rendered the software “unfit for its intended purpose.” Some patient information was not accurately recorded, which had the potential, the consultant wrote, “to create major patient care risk which could lead to, at a minimum, inconvenience, and at worst, malpractice or even death.” Glitches at Mary Rutan included incidents in which the software would apparently change a patient’s gender at random or lose a doctor’s observations after an exam, the consultant reported. The company, he found, sometimes took months to address issues: One IT ticket, which related to a physician’s notes inexplicably deleting themselves, reportedly took 10 months to resolve. (The consultant also noted that similar problems appeared to be occurring at as many as a dozen other hospitals that had installed NextGen software.)
The Ohio hospital, which paid more than $1.5 million for its EHR system, claimed breach of contract. NextGen responds that it disputed the claims made in the lawsuit and that the matter was resolved in 2015 “with no findings of fact by a court related to the allegations.” The hospital declined to comment.
At the time, as it has been since then, NextGen’s software was certified by the government as meeting the requirements of the stimulus program. By 2016, NextGen had more than 19,000 customers who had received federal subsidies.
NextGen was subpoenaed by the Department of Justice in December 2017, months after becoming the subject of a federal investigation led by the District of Vermont. Frantz tells KHN and Fortune that NextGen is cooperating with the investigation. “This company was not dishonest, but it was not effective four years ago,” he says. Frantz also emphasizes that NextGen has “rapidly evolved” during his tenure, earning five industry awards since 2017, and that customers have “responded very positively.”
Glen Tullman, who until 2012 led Allscripts, another leading EHR vendor that benefited royally from the stimulus and that has been sued by numerous unhappy customers, admits that the industry’s race to market took priority over all else.
“It was a big distraction. That was an unintended consequence of that,” Tullman says. “All the companies were saying, This is a one-time opportunity to expand our share, focus everything there, and then we’ll go back and fix it.” The Justice Department has opened a civil investigation into the company, Securities and Exchange Commission filings show. Allscripts says in an email that it cannot comment on an ongoing investigation, but that the civil investigations by the Department of Justice relate to businesses it acquired after the investigations were opened.
Much of the marketing mayhem occurred because federal officials imposed few controls over firms scrambling to cash in on the stimulus. It was a gold rush—and any system, it seemed, could be marketed as “federally approved.” Doctors could shop for bargain-price software packages at Costco and Walmart’s Sam’s Club—where eClinicalWorks sold a “turnkey” system for $11,925—and cash in on the government’s adoption incentives.
The top-shelf vendors in 2009 crisscrossed the country on a “ stimulus tour ” like rock groups, gigging at some 30 cities, where they offered doctors who showed up to hear the pitch “a customized analysis” of how much money they could earn off the government incentives. Following the same playbook used by pharmaceutical companies, EHR sellers courted doctors at fancy dinners in ritzy hotels. One enterprising software firm advertised a “cash for clunkers” deal that paid $3,000 to doctors willing to trade in their current records system for a new one. Athenahealth held “invitation only” dinners at luxury hotels to advise doctors, among other things, how to use the stimulus to get paid more and capture available incentives. Allscripts offered a no-money-down purchase plan to help doctors “maximize the return on your EHR investment.” (An Athena­health spokesperson says the company’s “dinners were educational in nature and aimed at helping physicians navigate the government program.” Allscripts did not respond directly to questions about its marketing practices, but says it “is proud of the software and services [it provides] to caregivers across the globe.”)
EHRs were supposed to reduce health care costs, at least in part by preventing duplicative tests. But as the federal government opened the stimulus tap, many raised doubts about the promised savings. Advocates bandied about a figure of $80 billion in cost savings even as congressional auditors were debunking it. While the jury’s still out, there’s growing suspicion the digital revolution may potentially raise health care costs by encouraging overbilling and new strains of fraud and abuse.
In September 2012, following press reports suggesting that some doctors and hospitals were using the new technology to improperly boost their fees, a practice known as “upcoding,” then–Health and Human Services chief Kathleen Sebelius and Attorney General Eric Holder warned the industry not to try to “game the system.”
There’s also growing evidence that some doctors and health systems may have overstated their use of the new technology to secure stimulus funds, a potentially enormous fraud against Medicare and Medicaid that likely will take many years to unravel. In June 2017, the HHS inspector general estimated that Medicare officials made more than $729 million in subsidy payments to hospitals and doctors that didn’t deserve them.
Individual states, which administer the Medicaid portion of the program, haven’t fared much better. Audits have uncovered overpayments in 14 of 17 state programs reviewed, totaling more than $66 million, according to inspector general reports.
Last month Sen. Charles Grassley, an Iowa Republican who chairs the Senate Finance Committee, sharply criticized CMS for recovering only a tiny fraction of these bogus payments, or what he termed a “spit in the ocean.”
EHR vendors have also been accused of egregious and patient-endangering acts of fraud as they raced to cash in on the stimulus money grab. In addition to the U.S. government’s $155 million False Claims Act settlement with eClinicalWorks noted above, the federal government has reached a second settlement over similar charges against another large vendor, Tampa-based Greenway Health. In February, that company settled with the government for just over $57 million without denying or admitting wrongdoing. “These are cases of corporate greed, companies that prioritized profits over everything else,” says Christina Nolan, the U.S. attorney for the District of Vermont, whose office led the cases. (In a response, Greenway Health did not address the charges or the settlement but said it was “committing itself to being the standard-bearer for quality, compliance, and transparency.”) Tower of Babel
In early 2017, Seema Verma, then the country’s newly appointed CMS administrator, went on a listening tour. She visited doctors around the country, at big urban practices and tiny rural clinics, and from those frontline physicians she consistently heard one thing: They hated their electronic health records. “Physician burnout is real,” she tells KHN and Fortune . The doctors spoke of the difficulty in getting information from other systems and providers, and they complained about the government’s reporting requirements, which they perceived as burdensome and not meaningful.
What she heard then became suddenly personal one summer day in 2017, when her husband, himself a physician, collapsed in the airport on his way home to Indianapolis after a family vacation. For a frantic few hours, the CMS administrator fielded phone calls from first responders and physicians—Did she know his medical history? Did she have information that could save his life?—and made calls to his doctors in Indiana, scrambling to piece together his record, which should have been there in one piece. Her husband survived the episode, but it laid bare the dysfunction and danger inherent in the existing health information ecosystem. Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, is taking on health “information blockers,” gag clauses, and more. Photograph by T.J. Kirkpatrick for Fortune
The notion that one EHR should talk to another was a key part of the original vision for the HITECH Act, with the government calling for systems to be eventually interoperable.
What the framers of that vision didn’t count on were the business incentives working against it. A free exchange of information means that patients can be treated anywhere. And though they may not admit it, many health providers are loath to lose their patients to a competing doctor’s office or hospital. There’s a term for that lost revenue: “leakage.” And keeping a tight hold on patients’ medical records is one way to prevent it.
There’s a ton of proprietary value in that data, says Blumenthal, who now heads the Commonwealth Fund, a philanthropy that does health research. Asking hospitals to give it up is “like asking Amazon to share their data with Walmart ,” he says.
Blumenthal acknowledges that he failed to grasp these perverse business dynamics and foresee what a challenge getting the systems to talk to one another would be. He adds that forcing interoperability goals early on, when 90% of the nation’s providers still didn’t have systems or data to exchange, seemed unrealistic. “We had an expression: They had to operate before they could interoperate,” he says.
In the absence of true incentives for systems to communicate, the industry limped along; some providers wired up directly to other select providers or through regional exchanges, but the efforts were spotty. A Cerner-backed interoperability network called CommonWell formed in 2013, but some companies, including dominant Epic, didn’t join. (“Initially, Epic was neither invited nor allowed to join,” says Sumit Rana, senior vice president of R&D at Epic. Jitin Asnaani, executive director of CommonWell counters, “We made repeated invitations to every major EHR … and numerous public and private invitations to Epic.”)
Epic then supported a separate effort to do much the same.
Last spring, Verma attempted to kick-start the sharing effort and later pledged a war on “information blocking,” threatening penalties for bad actors. She has promised to reduce the documentation burden on physicians and end the gag clauses that protect the EHR industry. Regarding the first effort at least, “there was consensus that this needed to happen and that it would take the government to push this forward,” she says. In one sign of progress last summer, the dueling sharing initiatives of Epic and Cerner, the two largest players in the industry, began to share with each other—though the effort is fledgling.
When it comes to patients, though, the real sharing too often stops. Despite federal requirements that providers give patients their medical records in a timely fashion, in their chosen format, and at low cost (the government recommends a flat fee of $6.50 or less), patients struggle mightily to get them. A 2017 study by researchers at Yale found that of America’s 83 top-rated hospitals, only 53% offer forms that provide patients with the option to receive their entire medical record. Fewer than half would share records via email. One hospital charged more than $500 to release them.
Sometimes the mere effort to access records leads to court. Jennifer De Angelis, a Tulsa attorney, has frequently sparred with hospitals over releasing her clients’ records. She says they either attempt to charge huge sums for them or force her to obtain a court order before releasing them. De Angelis adds that she sometimes suspects the records have been overwritten to cover up medical mistakes. David Blumenthal, Obama’s national coordinator for health information technology from 2009 to 2011. Chris Crisman—Redux
Consider the case of 5-year-old Uriah R. Roach, who fractured and cut his finger on Oct. 2, 2014, when it was accidentally slammed in a door at school. Five days later, an operation to repair the damage went awry, and he suffered permanent brain damage, apparently owing to an anesthesia problem. The Epic electronic medical file had been accessed more than 76,000 times during the 22 days the boy was in the hospital, and a lawsuit brought by his parents contended that numerous entries had been “corrected, altered, modified and possibly deleted after an unexpected outcome during the induction of anesthesia.” The hospital denied wrongdoing. The case settled in November 2016, and the terms are confidential.
More than a dozen other attorneys interviewed cited similar problems, especially with gaining access to computerized “audit trails.” In several cases, court records show, government lawyers resisted turning over electronic files from federally run hospitals. That happened to Russell Uselton, an Oklahoma lawyer who represented a pregnant teen admitted to the Choctaw Nation Health Care Center in Talihina, Okla. Shelby Carshall, 18, was more than 40 weeks pregnant at the time. Doctors failed to perform a cesarean section, and her baby was born brain-damaged as a result, she alleged in a lawsuit filed in 2017 against the U.S. government. The baby began having seizures at 10 hours old and will “likely never walk, talk, eat, or otherwise live normally,” according to pleadings in the suit. Though the federal government requires hospitals to produce electronic health records to patients and their families, Uselton had to obtain a court order to get the baby’s complete medical files. Government lawyers denied any negligence in the case, which is pending.
“They try to hide anything from you that they can hide from you,” says Uselton. “They make it extremely difficult to get records, so expensive and hard that most lawyers can’t take it on,” he said.
Nor, it seems, can high-ranking federal officials. When Seema Verma’s husband was discharged from the hospital after his summer health scare, he was handed a few papers and a CD-ROM containing some medical images—but missing key tests and monitoring data. Says Verma, “We left that hospital and we still don’t have his information today.” That was nearly two years ago.
A version of this article appears in the April 2019 issue of Fortune with the headline “Death by a Thousand Clicks.”

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Explaining The Cost Of Having Botox Injections

8 minutes ago by Mae Casey In the cosmetic world, when you have to take up any treatment then the best one to consider is Botox in Montreal . When compared to a plethora of treatments , Botox remains best when it comes to the enhancement of beauty and life. The Botox treatment focus on treating and paralyzing fac ial muscles to remove wrinkles and most of the time, people prefer to use Botox to make them young . Now, you will be curious to know what Botox provides. Botox is capable to provide treatment even for many medical problems. They can cure migraine headaches to excessive sweating. The most popular treatment that Botox can cure is that they can smooth wrinkled foreheads and erase crow�s feet. The common problems that most of the people face are wrinkles and fine lines are present in the forehead, around your eyes, and rest of your face. The process in Botox is w hen you inject into muscles, it is easy to blocks signals from nerves. As a result, it causes muscles to lose its contracting ability. The wrinkles get soften and give you relaxation. In the event you loved this post in addition to you would want to receive more details concerning Botox forehead generously stop by the web-site. The effect is temporary, as Botox wear off over time in a short span . If you continue to carry out Botox over a long time, it will affect the muscles in a natural manner. Still, Botox is an effective cosmetic treatment and think there are some wrinkles that are difficult to treat . Wrinkles caused by over-exposure to sun will not respond to Botox. Thus, it is essential to handle your skin with utmost care. While Botox definitely helps you in maintaining a more youthful and healthier appearance, the injections will not favor your positively in the long term if you fail to take care of yourself. If possible, use sunscreen, avoid over exposure to sun, and stay apart from tanning booths or anything else, which may irritate your skin. Botox is clinically tested & approved so that it is a safe as well as effective method to smooth out your wrinkles and fine lines. With Botox forehead, you are going to work towards making you much younger than before. By getting wrinkles and lines removed from your face, you will definitely have a good profound effect on the way, which you look to others. A perfect Botox treatment can help you roll back the years, as it improves your physical appearance. Botox is ideal for those who need a boost to look younger and hotter as well. It is very clear that Botox is hugely beneficial for improving the way you want to look and feel. Botox foreheadBotox medicines help you to boost confidence and have perfect self-esteem. Many people suffer from low self-confidence and they could not cope up in life . You need to enhance and improve your confidence. For this, Botox treatment is the best way to improve confidence. As a result, it can help you to step up the lives of people and even Botox can reduce the risk in life. Only, when you have the proper procedure, you can easily find a better result in the case of Botox. When you see other cosmetic procedures, it will surely take overtime by putting you at risks like having internal bleeding. Even to a greater extent, m any treatments need extensive recovery periods to recover and they result only in both exhausting and uncomfortable. Rather when you use Botox treatment, it is easy to feel the difference. Using Botox is a safe process when you undergo a complete process. Using Botox injections has less recovery time and side effects. Due to proper procedure, there is no high risk while undergoing the treatment. Now, you can use cosmetic treatment without thinking of the side effects and they are less risk type to use. Getting cosmetic treatment done usually takes time. In addition, you need to prepare for it on your own. Take enough time to get surgery done and recover from it. The biggest advantage of Botox is that it is a quick as well as convenient treatment. You may believe it or not, an average injection takes less than fifteen minutes to administer. Usually, the results are apparent soon after two days of the treatment. Some procedures need you to be bedridden for several days after the treatment while Botox never need you to put your life on hold. When you come to Botox treatment, you need not to worry about the medicine. The reason is that they can help you to reduce the migraine health problem . A Botox injection can minimize the occurrence of migraines. Moreover, one can relax the muscles, which are responsible for these headaches. Apart from this, it reduces pain signals to your brain. Do you know that Botox can also help you in dealing with excessive sweating? Though heavy sweating is not a serious problem, it may have some negative impacts on your self-esteem. Now you can understand that the Botox help you to have strong bonding with the medical field. Another benefit of Botox is, it can be utilized to alleviate some eye conditions like eyelid spasms, blurred vision, and crossed eyes. It does it by relaxing the eye muscles and so, they will not work against each other. In turn, it gives time to other eyes muscles for healing. If you have an overactive bladder, you can get its frequent and unexpected contractions under control with the help of Botox. It is significant to control those bladder contractions. Otherwise, they may cause frequent urination and urinary incontinence. By using a cystoscope, Botox injects into the bladder and treat these conditions. The Botox injection will normalize your urination by making bladder contract regularly. People who suffer from enlarged prostates can have relief from Botox injection . The remedy can last for up to a year. Apart from this, if Botox injected into prostate glands, one has to face issues like frequent urination and urinary tract infections. The side effects, which may occur with medications, include erectile dysfuncti on or incontinence. Botox improves the flow of urination and also reduces the size of the gland. Do not worry that the Montreal Botox clinic gives you the best results in case of health benefits. There are some medical professionals who prove that Botox is a very useful treatment to heal arthritis pain.

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Time ago I was asked to do a reflection manuscript for migraine and also frustration relief. I actually didn’t have enough direct experience to do a deep dive as well as locate the ideal words or tone for this. And after that, I suddenly found myself experiencing occipital neuralgia for a month and also did I ever before obtain understanding into what that pain required. Release. I reserved a journey to Aruba. I meditated and also did yoga exercise and vowed my loyalty to pepper mint oil as well as lavender. As well as I chose these funny, wise souls, @bob and also brad, https://www.youtube.com/watch?v=8QRnfPrso0c, (they corresponded the pain to seeming like a stroke and also assisted me recuperate also). What I discovered is the value of a dark room, awesome as well as recovery air, and also visualizations that dialed down the anxiety as well as tension that was additional bolstering my discomfort. Constantly look for a physician’s assistance for clinical advice, as I truly can just vouch for my very own experiences. But this reflection may help, at the very the very least, to give you something to focus on when you need a respite. And also if you aren’t presently suffering, you may discover it helps lower stress and anxiety.

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What you need to know about using essential oils

Let friends in your social network know what you are reading about Facebook Email What you need to know about using essential oils Essential oil use is on the rise, but do they work to address your health concerns? Post to Facebook What you need to know about using essential oils Essential oil use is on the rise, but do they work to address your health concerns? Check out this story on courierpostonline.com: https://www.courierpostonline.com/story/life/2019/06/03/what-you-need-know-using-essential-oils/1291227001/ Cancel Send A link has been sent to your friend’s email address. Posted! A link has been posted to your Facebook feed. Join the Conversation To find out more about Facebook commenting please read the Conversation Guidelines and FAQs Comments
This conversation is moderated according to USA TODAY’s community rules . Please read the rules before joining the discussion. What you need to know about using essential oils Candy Grande, Special to the Cherry Hill Courier-Post Published 6:00 a.m. ET June 3, 2019 CLOSE Evan Chait, PT, founder of Kinetic Physical Therapy in Ramsey, NJ, uses essential oils to activate different parts of the brain in his practice. Danielle Parhizkaran, NorthJersey CONNECT COMMENT EMAIL MORE
Evan Chait, left, founder of Kinetic Physical Therapy in Ramsey, uses essential oils in his practice. (Photo: Danielle Parhizkaran/NorthJersey.com) Kristi Fuller of Voorhees began using essential oils two years ago, after her mother used them to promote a calm environment for Kristi’s father, who was battling cancer at the time. “She said he would become less agitated and fall into a more comfortable sleep which lead me to do some research,” says Fuller, a special education teacher who has been teaching in Washington Township, Gloucester County, for 18 years. “My boys were ages 3 and 5 at the time and started to develop some really poor sleep habits; they would have a hard time settling down before bed and staying asleep all night. I would often hear little footsteps in the night. I was exhausted as were they. I was searching for a natural sleep solution which lead me to use the essential oils.” Now, Fuller’s only regret is not using the oils sooner. She uses them aromatically in a humidifier with cold water to cause a mist in the bedroom she shares with her husband, Jason, and in the bedrooms of sons Jake, 8, and Ryan, 5. She also uses them topically and a few can even be ingested. More: NJ Breweries: Latest beer from Double Nickel aims to lessen sting of hunger “Essential oils can be used to boost the immune system, help with sleep problems, skin support, digestive support and more,” says Fuller. “When I get hormonal headaches and migraines, I reach for my oils instead of an over-the-counter medicine. I will apply them to my neck and head, or take the cap off and inhale it deeply.”
“Essential oils boost the immune system, help with digestive health and much more,” says Evan Chait, founder of Kinetic Physical Therapy in Ramsey. “They can retrain and reprogram the brain. There are receptors in the brain which the smell center triggers, and then that has an effect on the body.” (Photo: Danielle Parhizkaran/NorthJersey.com) Her favorite essential oil is Young Living’s Thieves, a blend of clove, lemon, cinnamon bark, eucalyptus radiata and rosemary essential oils, some of which may have a positive impact on immune systems. She uses this to clean her windows, floors, sinks, bathrooms and more. “Since it helps with the immune system we have glass bottles with roller tops and roll it on our feet every night,” she says. “We made it through the entire winter without one pediatrician visit. Since we started using this two years ago, our pediatrician bills have decreased.” Fuller is so happy with the results and wellness benefits the oils have brought her family, that she has become a Young Living distributor. She does have one piece of advice for those interested in giving the oils a try: “My rule of thumb is ‘low and slow’,” she says. “Start with one or two oils and build upon that. They don’t expire if they are stored properly.” Which oils are right for you? At Bond and Bangs Apothecary in Asbury Park, owner andaromatherapist Vivian Taormina offers aromatic consultations for her clients. The consultation is a minimum of one hour, she says, and Taormina creates oil blends from the more than 100 essential oils in her shop specifically for her customers’ needs. “They may come in the shop for one problem, but after speaking with them we will may find they have other concerns,” says Taormina. “At the consultation they will receive up to two products that can help physical concerns, like pain relief, sleep troubles or acne, or mental concerns, like feeling foggy and having difficulties concentrating through the day.” Bonds and Bangs carries a large variety of organic oils ranging in price from $7.99 to about $69.99. They are known for having rare and hard to find oils, including the “almost extinct” sandalwood oil, says Taormina.
The interest in essential oils has been rising in recent years, Google Trends says, and has hit a new high this year. (Photo: MadeleineSteinbach/ / Getty Images) “Sandalwood is expensive because it is rare,” she says. “It’s therapeutic properties include being an antibacterial, an antidepressant and an anti-inflammatory, but it’s mostly known for calming the nervous system.” Because oils are natural, Taormina says they won’t cause the same type of reactions as chemical products, although some oils should be diluted before use. “Oils come from plants and trees so they are all natural,” she says. “They are fragrant but not a fragrance which is chemically derived and man made. Essential oils won’t cause headaches the way chemical fragrances can. I work with the scents all day, and in the beginning was afraid I would get a headache by the end of the day, but I never have.” Taormina believes essential oils are effective for boosting health and wellness. “They are an alternative or complementary medicine because it comes from a plant,” she says. “It’s a holistic approach. It may take awhile to see the effects but they do work, and they really can help people.”
Evan Chait, founder of Kinetic Physical Therapy in Ramsey, uses essential oils, as well as CBD oil, in his practice. (Photo: Danielle Parhizkaran/NorthJersey.com) A medical perspective Evan Chait, a physical therapist, acupuncturist and nutritionist, owns Kinetic PT in Ramsey, and uses essential oils on many of his patients. “Essential oils boost the immune system, help with digestive health and much more,” says Chait. “ They can retrain and reprogram the brain. There are receptors in the brain which the smell center triggers, and then that has an effect on the body.” He uses CBD oil on some of his patients to help with sleep and pain. “CBD oil is not an essential oil, but an extract from the hemp plant,” says Chait. “There is no marijuana in it whatsoever, and can be used by children and adults. It has all the anti-inflammatory benefits without the negative side effects of THC.” Chait also will use ginger, chamomile, clove, eucalyptus and many other kinds of essential oils, he says. He issues a caution to those using them for the first time to avoid irritating the skin. “Be careful when using them topically, they have to be diluted with another oil like coconut oil,” he says. “A diffuser is good for children. It can be set up in their bedrooms and turned on at night. Lavender and chamomile are good to use for a better night’s sleep.” As with any purchase, customers should be cautious and buy only from reputable companies to ensure products are safe and contain advertised ingredients. It is also recommended that you discuss the use of essential oils with your primary care physician before use. Chait says essential oils are beneficial and the biggest changes occur after 30 days of use, but they work better when people maintain an otherwise healthy lifestyle. “You can’t use essential oils and eat McDonalds every day,” he says. “They can be beneficial to health and wellness but in combination with eating right and exercising. They play a role in the whole healthy living lifestyle.” For more information For more about Young Living Essential Oils visit www.oily.life/kristifuller Bonds and Bangs Apothecary is located at 701 Bangs Ave., Asbury Park. 732-455-3334; www.facebook.com/bondandbangs Kinetic PT is at 171 Lake St., Ramsey. There also is a location at 182 Kinderkamack St., Park Ridge. 201-308-0182, 800-970-3274; 201-308-1933 or www.kineticpt.com CONNECT COMMENT EMAIL MORE Share your feedback to help improve our site experience! More Stories

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