??? ????? ?? ??? ???? ?????? ???? ??? ????????? ???? ?????? ????? ????? ???? ?? ????? ?????? ????? ????? ???? ?? ?????? ?? ????? ???? ?? ???? ???. ?? ???? ???? ?????? (Trade-off) ?? ?????-???? ???? ????.

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12
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13
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14
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????? ????? ????? CPT 57967 24620
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????????? ?????????? ????? ???? ?????? 1038 56160
????????? ?????????? ????? ???? ???????? 12184 15543
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??????? 3103 1243
???? ????? 400 400
?? ????? ???? ???? ????? ????? 61844 35680
??? 436787 374332
15
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16
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17
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18
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?????
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19
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  ?????? ?????????? ?????? 86400 ???? ?? ???? ??
  ??????????? ???? ????.
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  ??????? ?? ????????? ?????? ?? ?? 65 ???? ????
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  37/7???? ?? 21/4 ???? ????? ????? ???.
• ???? ????? Maimonides ????? ???? ??? ?? ?????
  ???? ????? ??????? ?? ????? 4/30 ???? ?? 26/7 ??
  05/5 ??? ???? ????? ???.
• Heritage Behavioral Health ?? ????? ???
  ????????????? ???? ????????? ?? ????? 70 ??
  ???????? ?? ????? ???? ???.
• ??????? Illinois ?? ???? ????? ?????? ????? ????
  ????? ?? ?????? ?????? ???? ???????? ?? ?????????
  ???? ?? ?????? ?????? ?? ????? ???? 2/1 ??????
  ???? ???? ????? ???.

20
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21
??????????

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  ????? ??? ?? ?????????? HIS ?? ????????????.

22
?????

• ?. ?????? ?. ?????? ?. ???? ??????? ??????
  ?????? ????? ?????????? ?? ????? ????? ????
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  1386
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  ??????? ?????? 1387
• ?. ?????? ?. ????????? ??? ????? ??????
  ?????????? ????? ?? ?????? ???? ?????? ????
  ?????? ???? ? ?????? ??????? ????? ??????? ?????
  ? ????? ?????? 1387
• ?. ?????? ?. ?????? ?. ???????????? ??????
  ?????????? ?????? ??????? ??????????? ? ??????
  ?????? ???? ?????? ???? ? ?????? ???????? ?????
  ??????? ????? ? ????? ?????? 1386

23
?????

• Cost-effectiveness analysis, Wikipedia, The
  Free Encyclopedia,
• http//en.wikipedia.org/wiki/Cost-effective, 2008
• WHO-CHOICE, CHOosing Interventions that are Cost
  Effective
• http//www.who.int/choice/en, 2008
• Medicare and Medical Technology Policy, Sean
  Tunis MD, MSc , Chief Medical Officer, CMS,
  February, 2005
• http//www.upenn.edu/ldi/tunis.ppt, 2008
• T. Tan-Torres Edejer et al., Making choices in
  health WHO guide to cost-effectiveness
  analysis, World Health Organization, Geneva,
  2003
• Strategy on health care financing for Countries
  of the Western Pacific and South-East Asia
  Regions (20062010), World Health Organization,
  Western Pacific Region and South-East Asia
  Region, 2005
• Primary Health Care Now More Than Ever, The
  World Health Report 2008, World Health
  Organization, Geneva, 2008
• M. H. Zaroukian, EMR Cost-Benefit Analysis
  Managing ROI into Reality, EMR Medical Director,
  MSU HealthTeam, Michigan State University, 2006
• F. Alemi, L. Baliton, Estimating Cost of an
  Activity EHR, Information technology project
  management, 2008

24
?????

• Electronic Health Records Overview, National
  Institutes of Health, National Center for
  Research Resources, The MITRE Corporation, April
  2006
• EMR Return on Investment, Benchmark Systems,
  Healthcare Solution
• D. Goldstein, P. Groen, Value Measurement and
  Return on Investment for EHRs, 2006
• Follow-up return on investment study, Conducted
  by Gates, Moore company for Greenway medical
  technologies
• Return On Investment (ROI) for the Ambulatory
  Electronic Medical Record, HIMSS, Transforming
  healthcare trough IT
• EHR - Estimated Cost Savings Worksheet, VistA
  ROI Example
• J. Sidorov , It Aint Necessarily So The
  Electronic Health Record And The Unlikely
  Prospect Of Reducing Health Care Costs,
  MarketWatch, Health Affairs, Volume 25, Number 4,
  2006
• Electronic health record, Wikipedia, The Free
  Encyclopedia,
• http//en.wikipedia.org/wiki/Electronic_health_rec
  ord, 2008
• L. Nicholson, Electronic Health Records in the
  United Kingdom of Great Britain Northern
  Ireland, EHR Conference, Amsterdam, June 2008
• M. Catz, J. Bayne, Canada Health Infoway A
  pan-Canadian Approach, Canada Health Infoway,
  AMIA Annual Symposium Proc., 2003