title: Voter turnout

text: Indonesia, which before 1998 always had a high percentage of voter (more than 87%) but then dip down to low 70% in the 2014, saw a record breaking voters in the 2019 Indonesian general election with more than 158 million people cast their ballots on the same day, and has been called "the world's most complex one-day elections".


title: Voter turnout

text: Wealth and literacy have some effect on turnout, but are not reliable measures. Countries such as Angola and Ethiopia have long had high turnouts, but so have the wealthy states of Europe. The United Nations Human Development Index shows some correlation between higher standards of living and higher turnout. The age of a democracy is also an important factor. Elections require considerable involvement by the population, and it takes some time to develop the cultural habit of voting, and the associated understanding of and confidence in the electoral process. This factor may explain the lower turnouts in the newer democracies of Eastern Europe and Latin America. Much of the impetus to vote comes from a sense of civic duty, which takes time and certain social conditions that can take decades to develop:


title: Voter turnout

text: Demographics also have an effect. Older people tend to vote more than youths, so societies where the average age is somewhat higher, such as Europe; have higher turnouts than somewhat younger countries such as the United States. Populations that are more mobile and those that have lower marriage rates tend to have lower turnout. In countries that are highly multicultural and multilingual, it can be difficult for national election campaigns to engage all sectors of the population.


title: Voter turnout

text: The nature of elections also varies between nations. In the United States, negative campaigning and character attacks are more common than elsewhere, potentially suppressing turnouts. The focus placed on get out the vote efforts and mass-marketing can have important effects on turnout. Partisanship is an important impetus to turnout, with the highly partisan more likely to vote. Turnout tends to be higher in nations where political allegiance is closely linked to class, ethnic, linguistic, or religious loyalties. Countries where multiparty systems have developed also tend to have higher turnouts. Nations with a party specifically geared towards the working class will tend to have higher turnouts among that class than in countries where voters have only big tent parties, which try to appeal to all the voters, to choose from. A four-wave panel study conducted during the 2010 Swedish national election campaign, show (1) clear differences in media use between age groups and (2) that both political social media use and attention to political news in traditional media increase political engagement over time. It's important to note that social media is not always used effectively and may sometimes have a negative impact on the results of the election. Barack Obama utilized Facebook to his benefit during his first run for presidency and truly jumpstarted the use of social media in political campaigns. We recently saw the utilization of social media and perhaps the negative impacts social media has on campaigns in the recent 2020 election.


title: Voter turnout

text: Rosenstone and Hansen contend that there is a decline in turnout in the United States and that it is the product of a change in campaigning strategies as a result of the so-called new media. Before the introduction of television, almost all of a party's resources would be directed towards intensive local campaigning and get out the vote initiatives. In the modern era, these resources have been redirected to expensive media campaigns in which the potential voter is a passive participant. During the same period, negative campaigning has become ubiquitous in the United States and elsewhere and has been shown to impact voter turnout. Attack ads and smear campaigns give voters a negative impression of the entire political process. The evidence for this is mixed: elections involving highly unpopular incumbents generally have high turnout; some studies have found that mudslinging and character attacks reduce turnout, but that substantive attacks on a party's record can increase it. To counter this, programs such as MTV's "Rock the Vote" and the "Vote or Die" initiatives have been introduced to increase turnouts of those between the ages of 18 and 25. A number of governments and electoral commissions have also launched efforts to boost turnout. For instance, Elections Canada has launched mass media campaigns to encourage voting prior to elections, as have bodies in Taiwan and the United Kingdom.


title: Voter turnout

text: Structural differences between democracies, including the complexity of the system and ease of voting are more often used to explain differences in turnout between nations, with United States voters in particular suffering from a complicated maze of federalism and separation of powers that is relatively unique among democracies. The Brennan Center for Justice reported that in 2016 fourteen states passed restrictive voting laws. Examples of these laws are photo ID mandates, narrow times for early voter, and limitations on voter registration. Barbour and Wright also believe that one of the causes is restrictive voting laws but they call this system of laws regulating the electorate. The Constitution gives states the power to make decisions regarding restrictive voting laws. In 2008 the Supreme Court made a crucial decision regarding Indiana's voter ID law in saying that it does not violate the constitution. Since then almost half of the states have passed restrictive voting laws. These laws contribute to Barbour and Wrights idea of the rational nonvoter. This is someone who does not vote because the benefits of them not voting outweighs the cost to vote. These laws add to the "cost" of voting, or reason that make it more difficult and to vote.


title: Voter turnout

text: Google extensively studied the causes behind low voter turnout in the United States, and argues that one of the key reasons behind lack of voter participation is the so-called "interested bystander". According to Google's study, 48.9% of adult Americans can be classified as "interested bystanders", as they are politically informed but are reticent to involve themselves in the civic and political sphere. This category is not limited to any socioeconomic or demographic groups. Google theorizes that individuals in this category suffer from voter apathy, as they are interested in political life but believe that their individual effect would be negligible. These individuals often participate politically on the local level, but shy away from national elections.


title: Voter turnout

text: The chance of any one vote determining the outcome is low. Some studies show that a single vote in a voting scheme such as the Electoral College in the United States has an even lower chance of determining the outcome. Other studies claim that the Electoral College actually increases voting power. Studies using game theory, which takes into account the ability of voters to interact, have also found that the expected turnout for any large election should be zero.


title: Voter turnout

text: The basic formula for determining whether someone will vote, on the questionable assumption that people act completely rationally, is


title: Voter turnout

text: Since "P" is virtually zero in most elections, "PB" may be also near zero, and "D" is thus the most important element in motivating people to vote. For a person to vote, these factors must outweigh "C". Experimental political science has found that even when "P" is likely greater than zero, this term has no effect on voter turnout. Enos and Fowler (2014) conducted a field experiment that exploits the rare opportunity of a tied election for major political office. Informing citizens that the special election to break the tie will be close (meaning a high "P" term) has little mobilizing effect on voter turnout.


title: Voter turnout

text: Riker and Ordeshook developed the modern understanding of "D". They listed five major forms of gratification that people receive for voting: complying with the social obligation to vote; affirming one's allegiance to the political system; affirming a partisan preference (also known as expressive voting, or voting for a candidate to express support, not to achieve any outcome); affirming one's importance to the political system; and, for those who find politics interesting and entertaining, researching and making a decision. Other political scientists have since added other motivators and questioned some of Riker and Ordeshook's assumptions. All of these concepts are inherently imprecise, making it difficult to discover exactly why people choose to vote.


title: Voter turnout

text: Recently, several scholars have considered the possibility that B includes not only a personal interest in the outcome, but also a concern for the welfare of others in the society (or at least other members of one's favorite group or party). In particular, experiments in which subject altruism was measured using a dictator game showed that concern for the well-being of others is a major factor in predicting turnout and political participation. Note that this motivation is distinct from D, because voters must think others benefit from the "outcome" of the election, not their "act" of voting in and of itself.


title: Voter turnout

text: Turnout differences appear to persist over time; in fact, the strongest predictor of individual turnout is whether or not one voted in the previous election. As a result, many scholars think of turnout as habitual behavior that can be learned or unlearned, especially among young adults.


title: Voter turnout

text: Studies have found that improving children's social skills and enrolling them in high-quality early-childhood educational programs increases their turnout as adults.


title: Voter turnout

text: Socioeconomic factors are significantly associated with whether individuals develop the habit of voting. The most important socioeconomic factor affecting voter turnout is education. The more educated a person is, the more likely they are to vote, even controlling for other factors that are closely associated with education level, such as income and class. Income has some effect independently: wealthier people are more likely to vote, regardless of their educational background. There is some debate over the effects of ethnicity, race, and gender. In the past, these factors unquestionably influenced turnout in many nations, but nowadays the consensus among political scientists is that these factors have little effect in Western democracies when education and income differences are taken into account. A 2018 study found that while education did not increase turnout on average, it did raise turnout among individuals from low socioeconomic status households. Public-sector employees have higher voter turnout than private-sector employees.


title: Voter turnout

text: However, since different ethnic groups typically have different levels of education and income, there are important differences in turnout between such groups in many societies. Other demographic factors have an important influence: young people are far less likely to vote than the elderly. Occupation has little effect on turnout, with the notable exception of higher voting rates among government employees in many countries.


title: Voter turnout

text: There can also be regional differences in voter turnout. One issue that arises in continent-spanning nations, such as Australia, Canada, the United States and Russia, is that of time zones. Canada banned the broadcasting of election results in any region where the polls have not yet closed; this ban was upheld by the Supreme Court of Canada.


title: Voter turnout

text: Within countries there can be important differences in turnout between individual elections. Elections where control of the national executive is not at stake generally have much lower turnouts—often half that for general elections. Off-year municipal and provincial elections, and by-elections to fill casual vacancies, typically have lower turnouts, as do elections for the parliament of the supranational European Union, which is separate from the executive branch of the EU's government. In the United States, midterm congressional elections attract far lower turnouts than Congressional elections held concurrently with Presidential ones. Runoff elections also tend to attract lower turnouts.


title: Voter turnout

text: In theory, one of the factors that is most likely to increase turnout is a close race. Following the Downsian Closeness hypothesis and the idea of instrumental voting, voters rationally estimate the costs and benefits of participating in an election. Benefits exceed the costs if a close outcome of the election is expected and voters believe their ballot may be decisive for the outcome. Additionally, in these elections parties increase their mobilization efforts. Although the logic of instrumental voting applies to all elections, the effects are more prominent in democracies and majoritarian electoral systems.


title: Voter turnout

text: An example is the 2004 U.S. presidential election. With an intensely polarized electorate and all polls showing a close finish between President George W. Bush and Democratic challenger John F. Kerry, the turnout in the election was close to 60%, resulting in a record number of popular votes for both candidates (around 62 million for Bush and 59 million for Kerry). However, this race also demonstrates the influence that contentious social issues can have on voter turnout; for example, the voter turnout rate in 1860 wherein anti-slavery candidate Abraham Lincoln won the election was the second-highest on record (81.2 percent, second only to 1876, with 81.8 percent). Nonetheless, there is evidence to support the argument that predictable election results—where one vote is not seen to be able to make a difference—have resulted in lower turnouts, such as Bill Clinton's 1996 re-election (which featured the lowest voter turnout in the United States since 1924), the United Kingdom general election of 2001, and the 2005 Spanish referendum on the European Constitution; all of these elections produced decisive results on a low turnout.


title: Voter turnout

text: A 2020 NBER paper, examining evidence from Swiss referendums, found that an awareness by the electorate that an election would be close increased turnout. Controlling for canton and vote fixed effects, the study determined "that greater cantonal newspaper coverage of close polls significantly increases voter turnout"


title: Voter turnout

text: One 2017 study in the "Journal of Politics" found that, in the United States, incarceration had no significant impact on turnout in elections: ex-felons did not become less likely to vote after their time in prison. Also in the United States, incarceration, probation, and a felony record deny 5–6 million Americans of the right to vote, with reforms gradually leading more states to allow people with felony criminal records to vote, while almost none allow incarcerated people to vote.


title: Voter turnout

text: A 2017 study in "Electoral Studies" found that Swiss cantons that reduced the costs of postal voting for voters by prepaying the postage on return envelopes (which otherwise cost 85 Swiss Franc cents) were "associated with a statistically significant 1.8 percentage point increase in voter turnout". A 2016 study in the "American Journal of Political Science" found that preregistration – allowing young citizens to register before being eligible to vote – increased turnout by 2 to 8 percentage points. A 2019 study in "Social Science Quarterly" found that the introduction of a vote‐by‐mail system in Washington state led to an increase in turnout. Another 2019 study in "Social Science Quarterly" found that online voter registration increased voter turnout, in particular for young voters. A 2020 study in "Political Behavior" found that a single postcard by election officials to unregistered eligible voters boosted registration rates by a percentage point and turnout by 0.9 percentage points, with the strongest effects on young, first-time voters.


title: Voter turnout

text: A 2018 study in the "British Journal of Political Science" found that internet voting in local elections in Ontario, Canada, only had a modest impact on turnout, increasing turnout by 3.5 percentage points. The authors of the study say that the results "suggest that internet voting is unlikely to solve the low turnout crisis, and imply that cost arguments do not fully account for recent turnout declines."


title: Voter turnout

text: A 2017 experimental study found that by sending registered voters between the ages of 18 and 30 a voter guide containing salient information about candidates in an upcoming election (a list of candidate endorsements and the candidates' policy positions on five issues in the campaign) increased turnout by 0.9 points.


title: Voter turnout

text: A 2018 study found that "young people who pledge to vote are more likely to turn out than those who are contacted using standard Get-Out-the-Vote materials. Overall, pledging to vote increased voter turnout by 3.7 points among all subjects and 5.6 points for people who had never voted before."


title: Voter turnout

text: Research results are mixed as to whether bad weather affects turnout. There is research that shows that precipitation can reduce turnout, though this effect is generally rather small, with most studies finding each millimeter of rainfall to reduce turnout by 0.015 to 0.1 percentage points. At least two studies, however, found no evidence that weather disruptions reduce turnout. A 2011 study found "that while rain decreases turnout on average, it does not do so in competitive elections." Some research has also investigated the effect of temperature on turnout, with some finding increased temperatures to moderately increase turnout. Some other studies, however, found temperature to have no significant impact on turnout. These variations in turnout can also have partisan impacts; a 2017 study in the journal "American Politics Research" found that rainfall increased Republican vote shares, because it decreased turnout more among Democratic voters than Republican voters. Studies from the Netherlands and Germany have also found weather-related turnout decreases to benefit the right, while a Spanish study found a reverse relationship.


title: Voter turnout

text: The season and the day of the week (although many nations hold all their elections on the same weekday) can also affect turnout. Weekend and summer elections find more of the population on holiday or uninterested in politics, and have lower turnouts. When nations set fixed election dates, these are usually midweek during the spring or autumn to maximize turnout. Variations in turnout between elections tend to be insignificant. It is extremely rare for factors such as competitiveness, weather, and time of year to cause an increase or decrease in turnout of more than five percentage points, far smaller than the differences between groups within society, and far smaller than turnout differentials between nations.


title: Voter turnout

text: A 2018 study in the "American Political Science Review" found that the parents to newly enfranchised voters "become 2.8 percentage points more likely to vote." A 2018 study in the journal "Political Behavior" found that increasing the size of households increases a household member's propensity to vote.


title: Voter turnout

text: A 2018 PlosOne study found that a "partisan who is married to a co-partisan is more likely to vote. This phenomenon is especially pronounced for partisans in closed primaries, elections in which non-partisan registered spouses are ineligible to participate."


title: Voter turnout

text: According to a 2018 study, get-out-the-vote groups in the United States who emphasize ballot secrecy along with reminders to vote increase turnout by about 1 percentage point among recently registered nonvoters.


title: Voter turnout

text: There are philosophical, moral, and practical reasons that some people cite for not voting in electoral politics, typically owing to obstacles to voting, though some of the practical reasons for abstention have more to do with rare, difficult to predict situations arising from flaws in the design of the voting system that fail to efficiently capture voter preferences.


title: Juan Manuel Santos

text: Juan Manuel Santos Calderón (; born 10 August 1951) is a Colombian politician who was the President of Colombia from 2010 to 2018. He was the sole recipient of the 2016 Nobel Peace Prize.


title: Juan Manuel Santos

text: An economist by profession and a journalist by trade, Santos is a member of the wealthy and influential Santos family, who from 1913 to 2007 were the majority shareholders of "El Tiempo" until its sale to Planeta DeAgostini in 2007. He was a cadet at the Navy Academy in Cartagena. Shortly after graduating from the University of Kansas, he joined the National Federation of Coffee Growers of Colombia as an economic advisor and delegate to the International Coffee Organization in London, where he also attended the London School of Economics. In 1981, he was appointed deputy director of "El Tiempo" newspaper, becoming its director two years later. Santos earned a mid-career/master's in public administration in 1981 from Harvard Kennedy School (HKS), and was a 1988 Nieman Fellow for his award-winning work as a columnist and reporter. Santos was a Fulbright visiting fellow at Fletcher at Tufts University in 1981. Santos has been a member of the Washington-based think tank the Inter-American Dialogue since 1990, and he previously served as co-chair of the Board of Directors. Santos was president of the Freedom of Expression Commission for the Inter American Press Association.


title: Juan Manuel Santos

text: In 1991, he was appointed by President César Gaviria Trujillo as Colombia's first Minister of Foreign Trade. Santos worked in expanding international trade with Colombia, and worked in creating various agencies for this purpose including: Proexport, Bancoldex and Fiducoldex. In 2000, he was appointed by President Andrés Pastrana Arango as the 64th Minister of Finance and Public Credit.


title: Juan Manuel Santos

text: Santos rose to prominence during the administration of President Álvaro Uribe Vélez. In 2005, he co-founded and led the Social Party of National Unity (Party of the U), a liberal-conservative party coalition that backed the policies of President Uribe, successfully supporting his attempt to seek a constitutional reform to be able to run for a second term. In 2006, after Uribe's re-election, when the Party of the U won a majority of seats in the two chambers of Congress, Santos was appointed as Minister of National Defence, and continued defending the security policies of President Uribe, taking a strong and forceful stance against FARC and the other guerrilla groups operating in Colombia. Santos also created the Good Government Foundation. His time at the Ministry of Defense was tarnished by the ""False positives" scandal", the executions of thousands of civilians that the army passed off as guerrillas killed in combat. The scandal broke in 2008 with the identification of 19 young people whose disappearances had been reported by their families in Soacha (a suburb of Bogotá), whom the army presented as slain guerrillas. The sudden media coverage of this secret policy of the Colombian army led to an increase in the number of testimonies and judicial investigations that led to the identification of more than 6,000 executed civilians. Likely covered up by the military hierarchy and political leaders, these practices have remained generally unpunished; the impunity rate for soldiers who are war criminals is 98.5% according to the United Nations.


title: Juan Manuel Santos

text: In 2010, Santos won the presidential election as the protégé of Uribe. Some months after Santos' possession, Uribe became his strongest opponent, and also founded three years later the opposition party Democratic Center. This rivalry determined both Santos' unpopularity and his near-missed defeat during the 2014 Colombian presidential election against Uribe's protégé Óscar Iván Zuluaga.


title: Juan Manuel Santos

text: On 7 October 2016, Santos was announced as recipient of the Nobel Peace Prize for his efforts negotiating a peace treaty with the FARC-guerrilla in the country, despite his defeat in the referendum held over the deal, where the "No" campaign led by Uribe's Democratic Center won. The Colombian government and the FARC signed a revised peace deal on 24 November and sent it to Congress for ratification instead of conducting a second referendum. Both houses of Congress ratified the revised peace accord on 29–30 November 2016, marking an end to the conflict. The treaty brought deep divisions and polarization in the country, which questions its legitimacy. Santos has been named as one of "Time"s 100 most influential people. Santos left office with one of the lowest levels of popular approval ever, and his successor was Uribe's new protégé, Iván Duque, a moderate critic of Santos' peace treaty with the FARC guerilla.


title: Juan Manuel Santos

text: Santos was born in Bogotá, Colombia. He attended Colegio San Carlos, a private secondary school in Bogotá, where he spent most of his school years until 1967, when he enlisted in the Colombian Navy and transferred to the Admiral Padilla Naval Cadet School in Cartagena, graduating from it in 1969, and continuing in the Navy until 1971, finishing with the rank of naval cadet NA-42z 139.


title: Juan Manuel Santos

text: After leaving the Navy, Santos moved to the United States where he attended the University of Kansas. A member of Delta Upsilon fraternity, he graduated in 1973 with a Bachelor in Economics and Business Administration. On 31 October 2017, Santos received an honorary doctorate of human letters from KU.


title: Juan Manuel Santos

text: After graduating from the University of Kansas, Santos served as Chief Executive of the National Federation of Coffee Growers of Colombia to the International Coffee Organization in London. During this time he also attended the London School of Economics, graduating with a Master of Science in Economic Development in 1975. He then attended the John F. Kennedy School of Government at Harvard University, graduating with a Master of Public Administration in 1981. He returned to Colombia to become Deputy Director of his family owned newspaper "El Tiempo". Santos has been a member of the Washington-based think tank the Inter-American Dialogue since 1990, and he previously served as co-chair of the Board of Directors. He was president of the Freedom of Expression Commission for the Inter American Press Association.


title: Juan Manuel Santos

text: A Fulbright visiting fellow at the Fletcher School of Law and Diplomacy at Tufts University in 1981, and a Nieman Fellow at Harvard University in 1988, Santos also holds an honorary Doctor of Laws degree.


title: Juan Manuel Santos

text: He was Minister of Foreign Trade of Colombia during the administration of President César Gaviria Trujillo from 1991 to 1994 and also the Presidential Designate of Colombia from 1993 to 1994, Minister of Finance and Public Credit of Colombia during the administration of President Andres Pastrana Arango from 2000 to 2002. In 1992 he was appointed President of the VIII United Nations Conference on Trade and Development.


title: Juan Manuel Santos

text: In 1994 Juan Manuel Santos founded the Good Government Foundation, whose stated objective is helping and improving the governability and efficiency of the Colombian Government. This organization presented a proposal for a demilitarized zone and peace talks with the FARC guerrilla group. Juan Manuel Santos has been named as one of Time magazine's 100 most influential people. Universidade NOVA de Lisboa is granting the Honoris Causa Doctorate title to Juan Manuel Santos.


title: Juan Manuel Santos

text: Santos also founded the Social Party of National Unity (Party of the U) to support the presidency of Álvaro Uribe. He was named Minister of Defence on 19 July 2006. During his tenure as Defence Minister, the administration dealt a series of blows against the FARC guerrilla group, including the rescue of Fernando Araújo Perdomo, the death of FARC Secretariat member Raúl Reyes (a controversial military raid on Ecuador's border), and the non-violent rescue of former presidential candidate Ingrid Betancourt held captive since 2002, along with fourteen other hostages, including three Americans.


title: Juan Manuel Santos

text: In 2008 the 'false positives' scandal was uncovered, referring to revelations concerning extrajudicial executions carried out by members of the military in order to artificially increase the number of guerrillas killed by the Army and claim rewards from the government. On 4 November 2008, Santos admitted that the military had carried out extrajudicial executions and he pledged to resolve the issue. Twenty-seven military officers, including three generals and eleven colonels, were sacked after an internal army investigation concluded that they were responsible for administrative failures and irregularities in reporting enemy casualties and operational results. The Commander of the Colombian National Army, General Mario Montoya, resigned. By May 2009, 67 soldiers had been found guilty and over 400 were arrested pending trial.


title: Juan Manuel Santos

text: There are different estimates for the number of civilians who may have been killed in this manner. As of May 2009, prosecutors were investigating more than 900 cases involving over 1,500 victims and 1,177 members of the Colombian security forces. According to the "Coordinación Colombia-Europa-Estados Unidos" NGO coalition and the "Fundación para la Educación y el Desarrollo", an estimated 3,756 extrajudicial executions occurred between 1994 and 2009, of which 3,084 cases would have taken place after 2002.


title: Juan Manuel Santos

text: Families of the victims and non-governmental organisations have held the Uribe administration and Santos, as Defence Minister, responsible for the extrajudicial killings because they consider that the government's reward policies motivated the crimes. Directive 029 of 2005 issued under Defence Minister Camilo Ospina Bernal and presidential decree 1400 of May 2006 have been questioned for offering incentives and benefits in exchange for capturing or killing members of illegal armed groups.


title: Juan Manuel Santos

text: In June 2009, United Nations Special Rapporteur Philip Alston declared that extrajudicial executions had been carried out in a "more or less systematic manner" by numerous Colombian military personnel and found the number of trials for those implicated to be lacking, but stated that he had found no evidence of the executions being an official government policy and acknowledged a decrease in the number of reported cases.


title: Juan Manuel Santos

text: In March 2010, Santos publicly stated these executions had stopped since October 2008 and that this had been confirmed by the CINEP, one of Colombia's foremost human rights defence institutions. "Semana", a well-respected weekly magazine, reported that a few days later the CINEP responded to Santos's declarations by issuing a press release which stated that, while the number of reported cases had been significantly reduced after the Defence Ministry's measures were announced, the period between November 2008 and December 2009 still saw 7 such executions and 2 arbitrary detentions.


title: Juan Manuel Santos

text: Juan Manuel Santos announced his resignation from the Defence Ministry on 18 May 2009. Santos said that his resignation did not necessarily imply tossing his hat into the 2010 presidential race and that his participation in the electoral race depended on whether Uribe would pursue a third term, which he was willing to support. His resignation took effect on 23 May 2009. When the Constitutional Court ruled out the possibility of Uribe's participation in the upcoming elections, Santos officially launched his campaign for the presidency of the Republic of Colombia.


title: Juan Manuel Santos

text: On 20 June 2010, after two rounds of voting in the Presidential election, Juan Manuel Santos Calderón was officially elected as President of Colombia and was inaugurated on 7 August 2010 in the midst of a diplomatic crisis with Venezuela, which was quickly resolved.


title: Juan Manuel Santos

text: Santos announced on 27 August 2012 that the Colombian government had engaged in exploratory talks with FARC in order to seek an end to the conflict. He also said that he would learn from the mistakes of previous leaders, who failed to secure a lasting ceasefire with FARC, though the military would still continue operations throughout Colombia while talks continued. According to an unnamed Colombian intelligence source, Santos offered FARC assurances that no one would be extradited to stand trial in another country. The move has been viewed as a cornerstone of Santos' presidency. Former President Uribe has criticised Santos for seeking peace "at any costs" in contrast to his predecessor's rejection of talks.


title: Juan Manuel Santos

text: In October 2012, Santos received the Shalom Prize "for his commitment to seeking peace in his country and worldwide." Upon accepting the award from the Latin American chapter of the World Jewish Congress, Santos stated that "Both the people here and the people in Israel have been seeking peace for decades," adding that Colombia is in favour of a two-state solution to the Israeli-Palestinian conflict.


title: Juan Manuel Santos

text: In September 2016, Santos announced that an agreement had been made completely settling the dispute between the Colombian government and FARC on the basis of a truth and reconciliation-like process, in which a combination of complete admissions of guilt and community service on the part of perpetrators of misdeeds during the years of conflict would serve in place of retributive justice.


title: Juan Manuel Santos

text: The 52-year Colombian war has cost the country 152 billion (USD), according to conflict monitoring NGO Indepaz. Within the last five years the daily cost of the war has escalated to US$9.3 million per day – enough to feed 3 million people in Colombia and wipe out extreme poverty in that country.


title: Juan Manuel Santos

text: In May 2017, U.S. President Donald Trump and Santos held a joint news conference at the White House, where Trump praised Colombia's efforts to end a 52-year civil war that left more than 220,000 dead as a "great thing to watch."


title: Juan Manuel Santos

text: Around that time, it was reported that Trump had an "unusual meeting with former presidents Alvaro Uribe and Andres Pastrana" at his Florida resort Mar-a-Lago, lending weight to suspicion that Santos's political enemies were enlisting Trump's support against the historic peace accord. The event was widely reported in Colombia, yet never announced by the White House.


title: Juan Manuel Santos

text: In September 2017, Santos defended Colombia's record against Trump's complaints about what he called unacceptable growth in coca cultivation and production. Trump added that he considered downgrading the country in a White House assessment, which would result in reduced development and security funding. One source of contention is the usage of glyphosate to eradicate coca crops, which Colombia had halted in favor of other methods due to health concerns.


title: Juan Manuel Santos

text: Colombia defended its anti-narcotics efforts after the threat of Trump to decertify the country as a partner in counter-narcotics efforts.


title: Juan Manuel Santos

text: In July 2018, Santos called on Trump to urge Russian president Vladimir Putin to stop supporting Venezuela's authoritarian government. Santos has acknowledged that, in 2017, Trump raised the idea of a military invasion of Venezuela to drive out President Nicolas Maduro, which he and other Latin American leaders rejected at the time.


title: Juan Manuel Santos

text: During a Google hangout hosted by the Colombian newspaper "El Tiempo" on 20 May 2014, Santos voiced his support for same-sex marriage, saying: "Marriage between homosexuals to me is perfectly acceptable and what's more I am defending unions that exist between two people of the same sex with the rights and all of the same privileges that this union should receive."


title: Juan Manuel Santos

text: On 20 November 2013, Santos announced his intent to run for re-election in a presidential address, and formalized his intent by filing election papers with the National Civil Registry on 25 November. As the incumbent president he ran virtually unopposed in the Social Party of National Unity convention, receiving 772 votes of the 787 party delegates, and receiving the party's nomination on 28 January 2014. Santos and his allies also lobbied for the support of other political parties, receiving the nomination from the Liberal and Radical Change parties, forming the National Unity Coalition.


title: Juan Manuel Santos

text: On 12 March Santos officially launched his re-election campaign for the 2014 presidential election under the slogan: "We have done much, there is much to be done". On 24 February, Santos announced that the running mate for his 2014 reelection campaign would be is Germán Vargas Lleras, a veteran politician from one of Colombia's most powerful political dynasties, and his former Minister of Housing, City and Territory. The decision to replace Vice President Garzón as his running mate was an expected one, as Garzón had already announced his desire to retire from politics.


title: Juan Manuel Santos

text: On 15 May, Santos obtained 25.69% of the votes, falling behind his main rival, Óscar Iván Zuluaga Escobar of the Democratic Center, who obtained 29.25% of the votes. Since no one candidate earned the required majority, a run-off election was announced. In the second round, Santos received the backing and support of his former electoral rival: Clara López Obregón of the Alternative Democratic Pole, as well from dissident members of the Conservative and Green parties.


title: Juan Manuel Santos

text: On 15 June, Santos won 50.95% of the popular vote in the second round of the election. President Santos addressed supporters and volunteers gathered at the campaign's headquarters in the Claustro de La Enseñanza after his reelection and said: "This is the end of 50 years of conflict in this country, and it is the beginning of a new Colombia". Santos's victory, which was much smaller than his landslide result in 2010, was credited with strategic endorsements from left-wing politicians such as Clara López who appeared on a T.V. endorsement for Santos despite having nearly polar opposite views on many issues. This helped Santos, who had been neck and neck with his Conservative challenger on polls up to the second election round. Many among the Left whose fortunes had declined since the start of the FARC insurgency hoped a peaceful negotiation with FARC, which required a Santos victory, would help rehabilitate the left among the Conservative-Liberal dominated political scene in Colombia.


title: Juan Manuel Santos

text: On 14 March 2017 Santos acknowledged that his 2010 election campaign received illegal payments from Brazilian conglomerate Odebrecht.


title: Juan Manuel Santos

text: In November 2017, an investigation conducted by the International Consortium of Investigative Journalism claimed Juan Manuel Santos was in control of two offshore companies in Barbados. Following this, Santos clarified that he left the managing board of one of these companies before holding a ministerial office.


title: Juan Manuel Santos

text: Santos was born on 10 August 1951 in Bogotá to Enrique Santos Castillo and his wife Clemencia Calderón Nieto, his brothers are: Enrique, Luis Fernando, and Felipe. The Santos family has been a well established and influential family since the mid-20th century; his great-great-grandaunt was María Antonia Santos Plata, a martyr of the Independence of Colombia, and his great-granduncle was Eduardo Santos Montejo, President of Colombia between 1938 and 1942, who acquired the national newspaper "El Tiempo". From there, his family has been connected to the newspaper and influenced the political life of the country; Eduardo's brother, Enrique, grandfather of Juan Manuel, and editor in chief of "El Tiempo", was known as ""Calibán"" to his readers, and his three sons, Enrique (Juan Manuel's father) and Hernando Santos Castillo, and Enrique Santos Molano were chief editor, director, and columnist respectively. Through his father's brother, Hernando, and his mother's sister, Elena, Juan Manuel is also first cousin on both sides to Francisco Santos Calderón, former Vice President of Colombia during the previous administration from 2002 to 2010.


title: Juan Manuel Santos

text: Santos first married Silvia Amaya Londoño, a film director and television presenter, but divorced three years later having no children together. He then married María Clemencia Rodríguez Múnera, or ""Tutina"" as she is known to those close to her, an industrial designer he had met while she worked as a private secretary at the Ministry of Communications and he was Deputy Director of "El Tiempo". Together they had three children, Martín (born 1989), María Antonia (born 1991), and Esteban (born 1993).


title: Juan Manuel Santos

text: A new plant species from Northeastern Colombia has been named Espeletia praesidentis, in honour of efforts made by President Santos to build peace.


title: Golden age hip hop

text: Golden age hip hop is a name given to mainstream hip hop music created from the mid-1980s to early-mid 1990s, particularly by artists and musicians originating from the New York metropolitan area. An outgrowth of the new school hip hop movement, it is characterized by its diversity, quality, innovation and influence on hip hop after the genre's emergence and establishment in the old-school era, and is associated with the development and eventual mainstream success of hip hop. There were various types of subject matter, while the music was experimental and the sampling from old records was eclectic.


title: Golden age hip hop

text: The artists most often associated with the period are LL Cool J, Slick Rick, Ultramagnetic MC's, the Jungle Brothers, Run-D.M.C., Public Enemy, Beastie Boys, KRS-One, Eric B. & Rakim, De La Soul, Big Daddy Kane, EPMD, Biz Markie, Salt-N-Pepa, Queen Latifah, Gang Starr, and A Tribe Called Quest. Releases by these acts co-existed in this period with, and were as commercially viable as, those of early gangsta rap artists such as Schoolly D, Ice-T, Geto Boys, N.W.A, the sex raps of 2 Live Crew and Too Short, and party-oriented music by acts such as the Fat Boys, DJ Jazzy Jeff & the Fresh Prince, MC Hammer, and Vanilla Ice.


title: Golden age hip hop

text: The golden age is noted for its innovation – a time "when it seemed that every new single reinvented the genre," according to "Rolling Stone". Referring to "hip-hop in its golden age", "Spin"<nowiki>'</nowiki>s editor-in-chief Sia Michel said, "there were so many important, groundbreaking albums coming out right about that time",


title: Golden age hip hop

text: and MTV's Sway Calloway added: "The thing that made that era so great is that nothing was contrived. Everything was still being discovered and everything was still innovative and new". Writer William Jelani Cobb said, "what made the era they inaugurated worthy of the term golden was the sheer number of stylistic innovations that came into existence... in these golden years, a critical mass of mic prodigies were literally creating themselves and their art form at the same time".


title: Golden age hip hop

text: The term "Golden age hip hop" frames the late 1980s in mainstream hip hop, said to be characterized by its diversity, quality, innovation and influence, and associated with Public Enemy, KRS-One and his Boogie Down Productions, Eric B. & Rakim, Ultramagnetic MCs, De La Soul, A Tribe Called Quest, and the Jungle Brothers due to their themes of Afrocentricity and political militancy, their experimental music, and their eclectic sampling. This same period is sometimes referred to as "mid-school" or a "middle school" in hip hop, the phrase covering acts such as Gang Starr, the UMC's, Main Source, Lord Finesse, EPMD, Just Ice, Stetsasonic, True Mathematics, and Mantronix.


title: Golden age hip hop

text: The innovations of Run-D.M.C., LL Cool J, and new school producers such as Larry Smith, and Rick Rubin of Def Jam Recordings, were quickly advanced on by the Beastie Boys, Marley Marl and his Juice Crew MCs, Boogie Down Productions, Public Enemy, and Eric B. & Rakim. Hip hop production became denser, rhymes and beats faster, as the drum machine was augmented with the sampler technology. Rakim took lyrics about the art of rapping to new heights, while KRS-One and Chuck D pushed "message rap" towards black activism. Native Tongues artists' inclusive, sample-crowded music accompanied their positivity, Afrocentricity and playful energy.


title: Golden age hip hop

text: During the golden age of hip hop, samples were heavily used. The ability to sample different beats, riffs and patterns from a wide variety of sources gave birth to a new breed of producers and DJs who did not necessarily need formal musical training or instruments, just a good ear for sound collages. These samples were derived from a number of genres, ranging from jazz, funk and soul to rock and roll. For example, "Paul's Boutique", the Beastie Boys' second studio album, drew from over 200 individual samples, 24 of which were featured on the last track of the album. Samples and sound bites were not limited to just music. RZA of the Wu-Tang Clan, a hip hop collective formed in the 1990s, sampled sound clips from his own collection of 1970s kung-fu films to bolster and frame the group's gritty lyrical content. Many of the sample-laden albums released during this time would not be able to receive legal clearance today.


title: Golden age hip hop

text: The era also provided some of the greatest advances in rapping technique. Kool G Rap, referring to the golden age in the book "How to Rap" said, "that era bred rappers like a Big Daddy Kane, a KRS-One, a Rakim, a Chuck D... their rapping capability and ability – these dudes were phenomenal". Many of hip hop's biggest artists were also at their creative peak. Allmusic said the golden age "witnessed the best recordings from some of the biggest rappers in the genre's history... overwhelmingly based in New York City, golden age rap is characterized by skeletal beats, samples cribbed from hard rock or soul tracks, and tough dis raps... rhymers like PE's Chuck D, Big Daddy Kane, KRS-One, Rakim, and LL Cool J basically invented the complex wordplay and lyrical kung-fu of later hip-hop".


title: Golden age hip hop

text: In addition to lyrical self-glorification, hip hop was also used as a form of social protest. Lyrical content from the era often drew attention to a variety of social issues including Afrocentric living, drug use, crime and violence, religion, culture, the state of the American economy, and the modern man's struggle. Conscious and political hip hop tracks of the time were a response to the effects of American capitalism and former President Reagan's conservative political economy. According to Rose Tricia, "In rap, relationships between black cultural practice, social and economic conditions, technology, sexual and racial politics, and the institution policing of the popular terrain are complex and in constant motion. Even though hip hop was used as a mechanism for different social issues it was still very complex with issues within the movement itself.


title: Golden age hip hop

text: There was also often an emphasis on black nationalism. Hip hop scholar Michael Eric Dyson stated, "during the golden age of hip hop, from 1987 to 1993, Afrocentric and black nationalist rap were prominent", and critic Scott Thill described the time as "the golden age of hip hop, the late '80s and early '90s when the form most capably fused the militancy of its Black Panther and Watts Prophets forebears with the wide-open cultural experimentalism of De La Soul and others". Stylistic variety was also prominent; MSNBC said that in the golden age, "rappers had an individual sound that was dictated by their region and their communities, not by a marketing strategist," the "Village Voice" referred to the golden age's "eclecticism", and Ben Duinker and Denis Martin of "Empirical Musicology Review" wrote that "The constant flow of new, boundary-pushing Golden Age album releases exemplifies this era's unprecedented stylistic fluidity."


title: Golden age hip hop

text: AllMusic writes, "Hip-hop's golden age is bookended by the commercial breakthrough of Run-D.M.C. in 1986 and the explosion of gangsta rap with NWA in the late 80s and Dr. Dre and Snoop Doggy Dogg in 1993." However, the specific time period that the golden age covers varies among different sources. The "New York Times" also defines hip-hop's golden age as the "late 1980s and early 90s". Ed Simons of the Chemical Brothers said, "there was that golden age of hip-hop in the early 90s when the Jungle Brothers made "Straight Out the Jungle" and De La Soul made "Three Feet High and Rising"" (though these records were in fact made in 1988 and 1989 respectively). MSNBC called the 1980s the "Golden Age" of hip-hop music. The Guardian states, "The golden age of hip-hop, from 1986 to 1993, gave the world an amazing number of great records," and also describes the period in November 1993, when A Tribe Called Quest and Wu-Tang Clan released albums, as "The Next Golden age."


title: Golden age hip hop

text: The golden age is described by scholar Mickey Hess as "circa 1986-1994." Carl Stoffers of "New York Daily News" describes the golden age as "spanning from approximately 1986 to 1997." Brad Callas of Medium.com writes that "Hip-Hop's Golden Age is loosely bookended by the genre's commercial breakthrough in the late 1980s and the back-to-back deaths of 2Pac and Biggie in the late 1990s." In their article "In Search of the Golden Age Hip-Hop Sound", music theorists Ben Duinker and Denis Martin of "Empirical Musicology Review" use "the 11 years between and including 1986 and 1996 as chronological boundaries" to define the golden age, bookended by the releases of "Raising Hell" and "License to Ill" and the deaths of Tupac Shakur and the Notorious B.I.G. Will Lavin of uDiscover Music states "It's generally accepted that the Golden Age occurred from the mid '80s and mid '90s; it was then that all the elements of the culture – breaking, graffiti art and DJing – broke cover to enter the mainstream." Music critic Tony Green, in the book "Classic Material", refers to the two-year period 1993–1994 as "a second Golden Age" that saw influential, high-quality albums using elements of past classicism – drum machines (Roland TR-808), drum samplers (Akai MPC60, E-mu SP-1200), turntable scratches, references to old school hip hop hits, and "tongue-twisting triplet verbalisms" – while making clear that new directions were being taken. Green lists as examples the Wu-Tang Clan's "Enter the Wu-Tang (36 Chambers)", Nas's "Illmatic", De La Soul's 1993 release "Buhloone Mindstate", Snoop Doggy Dogg's "Doggystyle", A Tribe Called Quest's third album "Midnight Marauders" and the Outkast debut "Southernplayalisticadillacmuzik". Dart Adams of "Festival Peak" described this "2nd Golden Era" as spanning 1992 to 1996, and cites the release of Puff Daddy and Mase's "Can't Nobody Hold Me Down" in 1997 as being the start of mainstream rap's "Jiggy Era".


title: Golden age hip hop

text: According to copyright, music, and pop culture scholars Kembrew Mcleod and Peter DiCola, the golden age of hip-hop sampling spans from 1987 to 1992. Artists and record labels were not yet aware of the permanence of hip-hop culture in mainstream media, and did not yet accept it as a legitimate institution. They believe the ruling made in "Grand Upright Music, Ltd. v. Warner Bros. Records Inc." marked the end of the golden age of hip hop and its sampling practices.


title: Golden age hip hop

text: Notable hip hop producer and innovator, Marley Marl, formed the Juice Crew hip hop collective. Marl also founded Cold Chillin' Records and assembled various hip hop acts, including MC Shan, Big Daddy Kane, Biz Markie, Roxanne Shanté, Kool G Rap & DJ Polo, and Masta Ace. His Juice Crew collective was an important force in ushering the "golden age" era of hip hop, with advances in lyrical technique, distinctive personalities of emerging artists like Biz Markie and Big Daddy Kane, and attaining crossover commercial success for hip hop music. Marley Marl's first production was an "answer record" to "Sucker MCs" in 1983 entitled "Sucker DJs" by Dimples D. Soon after came 14-year-old Roxanne Shanté's answer to UTFO's "Roxanne Roxanne", "Roxanne's Revenge" (1985), sparking off the huge wave of answer records known as the Roxanne Wars. More disses (insults intended to show disrespect) from Shanté followed: "Bite This" (1985), "Queen of Rox" (1985), introducing Biz Markie on "Def Fresh Crew" (1986), "Payback" (1987), and "Have a Nice Day" (1987).


title: Golden age hip hop

text: Shante's "Have a Nice Day" had aimed some barbs at the principal two members of a new group from the Bronx called Boogie Down Productions (BDP): "Now KRS-ONE you should go on vacation with that name soundin' like a wack radio station, and as for Scott La Rock, you should be ashamed, when T La Rock said "It's Yours", he didn't mean his name". Boogie Down Productions had manufactured a disagreement with the Juice Crew's MC Shan, releasing "South Bronx" and "The Bridge is Over" in reply to his "The Bridge" and "Kill That Noise" respectively. KRS-One considered Run-D.M.C. the epitome of rap music in 1984 and had begun to rap following their lead. He has also said that BDP's approach reflected a feeling that the early innovators like Run-D.M.C. and LL Cool J were by 1986 tainted by commercial success and out of touch with the streets.


title: Golden age hip hop

text: Boogie Down's first album "Criminal Minded" (1987) admitted a reggae influence and had KRS-One imitating the Beatles' "Hey Jude" on the title track. It also contained two tales of grim street life, yet played for callous laughs: "The P Is Free", in which KRS speaks of throwing out his girl who wants crack cocaine in exchange for sex, and "9mm Goes Bang", in which he shoots a drug dealer then cheerfully sings "la la la la la la". Songs like these presaged the rise of an underground that matched violent lyrics to the hardcore drum machine tracks of the new school. The cover of "Criminal Minded" was a further reflection of a move towards this sort of radical image, depicting the group in a half-light, holding firearms. The next album "By All Means Necessary" (1988) left that element behind for political radicalism following the murder of Scott La Rock, with its title and cover alluding to Malcolm X. KRS-One became involved with the Stop the Violence Movement at this time. Boogie Down Productions, along with Run-D.M.C. and Public Enemy, associated the new school as rap music with a strong message.


title: Golden age hip hop

text: Eric B. & Rakim appeared with the Marley Marl produced "Eric B. Is President" and "My Melody" on Zakia Records in 1986. Both tracks appeared on "Paid in Full" (1987). Just as Boogie Down Productions had, the pair reflected changes in street life on their debut's cover, which depicted the two wearing large gold chains and surrounded by money. Like "Criminal Minded", the sampling prevalent in the album cemented James Brown's status as a hip hop source, while Rakim's allusions showed the growing influence of mystic Islam-offshoot The Nation of Gods and Earths in hip-hop. The music was minimalist, austerely so, with many writers noting that coupled with Rakim's precise, logical style, the effect was almost one of scientific rigour. The group followed "Paid in Full" with "Follow the Leader" (1988) (on which they were open-minded enough to sample the Eagles), "Let the Rhythm Hit 'Em" (1990) and "Don't Sweat the Technique" (1992).


title: Golden age hip hop

text: Jess Harvell in "Pitchfork" in 2005 wrote that "Rakim's innovation was applying a patina of intellectual detachment to rap's most sacred cause: talking shit about how you're a better rapper than everyone else." Christgau in the "Village Voice" in 1990 wrote of Rakim's style as "calm, confident, clear. On their third album, as on their phase-shifting 1986 debut," he continues, "Eric B.'s samples truly are beats, designed to accentuate the natural music of an idealized black man's voice." Looking back at the late eighties in "Rolling Stone" in 1997, Ed Moralez describes Rakim as "the new-school MC of the moment, using a smooth baritone to become the jazz soloist of mystic Afrocentric rap."


title: Golden age hip hop

text: Public Enemy, having been reluctantly convinced to sign to a record label, released "Yo! Bum Rush the Show" on Def Jam in 1987. It debuted the Public Enemy logo, a circle of hatted b-boy in a sniper's cross-hairs, was replete with battle rhymes ("Miuzi Weighs a Ton", "Public Enemy #1"), social-political fare ("Rightstarter (Message to a Black Man)") and anti-crack messages ("Megablast"). The album was a critical and commercial success, particularly in Europe, unusually so for a hip hop album at that time. "Bumrush the Show" had been recorded on the heels of Run-D.M.C.'s "Raising Hell", but was held back by Def Jam in order for them to concentrate on releasing and promoting the Beastie Boys' "License to Ill". Chuck D of Public Enemy felt that by the time their first record was released, Boogie Down Productions and Rakim had already changed the landscape for how an MC could rap. Public Enemy were already recording their second album "It Takes a Nation of Millions to Hold Us Back" (Def Jam, 1988) when "Bumrush" hit stores.


title: Golden age hip hop

text: The underground sound, centered on urban violence, that was to become gangsta rap, existed on the East Coast soon after Run-D.M.C. had inaugurated the new school of hip hop. Philadelphia's Schoolly D self-released "Gangsta Boogie" in 1984, and "P.S.K. What Does It Mean?"/"Gucci Time" in 1985, leading to "Saturday Night" (Schoolly D, 1986, Jive, 1987). The West Coast, which became the home of gangsta rap, had Toddy Tee's influential "Batteram" mixtape in 1985, and Ice-T's "Six in the Morning" in 1986 before N.W.A's first records, leading to the hugely successful "Straight Outta Compton" in 1988.


title: Golden age hip hop

text: Developments in the New York new school continuum in this climate were represented by the Native Tongues groups—The Jungle Brothers, De La Soul, A Tribe Called Quest, Queen Latifah, Chi-Ali, and Monie Love—along with fellow travellers like Leaders of the New School, KMD and Brand Nubian. They moved away from aggressive, macho posturing, towards ambiguity, fun and Afrocentricity. Their music was sample-crowded, more open and accessible than their new school predecessors. De La Soul's debut sampled everyone from the Turtles to Steely Dan, while A Tribe Called Quest matched tough beats to mellow jazz samples and playful, thoughtful raps.


title: Golden age hip hop

text: This lawsuit was known for effectively ending the "Wild West" period for sampling during the golden age of hip hop. In 1991, Gilbert O'Sullivan's song publisher sued Warner Brothers Records over the use of the original in Biz Markie's song "Alone Again." No copyright case precedents were cited in the ruling of the final verdict, and the presiding judge's opinion was prefaced with the words "Thou Shalt not Steal."


title: Golden age hip hop

text: The sixties pop band The Turtles filed a lawsuit in 1989 against hip hop group De La Soul for the uncleared use of a sampled element derived from their original 1968 track "You Showed Me." The lawsuit was settled out of court for a reported $1.7 million, though group members later claimed that the actual payout was significantly less.


title: Electronic health record

text: An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.


title: Electronic health record

text: For several decades, electronic health records (EHRs) have been touted as key to increasing of quality care. Electronic health records are used for other reasons than charting for patients; today, providers are using data from patient records to improve quality outcomes through their care management programs. EHR combines all patients demographics into a large pool, and uses this information to assist with the creation of "new treatments or innovation in healthcare delivery" which overall improves the goals in healthcare. Combining multiple types of clinical data from the system's health records has helped clinicians identify and stratify chronically ill patients. EHR can improve quality care by using the data and analytics to prevent hospitalizations among high-risk patients.


title: Electronic health record

text: EHR systems are designed to store data accurately and to capture the state of a patient across time. It eliminates the need to track down a patient's previous paper medical records and assists in ensuring data is up-to-date, accurate and legible. It also allows open communication between the patient and the provider, while providing "privacy and security." It can reduce risk of data replication as there is only one modifiable file, which means the file is more likely up to date and decreases risk of lost paperwork and is cost efficient. Due to the digital information being searchable and in a single file, EMRs (electronic medical records) are more effective when extracting medical data for the examination of possible trends and long term changes in a patient. Population-based studies of medical records may also be facilitated by the widespread adoption of EHRs and EMRs.


title: Electronic health record

text: The terms EHR, electronic patient record (EPR) and EMR have often been used interchangeably, but differences between the models are now being defined. The electronic health record (EHR) is a more longitudinal collection of the electronic health information of individual patients or populations. The EMR, in contrast, is the patient record created by providers for specific encounters in hospitals and ambulatory environments and can serve as a data source for an EHR.


title: Electronic health record

text: In contrast, a personal health record (PHR) is an electronic application for recording personal medical data that the individual patient controls and may make available to health providers.


title: Electronic health record

text: While there is still a considerable amount of debate around the superiority of electronic health records over paper records, the research literature paints a more realistic picture of the benefits and downsides.


title: Electronic health record

text: The increased transparency, portability, and accessibility acquired by the adoption of electronic medical records may increase the ease with which they can be accessed by healthcare professionals, but also can increase the amount of stolen information by unauthorized persons or unscrupulous users versus paper medical records, as acknowledged by the increased security requirements for electronic medical records included in the Health Information and Accessibility Act and by large-scale breaches in confidential records reported by EMR users. Concerns about security contribute to the resistance shown to their adoption. When users log in into the electronic health records, it is their responsibility to make sure the information stays confidential and this is done by keeping their passwords unknown to others and logging off before leaving the station.


title: Electronic health record

text: Handwritten paper medical records may be poorly legible, which can contribute to medical errors. Pre-printed forms, standardization of abbreviations and standards for penmanship were encouraged to improve the reliability of paper medical records. An example of possible medical errors is the administration of medication. Medication is an intervention that can turn a person's status from stable to unstable very quickly. With paper documentation it is very easy to not properly document the administration of medication, the time given, or errors such as giving the "wrong drug, dose, form, or not checking for allergies" and could affect the patient negatively. It has been reported that these errors have been reduced by "55-83%" because records are now online and require certain steps to avoid these errors.


title: Electronic health record

text: Electronic records may help with the standardization of forms, terminology, and data input. Digitization of forms facilitates the collection of data for epidemiology and clinical studies. However, standardization may create challenges for local practice. Overall, those with EMRs that have automated notes and records, order entry, and clinical decision support had fewer complications, lower mortality rates, and lower costs.


title: Electronic health record

text: EMRs can be continuously updated (within certain legal limitations: see below). If the ability to exchange records between different EMR systems were perfected ("interoperability"), it would facilitate the coordination of health care delivery in nonaffiliated health care facilities. In addition, data from an electronic system can be used anonymously for statistical reporting in matters such as quality improvement, resource management, and public health communicable disease surveillance. However, it is difficult to remove data from its context.


title: Electronic health record

text: Sharing their electronic health records with people who have type 2 diabetes helps them to reduce their blood sugar levels. It is a way of helping people understand their own health condition and involving them actively in its management.


title: Electronic health record

text: Electronic medical records could also be studied to quantify disease burdens – such as the number of deaths from antimicrobial resistance – or help identify causes of, factors of and contributors to diseases, especially when combined with genome-wide association studies. For such purposes, electronic medical records could potentially be made available in securely anonymized or pseudonymized forms to ensure patients' privacy is maintained.<ref name="10.1073/pnas.0911686107"></ref> This may enable increased flexibility, improved disease surveillance, and novel life-saving treatments.


title: Electronic health record

text: Theoretically, free software such as GNU Health could be used or modified for various purposes that use electronic medical records i.a. via securely sharing anonymized patient treatments, medical history and individual outcomes (including by common primary care physicians).


title: Electronic health record

text: Ambulance services in Australia, the United States and the United Kingdom have introduced the use of EMR systems. EMS Encounters in the United States are recorded using various platforms and vendors in compliance with the NEMSIS (National EMS Information System) standard. The benefits of electronic records in ambulances include: patient data sharing, injury/illness prevention, better training for paramedics, review of clinical standards, better research options for pre-hospital care and design of future treatment options, data based outcome improvement, and clinical decision support.


title: Electronic health record

text: Using an EMR to read and write a patient's record is not only possible through a workstation but, depending on the type of system and health care settings, may also be possible through mobile devices that are handwriting capable, tablets and smartphones. Electronic Medical Records may include access to Personal Health Records (PHR) which makes individual notes from an EMR readily visible and accessible for consumers.


title: Electronic health record

text: Some EMR systems automatically monitor clinical events, by analyzing patient data from an electronic health record to predict, detect and potentially prevent adverse events. This can include discharge/transfer orders, pharmacy orders, radiology results, laboratory results and any other data from ancillary services or provider notes. This type of event monitoring has been implemented using the Louisiana Public health information exchange linking statewide public health with electronic medical records. This system alerted medical providers when a patient with HIV/AIDS had not received care in over twelve months. This system greatly reduced the number of missed critical opportunities.


title: Electronic health record

text: Within a meta-narrative systematic review of research in the field, various different philosophical approaches to the EHR exist. The health information systems literature has seen the EHR as a container holding information about the patient, and a tool for aggregating clinical data for secondary uses (billing, audit, etc.). However, other research traditions see the EHR as a contextualised artifact within a socio-technical system. For example, actor-network theory would see the EHR as an actant in a network, and research in computer supported cooperative work (CSCW) sees the EHR as a tool supporting particular work.


title: Electronic health record

text: Several possible advantages to EHRs over paper records have been proposed, but there is debate about the degree to which these are achieved in practice.


title: Electronic health record

text: Several studies call into question whether EHRs improve the quality of care. One 2011 study in diabetes care, published in the "New England Journal of Medicine", found evidence that practices with EHR provided better quality care.


title: Electronic health record

text: EMRs may eventually help improve care coordination. An article in a trade journal suggests that since anyone using an EMR can view the patient's full chart, it cuts down on guessing histories, seeing multiple specialists, smooths transitions between care settings, and may allow better care in emergency situations. EHRs may also improve prevention by providing doctors and patients better access to test results, identifying missing patient information, and offering evidence-based recommendations for preventive services.


title: Electronic health record

text: The steep price and provider uncertainty regarding the value they will derive from adoption in the form of return on investment has a significant influence on EHR adoption. In a project initiated by the Office of the National Coordinator for Health Information, surveyors found that hospital administrators and physicians who had adopted EHR noted that any gains in efficiency were offset by reduced productivity as the technology was implemented, as well as the need to increase information technology staff to maintain the system.


title: Electronic health record

text: The U.S. Congressional Budget Office concluded that the cost savings may occur only in large integrated institutions like Kaiser Permanente, and not in small physician offices. They challenged the Rand Corporation's estimates of savings. "Office-based physicians in particular may see no benefit if they purchase such a product—and may even suffer financial harm. Even though the use of health IT could generate cost savings for the health system at large that might offset the EHR's cost, many physicians might not be able to reduce their office expenses or increase their revenue sufficiently to pay for it. For example, the use of health IT could reduce the number of duplicated diagnostic tests. However, that improvement in efficiency would be unlikely to increase the income of many physicians." One CEO of an EHR company has argued if a physician performs tests in the office, it might reduce his or her income.


title: Electronic health record

text: Doubts have been raised about cost saving from EHRs by researchers at Harvard University, the Wharton School of the University of Pennsylvania, Stanford University, and others.


title: Electronic health record

text: In 2022 the chief executive of Guy's and St Thomas' NHS Foundation Trust, one of the biggest NHS organisations, said that the £450 million cost over 15 years to install the Epic Systems electronic patient record across its six hospitals, which will reduce more than 100 different IT systems down to just a handful, was "chicken feed" when compared to the NHS's overall budget.


title: Electronic health record

text: The implementation of EMR can potentially decrease identification time of patients upon hospital admission. A research from the Annals of Internal Medicine showed that since the adoption of EMR a relative decrease in time by 65% has been recorded (from 130 to 46 hours).


title: Electronic health record

text: The Healthcare Information and Management Systems Society, a very large U.S. healthcare IT industry trade group, observed in 2009 that EHR adoption rates "have been slower than expected in the United States, especially in comparison to other industry sectors and other developed countries. A key reason, aside from initial costs and lost productivity during EMR implementation, is lack of efficiency and usability of EMRs currently available." The U.S. National Institute of Standards and Technology of the Department of Commerce studied usability in 2011 and lists a number of specific issues that have been reported by health care workers. The U.S. military's EHR, AHLTA, was reported to have significant usability issues. Furthermore, studies such as the one conducted in BMC Medical Informatics and Decision Making, also showed that although the implementation of electronic medical records systems has been a great assistance to general practitioners there is still much room for revision in the overall framework and the amount of training provided. It was observed that the efforts to improve EHR usability should be placed in the context of physician-patient communication.


title: Electronic health record

text: However, physicians are embracing mobile technologies such as smartphones and tablets at a rapid pace. According to a 2012 survey by "Physicians Practice", 62.6 percent of respondents (1,369 physicians, practice managers, and other healthcare providers) say they use mobile devices in the performance of their job. Mobile devices are increasingly able to sync up with electronic health record systems thus allowing physicians to access patient records from remote locations. Most devices are extensions of desk-top EHR systems, using a variety of software to communicate and access files remotely. The advantages of instant access to patient records at any time and any place are clear, but bring a host of security concerns. As mobile systems become more prevalent, practices will need comprehensive policies that govern security measures and patient privacy regulations.


title: Electronic health record

text: Other advanced computational techniques have allowed EHRs to be evaluated at a much quicker rate. Natural language processing is increasingly used to search EMRs, especially through searching and analyzing notes and text that would otherwise be inaccessible for study when seeking to improve care. One study found that several machine learning methods could be used to predict the rate of a patient's mortality with moderate success, with the most successful approach including using a combination of a convolutional neural network and a heterogenous graph model.


title: Electronic health record

text: When a health facility has documented their workflow and chosen their software solution they must then consider the hardware and supporting device infrastructure for the end users. Staff and patients will need to engage with various devices throughout a patient's stay and charting workflow. Computers, laptops, all-in-one computers, tablets, mouse, keyboards and monitors are all hardware devices that may be utilized. Other considerations will include supporting work surfaces and equipment, wall desks or articulating arms for end users to work on. Another important factor is how all these devices will be physically secured and how they will be charged that staff can always utilize the devices for EHR charting when needed.


title: Electronic health record

text: The success of eHealth interventions is largely dependent on the ability of the adopter to fully understand workflow and anticipate potential clinical processes prior to implementations. Failure to do so can create costly and time-consuming interruptions to service delivery.


title: Electronic health record

text: Per empirical research in social informatics, information and communications technology (ICT) use can lead to both intended and unintended consequences.


title: Electronic health record

text: A 2008 Sentinel Event Alert from the U.S. Joint Commission, the organization that accredits American hospitals to provide healthcare services, states, 'As health information technology (HIT) and 'converging technologies'—the interrelationship between medical devices and HIT—are increasingly adopted by health care organizations, users must be mindful of the safety risks and preventable adverse events that these implementations can create or perpetuate. Technology-related adverse events can be associated with all components of a comprehensive technology system and may involve errors of either commission or omission. These unintended adverse events typically stem from human-machine interfaces or organization/system design." The Joint Commission cites as an example the United States Pharmacopeia MEDMARX database where of 176,409 medication error records for 2006, approximately 25 percent (43,372) involved some aspect of computer technology as at least one cause of the error.


title: Electronic health record

text: The British National Health Service (NHS) reports specific examples of potential and actual EHR-caused unintended consequences in its 2009 document on the management of clinical risk relating to the deployment and use of health software.


title: Electronic health record

text: In a February 2010, an American Food and Drug Administration (FDA) memorandum noted that EHR unintended consequences include EHR-related medical errors from (1) errors of commission (EOC), (2) errors of omission or transmission (EOT), (3) errors in data analysis (EDA), and (4) incompatibility between multi-vendor software applications or systems (ISMA), examples were cited. The FDA also noted that the "absence of mandatory reporting enforcement of H-IT safety issues limits the numbers of medical device reports (MDRs) and impedes a more comprehensive understanding of the actual problems and implications."


title: Electronic health record

text: A 2010 Board Position Paper by the American Medical Informatics Association (AMIA) contains recommendations on EHR-related patient safety, transparency, ethics education for purchasers and users, adoption of best practices, and re-examination of regulation of electronic health applications. Beyond concrete issues such as conflicts of interest and privacy concerns, questions have been raised about the ways in which the physician-patient relationship would be affected by an electronic intermediary.


title: Electronic health record

text: During the implementation phase, cognitive workload for healthcare professionals may be significantly increased as they become familiar with a new system.


title: Electronic health record

text: EHRs are almost invariably detrimental to physician productivity, whether the data is entered during the encounter or sometime thereafter. It is possible for an EHR to increase physician productivity by providing a fast and intuitive interface for viewing and understanding patient clinical data and minimizing the number of clinically irrelevant questions, but that is almost never the case. The other way to mitigate the detriment to physician productivity is to hire scribes to work alongside medical practitioners, which is almost never financially viable.


title: Electronic health record

text: As a result, many have conducted studies like the one discussed in the "Journal of the American Medical Informatics Association", "The Extent And Importance of Unintended Consequences Related To Computerized Provider Order Entry," which seeks to understand the degree and significance of unplanned adverse consequences related to computerized physician order entry and understand how to interpret adverse events and understand the importance of its management for the overall success of computer physician order entry.


title: Electronic health record

text: In the United States, Great Britain, and Germany, the concept of a national centralized server model of healthcare data has been poorly received. Issues of privacy and security in such a model have been of concern.


title: Electronic health record

text: In the European Union (EU), a new directly binding instrument, a regulation of the European Parliament and of the council, was passed in 2016 to go into effect in 2018 to protect the processing of personal data, including that for purposes of health care, the General Data Protection Regulation.


title: Electronic health record

text: These threats can either be internal, external, intentional and unintentional. Therefore, one will find health information systems professionals having these particular threats in mind when discussing ways to protect the health information of patients. It has been found that there is a lack of security awareness among health care professionals in countries such as Spain. The Health Insurance Portability and Accountability Act (HIPAA) has developed a framework to mitigate the harm of these threats that is comprehensive but not so specific as to limit the options of healthcare professionals who may have access to different technology.


title: Electronic health record

text: Personal Information Protection and Electronic Documents Act (PIPEDA) was given Royal Assent in Canada on 13 April 2000 to establish rules on the use, disclosure and collection of personal information. The personal information includes both non-digital and electronic form. In 2002, PIPEDA extended to the health sector in Stage 2 of the law's implementation. There are four provinces where this law does not apply because its privacy law was considered similar to PIPEDA: Alberta, British Columbia, Ontario and Quebec.


title: Electronic health record

text: The COVID-19 pandemic in the United Kingdom led to radical changes. NHS Digital and NHSX made changes, said to be only for the duration of the crisis, to the information sharing system GP Connect across England, meaning that patient records are shared across primary care. Only patients who have specifically opted out are excluded.


title: Electronic health record

text: Legal liability in all aspects of healthcare was an increasing problem in the 1990s and 2000s. The surge in the per capita number of attorneys in the USA and changes in the tort system caused an increase in the cost of every aspect of healthcare, and healthcare technology was no exception.


title: Electronic health record

text: Failure or damages caused during installation or utilization of an EHR system has been feared as a threat in lawsuits. Similarly, it's important to recognize that the implementation of electronic health records carries with it significant legal risks.


title: Electronic health record

text: This liability concern was of special concern for small EHR system makers. Some smaller companies may be forced to abandon markets based on the regional liability climate. Larger EHR providers (or government-sponsored providers of EHRs) are better able to withstand legal assaults.


title: Electronic health record

text: While there is no argument that electronic documentation of patient visits and data brings improved patient care, there is increasing concern that such documentation could open physicians to an increased incidence of malpractice suits. Disabling physician alerts, selecting from dropdown menus, and the use of templates can encourage physicians to skip a complete review of past patient history and medications, and thus miss important data.


title: Electronic health record

text: Another potential problem is electronic time stamps. Many physicians are unaware that EHR systems produce an electronic time stamp every time the patient record is updated. If a malpractice claim goes to court, through the process of discovery, the prosecution can request a detailed record of all entries made in a patient's electronic record. Waiting to chart patient notes until the end of the day and making addendums to records well after the patient visit can be problematic, in that this practice could result in less than accurate patient data or indicate possible intent to illegally alter the patient's record.


title: Electronic health record

text: In some communities, hospitals attempt to standardize EHR systems by providing discounted versions of the hospital's software to local healthcare providers. A challenge to this practice has been raised as being a violation of Stark rules that prohibit hospitals from preferentially assisting community healthcare providers. In 2006, however, exceptions to the Stark rule were enacted to allow hospitals to furnish software and training to community providers, mostly removing this legal obstacle.


title: Electronic health record

text: In cross-border use cases of EHR implementations, the additional issue of legal interoperability arises. Different countries may have diverging legal requirements for the content or usage of electronic health records, which can require radical changes to the technical makeup of the EHR implementation in question. (especially when fundamental legal incompatibilities are involved) Exploring these issues is therefore often necessary when implementing cross-border EHR solutions.


title: Electronic health record

text: The United Nations World Health Organization (WHO) administration intentionally does not contribute to an internationally standardized view of medical records nor to personal health records. However, WHO contributes to minimum requirements definition for developing countries.


title: Electronic health record

text: The United Nations accredited standardization body International Organization for Standardization (ISO) however has settled thorough word for standards in the scope of the HL7 platform for health care informatics. Respective standards are available with ISO/HL7 10781:2009 Electronic Health Record-System Functional Model, Release 1.1 and subsequent set of detailing standards.


title: Electronic health record

text: The majority of the countries in Europe have made a strategy for the development and implementation of the Electronic Health Record Systems. This would mean greater access to health records by numerous stakeholders, even from countries with lower levels of privacy protection. The forthcoming implementation of the Cross Border Health Directive and the EU Commission's plans to centralize all health records are of prime concern to the EU public who believe that the health care organizations and governments cannot be trusted to manage their data electronically and expose them to more threats.


title: Electronic health record

text: The idea of a centralized electronic health record system was poorly received by the public who are wary that governments may use of the system beyond its intended purpose. There is also the risk for privacy breaches that could allow sensitive health care information to fall into the wrong hands. Some countries have enacted laws requiring safeguards to be put in place to protect the security and confidentiality of medical information. These safeguards add protection for records that are shared electronically and give patients some important rights to monitor their medical records and receive notification for loss and unauthorized acquisition of health information. The United States and the EU have imposed mandatory medical data breach notifications.


title: Electronic health record

text: The purpose of a personal data breach notification is to protect individuals so that they can take all the necessary actions to limit the undesirable effects of the breach and to motivate the organization to improve the security of the infrastructure to protect the confidentiality of the data. The US law requires the entities to inform the individuals in the event of breach while the EU Directive currently requires breach notification only when the breach is likely to adversely affect the privacy of the individual. Personal health data is valuable to individuals and is therefore difficult to make an assessment whether the breach will cause reputational or financial harm or cause adverse effects on one's privacy.


title: Electronic health record

text: The Breach notification law in the EU provides better privacy safeguards with fewer exemptions, unlike the US law which exempts unintentional acquisition, access, or use of protected health information and inadvertent disclosure under a good faith belief.


title: Electronic health record

text: A common data model (CDM) is a specification that describes how data from multiple sources (e.g., multiple EHR systems) can be combined. Many CDMs use a relational model (e.g., the OMOP CDM). A relational CDM defines names of tables and table columns and restricts what values are valid.


title: Electronic health record

text: Each healthcare environment functions differently, often in significant ways. It is difficult to create a "one-size-fits-all" EHR system. Many first generation EHRs were designed to fit the needs of primary care physicians, leaving certain specialties significantly less satisfied with their EHR system.


title: Electronic health record

text: An ideal EHR system will have record standardization but interfaces that can be customized to each provider environment. Modularity in an EHR system facilitates this. Many EHR companies employ vendors to provide customization.


title: Electronic health record

text: This customization can often be done so that a physician's input interface closely mimics previously utilized paper forms.


title: Electronic health record

text: At the same time they reported negative effects in communication, increased overtime, and missing records when a non-customized EMR system was utilized. Customizing the software when it is released yields the highest benefits because it is adapted for the users and tailored to workflows specific to the institution.


title: Electronic health record

text: Customization can have its disadvantages. There is, of course, higher costs involved to implementation of a customized system initially. More time must be spent by both the implementation team and the healthcare provider to understand the workflow needs.


title: Electronic health record

text: Development and maintenance of these interfaces and customizations can also lead to higher software implementation and maintenance costs.


title: Electronic health record

text: An important consideration in the process of developing electronic health records is to plan for the long-term preservation and storage of these records. The field will need to come to consensus on the length of time to store EHRs, methods to ensure the future accessibility and compatibility of archived data with yet-to-be developed retrieval systems, and how to ensure the physical and virtual security of the archives.


title: Electronic health record

text: Additionally, considerations about long-term storage of electronic health records are complicated by the possibility that the records might one day be used longitudinally and integrated across sites of care. Records have the potential to be created, used, edited, and viewed by multiple independent entities. These entities include, but are not limited to, primary care physicians, hospitals, insurance companies, and patients. Mandl et al. have noted that "choices about the structure and ownership of these records will have profound impact on the accessibility and privacy of patient information."


title: Electronic health record

text: The required length of storage of an individual electronic health record will depend on national and state regulations, which are subject to change over time. Ruotsalainen and Manning have found that the typical preservation time of patient data varies between 20 and 100 years. In one example of how an EHR archive might function, their research "describes a co-operative trusted notary archive (TNA) which receives health data from different EHR-systems, stores data together with associated meta-information for long periods and distributes EHR-data objects. TNA can store objects in XML-format and prove the integrity of stored data with the help of event records, timestamps and archive e-signatures."


title: Electronic health record

text: In addition to the TNA archive described by Ruotsalainen and Manning, other combinations of EHR systems and archive systems are possible. Again, overall requirements for the design and security of the system and its archive will vary and must function under ethical and legal principles specific to the time and place.


title: Electronic health record

text: While it is currently unknown precisely how long EHRs will be preserved, it is certain that length of time will exceed the average shelf-life of paper records. The evolution of technology is such that the programs and systems used to input information will likely not be available to a user who desires to examine archived data. One proposed solution to the challenge of long-term accessibility and usability of data by future systems is to standardize information fields in a time-invariant way, such as with XML language. Olhede and Peterson report that "the basic XML-format has undergone preliminary testing in Europe by a Spri project and been found suitable for EU purposes. Spri has advised the Swedish National Board of Health and Welfare and the Swedish National Archive to issue directives concerning the use of XML as the archive-format for EHCR (Electronic Health Care Record) information."


title: Electronic health record

text: When care is provided at two different facilities, it may be difficult to update records at both locations in a co-ordinated fashion. Two models have been used to satisfy this problem: a centralized data server solution, and a peer-to-peer file synchronization program (as has been developed for other peer-to-peer networks). Synchronization programs for distributed storage models, however, are only useful once record standardization has occurred. Merging of already existing public healthcare databases is a common software challenge. The ability of electronic health record systems to provide this function is a key benefit and can improve healthcare delivery.


title: Electronic health record

text: The sharing of patient information between health care organizations and IT systems is changing from a "point to point" model to a "many to many" one. The European Commission is supporting moves to facilitate cross-border interoperability of e-health systems and to remove potential legal hurdles, as in the project www.epsos.eu/. To allow for global shared workflow, studies will be locked when they are being read and then unlocked and updated once reading is complete. Radiologists will be able to serve multiple health care facilities and read and report across large geographical areas, thus balancing workloads. The biggest challenges will relate to interoperability and legal clarity. In some countries it is almost forbidden to practice teleradiology. The variety of languages spoken is a problem and multilingual reporting templates for all anatomical regions are not yet available. However, the market for e-health and teleradiology is evolving more rapidly than any laws or regulations.


title: Electronic health record

text: In 2011, Moscow's government launched a major project known as UMIAS as part of its electronic healthcare initiative. UMIAS - the Unified Medical Information and Analytical System - connects more than 660 clinics and over 23,600 medical practitioners in Moscow. UMIAS covers 9.5 million patients, contains more than 359 million patient records and supports more than 500,000 different transactions daily. Approximately 700,000 Muscovites use remote links to make appointments every week.


title: Electronic health record

text: The European Commission wants to boost the digital economy by enabling all Europeans to have access to online medical records anywhere in Europe by 2020. With the newly enacted Directive 2011/24/EU on patients' rights in cross-border healthcare due for implementation by 2013, it is inevitable that a centralised European health record system will become a reality even before 2020. However, the concept of a centralised supranational central server raises concern about storing electronic medical records in a central location. The privacy threat posed by a supranational network is a key concern. Cross-border and Interoperable electronic health record systems make confidential data more easily and rapidly accessible to a wider audience and increase the risk that personal data concerning health could be accidentally exposed or easily distributed to unauthorised parties by enabling greater access to a compilation of the personal data concerning health, from different sources, and throughout a lifetime.


title: Electronic health record

text: The Lloyd George envelope digitisation project is the aim to have all paper copies of all historic patient data transferred onto computer systems. as part of the roll out new patients will no longer be given a transit label to register when moving practices. Not only is it a step closer to a Digital NHS and reduce the movement of records between practices, The Project also frees up space in practices that are used to store records as well as having the added benefit of being more environmentally friendly