exact change is an american independent book publishing company founded in 1989 by damon krukowski and naomi yang who , outside of their publishing careers , were musicians associated with galaxie 500 and damon and naomi .

the company specialises in re-publishing 19th - and 20th-century avant-garde literature and has published works by john cage , salvador dalí and denton welch among many others .

exact change

wild man software has released the exact change commemorative token . order exact change today and get yours !
exact change books are distributed to the trade by d . a . p .
i don ' t have change . could you pay the exact amount of money ?
paul labelle and the exact change band would like to welcome you to our website .
i don ' t have change . could you
pay exact amount of money
?
please , can you pay the exact amount ? i don ' t have any change .
i used : change = number ( change . tofixed ( 2 ) ) ;
exact change is the program of choice for coin and currency collectors of every level . exact change ' s extensive database dwarfs those of other coin programs . and , with well over 50 , 000 full - screen color images , exact change provides comprehensive coverage of obscure coins that no other program even contemplates .
the most common phrase is
exact change
, so you could say exact change , please . while
change
is usually applied to coins rather than bills when talking about currency , it is acceptable when talking about the return of excess given during a purchase ,
here ' s your change .
if you would like to contact exact change with any other queries please write info ( at ) exactchange . com
exact change is the leading choice for coin collecting software among windows users . now that same incredible performance is available to macintosh users !
exact change provides a wealth of powerful tools that are unique among coin programs . no other program offers foreign date conversion or exact change ' s proprietary ebook functionality . features such as unlimited user - defined fields allow complete customization of the program to accommodate your collecting interests .
you might say ,
could you please pay the exact amount sir / ma ' am , we ' re running low on change
.
if you would like to receive updates of new exact change releases , and notification of any special sales or offers , please join our email list .
exact change publishes books of experimental literature with an emphasis on surrealism , dada , pataphysics , and other nineteenth and twentieth century avant - garde art movements .
for playing such heavy - hitting male roles as lucifer , goebbels , “terrible jim fitch , ” richard nixon , god and others . exact change is a
exact decoupling of the dirac hamiltonian . i . general theory ( pdf , 483 kb )
and it is not always applied politely . this news story tells of a canadian woman who was fined $ 219 for not having exact change when riding a bus .
or you could say ,
would you care to use some change to pay the bill . we are currently out of small change
.
first , the cid array is transformed into a drawer object . then we handle the conditions of exact change and insufficient funds . then we loop through the denomination array and update the change and values while there is still money of this type in the drawer and while the denomination is larger than the change reminaing . then we add this denomination to the output only if any was used . finally , if there are no elements in change _ arr or we have leftover change , return the string “insufficient funds” .
to restrict a search to an exact phrase , enclose the search term in quotation marks . for instance ,
order exact change now and you ' ll receive a free copy of krause publication ' s silver fever , the story of the comstock mines and miners , and coins of the carson city mint .
of course , 99 pennies would do the same thing , but this little combo gives you the most flexibility with the least amount of change ( 10 coins ) in your pocket . and yes , once you make one purchase requiring change you may not be able to hit the exact change next time . but if you leave the house with these 10 coins every day , you can consider yourself well prepared in the change department , and as mark points out , it ' s a great way to slowly get rid of your pile of change .
you will have to get as much change from one type before moving to the next from greater value to lesser , and keep going until you have covered the whole change .
it ' s no surprise to anyone that greg wilson came out with another amazing product . everything that greg releases is ridiculously audience tested and commercial . so when i heard that exact change was coming to penguin , i got incredibly excited . exact change is a perfect gimmick ( and i can ' t think of many that i ' ve ever said that about ) . exact change is : - small ( no pocket management skills required ) - quick ( no fidgeting or unnatural movements ) with the amount of routines it comes with from tons of professionals , you have enough material to do a different effect with this gimmick for the next month . with your own creativity ? you have enough material to use exact change for a different effect at every show for the rest of your life . highly recommended .
“ [ exact change is ] a no - holds - barred exploration of one man’s journey to womanhood told through poetry and prose with comedy , drama and poignancy . in short , it is brilliant . ” mark horning , urltoken
lifehacker reader and blogger bostonmark posts a handy tip on what change you should be carrying so that you can cover any change requirement from $ 0 . 01 to $ 0 . 99 . the magic combo :
“seeing christine howey perform her one - woman show exact change is both a shattering and uplifting experience . ( the play ) is a tightly written , beautifully performed , thoroughly absorbing 80 - minute work that takes us from howey’s birth as dick in 1945 to her sex - change operation in brussels and coming - out party as a woman . ”
exact decoupling of the dirac hamiltonian . ii . the generalized douglas - kroll - hess transformation up to arbitrary order ( pdf , 486 kb )
b3lyp * was invented in this paper . we realized that spin state energetics depend in a regular way on the exact exchange admixture and recommended to decrease the amount of exact exchange . in order to change the notorious b3lyp functional to the least necessary extent , we suggested the 15 % admixture . it is know widely realized that the amount of exact exchange in contemporary functionals should not be too high for transition metal complexes ( see , for example , the m06 family of truhlar functionals and , in particular , the m06 - l variant ) .
a series of new videos have been posted on the videos page to address common questions about exact change . if you have a question that you ' d like to see addressed in a q & a video , please email us at wildman @ exactchange . info
i ' ve even seen signs that say small bills appreciated to indicate a cash box is running low on change .
“some shows offer an escape from the grayness of our lives , others give a lesson in history about obscure but relevant events in the past , some work on our various emotions making us feel “more alive” for the experience and still others have social relevance and are designed to change perceptions . christine howey’s one - woman show , exact change , manages to do all of the above . ”
there are new programs updates available for both the windows and macintosh editions of exact change . the image library has been updated and now contains more that seventy thousand images of coins and notes from around the world . check the news section for more information about these updates .
many exact change titles were originally published by larger houses , especially in the 1960s , but had more recently been left out of print ; some were previously published in the u . k . but not in north america ; others are new publications initiated by exact change . but in all cases these are books that we believe should be kept available always . we think of our list as a looking - glass version of the penguin classics or the library of america , drawn from works that are equally important but have in general been neglected in the u . s .
using word stemming would expand to documents containing “tyranny , ” “tyrannies , ” “tyrannical , ” as well as other forms , but not if “exact form” were selected .
here’s another way to solve it . it uses direct calculation instead of a while loop to calculate the change for each denomination .
we’ve just set up a youtube channel to stream exact change videos and we started it off with a fun little video about the cold war and it’s affect on coinage . please take a look and be sure to give it a thumbs up in order to help us really launch this new channel .
the macintosh version of exact change is a native macintosh application , not a windows program running under an emulator . yet , it ' s file compatible with the both the 32 - bit and 64 - bit windows versions . so , you can share collection information between a macintosh and a windows pc .
function checkcashregister ( price , cash , cid ) { var change = cash - price ; var currencyvalues = { 0 : 100 , 1 : 20 , 2 : 10 , 3 : 5 , 4 : 1 , 5 : 0 . 25 , 6 : 0 . 10 , 7 : 0 . 05 , 8 : 0 . 01 } ; console . log ( totalindrawer ( cid ) ) ; if ( change > totalindrawer ( cid ) | | enoughcurrencyvalue ( cid , change , currencyvalues ) = = = false ) { return ' insufficient funds ' ; } else if ( change = = totalindrawer ( cid ) ) { return ' closed ' ; } var ticket = createticket ( cid , change , currencyvalues ) ; / / here is your change , ma ' am . return ticket ; } function enoughcurrencyvalue ( cid , change , values ) { var lower = cid . reverse ( ) . filter ( function ( item , index ) { if ( values [ index ] < = change | | ( item [ 1 ] > = change & & values [ index ] < = change ) ) return item ; } , [ ] ) ; return totalindrawer ( lower ) > = change ; } function createticket ( cid , change , currencyvalues ) { var ticket = cid . filter ( function ( current , index ) { let changeacc = 0 ; while ( current [ 1 ] > = currencyvalues [ index ] & & current [ 1 ] > = 0 & & currencyvalues [ index ] < = change & & change > 0 ) { if ( enoughcurrency ( currencyvalues [ index ] , current [ 1 ] ) ) { change = change . tofixed ( 2 ) ; change - = currencyvalues [ index ] ; current [ 1 ] - = currencyvalues [ index ] ; changeacc + = currencyvalues [ index ] ; } } if ( changeacc > 0 ) { current [ 1 ] = changeacc ; return current ; } } ) ; return ticket ; } function enoughcurrency ( value , available ) { return available > = value ? true : false ; } function totalindrawer ( array ) { return array . reduce ( function ( prev , curr ) { return prev + curr [ 1 ] ; } , 0 ) ; }
just the fact that this is by gregory wilson made me want to buy this . after seeing the video , i made it a priority to buy exact change . what you get : exact change gimmick money clip 2 hour dvd with over 50 routines exact change gimmick : i can ' t say much here without exposing it , but this does not affect the clothes you wear . this can be done in jeans , shorts , pants , etc . the spectators will not find it ! why should i get this ? : the routine is simply stunning . that you have them choose a random number from 1 - 100 , and you pull out that amount of change from your pocket , nothing more , nothing less . they won ' t find the gimmick . is it really worth $ 75 ? : in my opinion , yes . an strong effect that looks 100 % impromptu , and that will last you a lifetime . and a 2 hour dvd of instruction , tips from years of experience , routines , patter ideas , and more . greg also teaches you how to use exact change with euro coins on the dvd . pros : pretty much everything listed above ! : ) cons : i honestly can ' t think of any besides the price , which is well worth paying . overall : just as the title says , outstanding ! highly recommended ! ( i have gotten wonderful reactions )
today , when you order
exact change by gregory wilson
, you ' ll instantly be emailed a penguin magic gift certificate . you can spend it on anything you like at penguin , just like cash . just complete your order as normal , and within seconds you ' ll get an email with your gift certificate .
normally returns documents containing “orduña” and “orduna” ( as it was sometimes written ) , but with the “exact form” switch , the search will only match on “orduña . ” in another example , searching for
exact change authors include guillaume apollinaire , louis aragon , antonin artaud , john cage , leonora carrington , giorgio de chirico , salvador dalí , morton feldman , alice james , alfred jarry , franz kafka , lautréamont , gérard de nerval , fernando pessoa , raymond roussel , philippe soupault , gertrude stein , stefan themerson , denton welch , and unica zürn .
a moving play about finding your voice and championing your identity ,
exact change
is the powerful and personal story of noted cleveland actor , journalist and critic christine howey ( formerly dick howey ) . before transitioning in 1990 , ms . howey was a celebrated stage actor in cleveland , known for playing such heavy - hitting male roles as lucifer , goebbels ,
terrible jim fitch ,
richard nixon , god and others . developed in part through cpt ' s new work development series ,
exact change
is a one - woman tour - de - force spiced with political rants , historical reflections , personal stories and an incisive wit that packs a punch . world premiere / northeast ohio creator .
} / / here is your change , ma’am . if ( diff = = 0 ) returnval = change ; if ( diff > 0 ) returnval = “insufficient funds” ; if ( diff = = 0 & & cid [ 0 ] [ 1 ] < 1 ) returnval = “closed” ; return returnval ; }
for any language other than french and english , please use the “exact form” switch ; as stemming is supported only for french and english , you may need to use wildcards to broaden your search terms .
the 2’s exist , but they can only change if they have the facts . these are the facts : equally competent women in science are viewed as less competent because of their gender . remember them . cite them . and if you want change , i would urge you to share them as widely as possible .
my approach first checks if there is enough cash in the drawer to satisfy the required change . then it loops through the cash in drawer ( cid ) array , starting with the largest denomination . each iteration checks if that denomination is smaller than the amount of change remaining and if there is actually any of that denomination in the cid . if not , it moves to the next denomination . if there is , it subtracts that denomination from the change and the cid , then adds that amount to changearr .
the search engine automatically expands nouns and verbs to match any form that derives from the word stem by a change in number , tense , or conjugation . for instance ,
function checkcashregister ( price , cash , cid ) { const values = [ 1 , 5 , 10 , 25 , 100 , 500 , 1000 , 2000 , 10000 ] ; let change = cash * 100 - price * 100 ; let allcash = true ; let moneyback = cid . reduceright ( function ( p , c , i ) { let out = math . min ( change - change % values [ i ] , c [ 1 ] * 100 ) ; change - = out ; if ( out ! = = c [ 1 ] * 100 ) { allcash = false ; } return out ? p . concat ( [ [ c [ 0 ] , out / 100 ] ] ) : p ; } , [ ] ) ; return change > 0 ?
insufficient funds
: allcash ?
closed
: moneyback ; }
whether you ' re entering a roosevelt dime , a mexican peso or a tongan pa ' anga ; just select the coin type and indicate the year and exact change will provide a wealth of information such as mintage , weight , diameter , metallic content , melt value , km number and much more . with a single click you can go directly to the page in your krause catalog dvd that references that coin type !
in january , poet and critic christine howey premiered
exact change
at cleveland public theatre . in the ensuing months , she streamlined the piece and , nearly a year later , delivered a weekend of heralded performances at akron ' s none too fragile theater . the new version is tighter , funnier and more moving , with a laser focus on howey ' s gender journey , detailing her bleak before and bright after .
with this courageous and timely production of exact change , written , performed , directed and designed by northeast ohio’s regional talent , the cleveland public theatre proves once again that it is a theatre of the people , giving voice to the silent pain in our society , transforming the minds and hearts of the region . in that , cpt is performing the most profound purpose of theatre . ” tom fulton , special correspondent , cleveland scene
this review discusses all exact - decoupling approaches and presents the first direct numerical comparison of them . it highlights the computational cost of x2c , bss , and dkh calculations . in fact , up to 8th order dkh calculations are more efficient than x2c and bss calculations .
if ( registervalue = = changevalue ) return “closed” ; if ( registervalue > changevalue ) { if ( changevalue > = 100 ) change . push ( [ “one hundred” , 100 math . floor ( changevalue / 100 ) ] ) ; changevalue = changevalue % 100 ; if ( changevalue > = 20 ) change . push ( [ “twenty” , 20 math . floor ( changevalue / 20 ) ] ) ; changevalue = changevalue % 20 ; if ( changevalue > = 10 ) change . push ( [ “ten” , 10 math . floor ( changevalue / 10 ) ] ) ; changevalue = changevalue % 10 ; if ( changevalue > = 5 ) change . push ( [ “five” , 5 math . floor ( changevalue / 5 ) ] ) ; changevalue = changevalue % 5 ; if ( changevalue > = 1 ) change . push ( [ “one” , 1 math . floor ( changevalue ) ] ) ; changevalue = changevalue % 1 ; if ( changevalue > = 0 . 25 ) { change . push ( [ “quarter” , 0 . 25 math . floor ( changevalue / 0 . 25 ) ] ) ; changevalue = changevalue % 0 . 25 ; } if ( changevalue > = 0 . 10 ) { change . push ( [ “dime” , 0 . 10 math . floor ( changevalue / 0 . 10 ) ] ) ; changevalue = changevalue % 0 . 1 ; } if ( changevalue > = 0 . 05 ) { change . push ( [ “nickel” , 0 . 05 math . floor ( changevalue / 0 . 05 ) ] ) ; changevalue = changevalue % 0 . 05 ; } if ( changevalue > = 0 . 01 ) { change . push ( [ “penny” , 0 . 01 * math . ceil ( changevalue / 0 . 01 ) ] ) ; } } else { return “insufficient funds” ; } if ( coinsvalue < smallchange ) return “insufficient funds” ;
here , we made an attempt toward a complete assignment of the vibrational spectrum of the prototypical thermal spincrossover complex fe ( phen ) 2 ( ncs ) 2 in order to calculate the entropy change of the entropy - driven thermal spincrossover phenomenon .
check out web - based video blogs by kyford23 that document his gender transition over a one year period . peruse the videos that range from the first steps of change , to a full year on testosterone and 2 . 5 months post - operation .
/ * jshint esversion : 6 * / function checkcashregister ( price , cash , cid ) { / / declare and initialize variables var change = math . round ( ( cash - price ) * 100 ) ; var value = 0 ; var changerecord = [ ] ; var currency = [ 1 , 5 , 10 , 25 , 100 , 500 , 1000 , 2000 , 10000 ] ; / / convert all floats to integers due to floating point number issue cid . foreach ( el = > el [ 1 ] = math . round ( el [ 1 ] * 100 ) ) ; / / helper function to check if sufficient cash for change is in the drawer function enoughfund ( cid ) { var sum = cid . filter ( ( el , i ) = > change > = currency [ i ] ) ; return sum . reduce ( ( a , b ) = > { return a + b [ 1 ] ; } , 0 ) ; } / / actual program / control flow starts here if ( enoughfund ( cid ) < change ) return
insufficient funds
; else if ( enoughfund ( cid ) = = = change ) return
closed
; else { for ( var i = cid . length - 1 ; i > - 1 ; i - - ) { value = 0 ; while ( cid [ i ] [ 1 ] > 0 & & change > = currency [ i ] ) { / / update everything as long as condition is true change - = currency [ i ] ; cid [ i ] [ 1 ] - = currency [ i ] ; / / value keeps track of the amount of each currency unit as change value + = currency [ i ] ; } if ( value ) changerecord . push ( [ cid [ i ] [ 0 ] , value ] ) ; } } / / divide each array by 100 to display a proper money format changerecord . foreach ( el = > el [ 1 ] = ( el [ 1 ] / 100 ) ) ; return changerecord ; }
if ( changevalue > = 0 . 10 ) { grab = changevalue > numbersonly [ 6 ] ? numbersonly [ 6 ] : 0 . 1 * math . floor ( changevalue / 0 . 1 ) ; change . push ( [
dime
, grab ] ) ; changevalue - = grab ; } if ( changevalue > = 0 . 05 ) { grab = changevalue > numbersonly [ 7 ] ? numbersonly [ 7 ] : 0 . 05 * math . floor ( changevalue / 0 . 05 ) ; change . push ( [
nickel
, grab ] ) ; changevalue - = grab ; } if ( changevalue > = 0 . 01 ) { change . push ( [
penny
, math . round ( changevalue * 100 ) / 100 ] ) ; }
/ / return changevalue ; grab = changevalue > numbersonly [ 5 ] ? numbersonly [ 5 ] : 0 . 25 * math . floor ( changevalue / 0 . 25 ) ; change . push ( [ “quarter” , grab ] ) ; changevalue - = grab ; }
you have to create a program that will handle when the register does not have enough cash or will have no cash after the transaction . other than that it needs to return an array of the change in the form of an array , so that will be a 2d array .
the
exact change
has been a musical institution in northeastern pa for more than two decades . the group led by paul labelle , is a nine piece ensemble which blends together very strong male and female vocals , sizzling rhythms , and a powerhouse horn section known as the
bad ass brass
. spontaneity , excitement , and superb solos cover the stage during live performances . professionalism and pride show in each and every engagement we do . we give total dedication to each and every arrangement we do . the band was chosen to play both inaugural celebrations of governor robert p . casey in harrisburg , pa for more than 10 , 000 people . the
exact change
recently opened for and backed
neil sadaka
and
frankie valli and the four seasons
with great success . all of our music is
live
with absolutely
no
prerecorded or sequenced music . we believe strongly in tailoring our music to the needs of the individual client . vast experience in all facets of music reflects in our staging and showmanship . the years together have only nurtured our sound . . . let us take you on a musical journey . . . feel the emotion on a grand scale . . . call us . . . we promise you
more today than yesterday
. click here for paul labelle ' s personal biography
what’s important is that the 2’s are out there . certainly , some gender bias in the workplace still takes the form of blatant misogyny . but a large portion of it does not . it’s subtle . it’s subconscious . and many people who perpetrate it , if only made aware of what they are doing , would want to change . i once knew of a professor who consistently made eye contact with males when engaging in conversations about science ; only when it was pointed out to him did he realize he was doing it , and he was grateful that someone told him so he could change .
function checkcashregister ( price , cash , cid ) { var worth = [ 0 . 01 , 0 . 05 , 0 . 10 , 0 . 25 , 1 . 00 , 5 . 00 , 10 . 00 , 20 . 00 , 100 . 00 ] ; var changearr = [ ] ; var change = cash - price ; var cashdrawer = 0 ; var changeavail = 0 ; for ( i = 0 ; i < cid . length ; i + + ) { cashdrawer + = cid [ i ] [ 1 ] ; } cashdrawer = cashdrawer . tofixed ( 2 ) ; if ( cashdrawer < cash - price ) { / / is there not enough cash in the drawer ? return
insufficient funds
; } else if ( cashdrawer = = cash - price ) { / / is there exactly enough cash in the drawer ? return
closed
; } else { for ( i = 8 ; i > - 1 ; i - - ) { / / create a copy of the cid array to prevent unwanted changes to it var cidcopy = [ ] ; for ( var k = 0 ; k < cid . length ; k + + ) { cidcopy [ k ] = cid [ i ] . slice ( ) ; } var x = worth [ i ] ; var y = cidcopy [ i ] ; var z = cidcopy [ i ] [ 0 ] ; / / if there is cash in the drawer of that denomination , / / and if that denomination is smaller than the change remaining : if ( change > = x & & cidcopy [ i ] [ 1 ] > 0 ) { change - = x ; change = number ( change . tofixed ( 2 ) ) ; / / round change to nearest hundredth cid [ i ] [ 1 ] - = x ; if ( ! changearr . length ) { changearr . unshift ( y ) ; changearr [ 0 ] [ 1 ] = x ; } else if ( changearr [ 0 ] [ 0 ] = = z ) { changearr [ 0 ] [ 1 ] + = x ; } else { changearr . unshift ( y ) ; changearr [ 0 ] [ 1 ] = x ; } i + + ; } } } / / here is your change , ma ' am . for ( j = 0 ; j < changearr . length ; j + + ) { changeavail + = changearr [ j ] [ 1 ] ; } if ( changeavail < cash - price ) { return
insufficient funds
; } else { return changearr . reverse ( ) ; } }
/ / let ' s deal with hundreds if ( changevalue > = 100 ) { grab = 100 * math . floor ( changevalue / 100 ) > numbersonly [ 0 ] ? numbersonly [ 0 ] : 100 * math . floor ( changevalue / 100 ) ; change . push ( [
one hundred
, grab ] ) ; changevalue - = grab ; } / / twenties if ( changevalue > = 20 ) { grab = 20 * math . floor ( changevalue / 20 ) > numbersonly [ 1 ] ? numbersonly [ 1 ] : 20 * math . floor ( changevalue / 20 ) ; change . push ( [
twenty
, grab ] ) ; changevalue - = grab ; } / / tens if ( changevalue > = 10 ) { grab = 10 * math . floor ( changevalue / 10 ) > numbersonly [ 2 ] ? numbersonly [ 2 ] : 10 * math . floor ( changevalue / 10 ) ; change . push ( [
ten
, grab ] ) ; changevalue - = grab ; } / / fives if ( changevalue > = 5 ) { grab = 5 * math . floor ( changevalue / 5 ) > numbersonly [ 3 ] ? numbersonly [ 3 ] : 5 * math . floor ( changevalue / 5 ) ; change . push ( [
five
, grab ] ) ; changevalue - = grab ; } / / ones if ( changevalue > = 1 ) { grab = changevalue > numbersonly [ 4 ] ? numbersonly [ 4 ] : math . ceil ( changevalue % 1 ) ; change . push ( [
one
, grab ] ) ; changevalue - = grab ; } if ( changevalue > = 0 . 25 ) {
while ( money / objdivid > = 1 & & diff > = objdivid ) { accumilator + = objdivid ; money = parsefloat ( money - objdivid ) . tofixed ( 2 ) ; diff = parsefloat ( diff - objdivid ) . tofixed ( 2 ) ; } if ( accumilator > 0 ) change . push ( [ currencyname , accumilator ] ) ;
here , we introduced the new concept of haptic quantum chemistry which addresses the human tactile sense and allows one to gain an enhanced chemical intuition about a reactive system and to explore its reactivity interactively . combined with efficient input facilities , the approach will change the way quantum chemical calculation are carried out and interpreted as soon as an efficient software package becomes available , a task that we solved in 2014 / 2015 .
“i feel a strong need to communicate the challenging issues and deep satisfaction that comes from finding one’s true gender . i know the idea of a gender change is a very foreign one for most people , even though each of us has to deal with gender and identity issues of our own in different ways . so i want to make the feelings and aspirations of a transgender person as accessible and understandable as possible .
by default the search broadens terms using word stemming , ignoring diacritics , among other things , to match on as many documents of interest as possible ; however , you may wish to change this behavior to match on documents which contain text exactly as you enter it , effectively disabling word stemming , and making the search case sensitive , diacritic sensitive , punctuation sensitive , whitespace sensitive , and “unwildcarded” . for example , a search for
function checkcashregister ( price , cash , cid ) { / / all amounts are multiplied by 100 until the final result to avoid errors with floating point math const denominations = {
penny
: 1 ,
nickel
: 5 ,
dime
: 10 ,
quarter
: 25 ,
one
: 100 ,
five
: 500 ,
ten
: 1000 ,
twenty
: 2000 ,
one hundred
: 10000 } let changedue = ( cash * 100 - price * 100 ) ; const register = cid . reverse ( ) . map ( el = > [ el [ 0 ] , math . round ( el [ 1 ] * 100 ) ] ) ; const registertotal = register . reduce ( ( sum , elem ) = > ( sum + elem [ 1 ] ) , 0 ) ; if ( changedue > registertotal ) return
insufficient funds
; if ( changedue = = = registertotal ) return
closed
; let partial ; let change = register . reduce ( ( acc , elem ) = > { / / for each denomination calculate the lesser of ( a ) the amount that could be paid with that / / denomination without going over the amount owed , and ( b ) the actual amount of that denomination in / / the register . denominations not used to make change are excluded from the resulting array . partial = math . min ( elem [ 1 ] , math . floor ( changedue / denominations [ elem [ 0 ] ] ) * denominations [ elem [ 0 ] ] ) ; if ( partial > 0 ) { changedue - = partial ; acc . push ( [ elem [ 0 ] , partial / 100 ] ) ; } return acc ; } , [ ] ) / / if the correct change could not be made from what was in the register . if ( changedue > 0 ) return
insufficient funds
return change ; }
but in a groundbreaking study published in pnas last week by corinne moss - racusin and colleagues , that is exactly what was done . on wednesday , sean carroll blogged about and brought to light the research from yale that had scientists presented with application materials from a student applying for a lab manager position and who intended to go on to graduate school . half the scientists were given the application with a male name attached , and half were given the exact same application with a female name attached . results found that the “female” applicants were rated significantly lower than the “males” in competence , hireability , and whether the scientist would be willing to mentor the student .
hi , thanks for catching that one . it seems to be a situation that is not tested for in any of the provided test - cases ( the change can be given only by skipping one of the denomenations , in this case the quarters ) . i suspect most other solutions on this page have the same problem , at least as far as i can see from skimming the code… i also don’t see an easy way to solve this based on my current solution , but it’s definitely an interesting case to think about .
function checkcashregister ( price , cash , cid ) { var changevalue = cash - price ; var flattened = [ ] . concat . apply ( [ ] , cid ) ; var numbersonly = flattened . filter ( function ( element ) { return ! isnan ( parsefloat ( element ) ) & & isfinite ( element ) ; } ) ; var registervalue = numbersonly . reduce ( ( a , b ) = > a + b , 0 ) . tofixed ( 2 ) ; var change = [ ] ; var smallchange = ( changevalue % 1 ) . tofixed ( 2 ) ; var coinsvalue = 0 ;
function checkcashregister ( price , cash , cid ) { var changevalue = cash - price ; var flattened = [ ] . concat . apply ( [ ] , cid ) ; var numbersonly = flattened . filter ( function ( element ) { return ! isnan ( parsefloat ( element ) ) & & isfinite ( element ) ; } ) . reverse ( ) ; var registervalue = numbersonly . reduce ( ( a , b ) = > a + b , 0 ) . tofixed ( 2 ) ; var change = [ ] ; var smallchange = ( changevalue % 1 ) . tofixed ( 2 ) ; var coinsvalue = 0 ; var grab = 0 ;
this is one of the most amazing gimmicks i have ever bought . i would not recommend this to 21th century people that can ' t do math in their head very well ( i was worried at first but i picked it up quickly ) and there is so much you can get out of this , the best $ 75 i ' ve spent in a long time - - greg never fails to produce top - of - the - line magic . i was performing this within a couple of hours and it is so diabolically deceptive , but you have to build up the performance and stress that your pocket is empty except for the amount of change the spectator freely names . highly recommended .
var obj = { “penny” : 0 . 01 , “nickel” : 0 . 05 , “dime” : 0 . 10 , “quarter” : 0 . 25 , “one” : 1 . 00 , “five” : 5 . 00 , “ten” : 10 . 00 , “twenty” : 20 . 00 , “one hundred” : 100 . 00 } ; var returnval ; var change = [ ] ; var diff = parsefloat ( cash - price ) . tofixed ( 2 ) ; for ( var i = cid . length - 1 ; i > = 0 ; i– ) { var accumilator = 0 ; var money = cid [ i ] [ 1 ] ; var currencyname = cid [ i ] [ 0 ] ; var objdivid = obj [ cid [ i ] [ 0 ] ] ;
the prop or gimmick is a $ 5 item . the dvd content is not worth the difference . it ' s essentially one effect with a few variations . i found the dvd valuable for its ditches , false transfers , etc ( i lost some of these moves in my shotty magic education ) , but i ' m not sure why this effect is marked so high . save your money and just do one of the many old effects which leave the spectator feeling like you ' ve done the exact same thing as wilson has done here . you could spend half the money on quadruple the valuable content on this site . will i perform this trick ? probably . i do like the effect . i just don ' t know if anyone will feel like this is worth $ 75 . once , after getting mugged in manhattan ( 3 card monte gone bad ) , i found myself with only an invisible deck in my pocket . i performed it for someone and asked him if he ' d pay $ 20 to learn how to do that . he did . it paid my way home . i don ' t know if he would have paid $ 20 to learn this . would you ?
the press was founded in 1989 by damon krukowski and naomi yang , known outside publishing as musicians from the bands damon & naomi , and galaxie 500 .
remember to use read - search - ask if you get stuck . try to pair program and write your own code
it is easier to handle if you have to close the register , or if you know how much money is in your register beforehand and you will not have enough money to complete the transaction . for this it is recommended to have a function to assign this information to a variable .
life is easier when you get to know the value of each currency type in the register instead of how much money is composed of that particular currency . so be sure to watch out for that .
do not add solutions that are similar to any existing solutions . if you think it is similar but better , then try to merge ( or replace ) the existing similar solution .
categorize the solution in one of the following categories — basic , intermediate and advanced .
please add your username only if you have added any relevant main contents . ( do not remove any existing usernames )
actually , i don’t see much value from converting the ‘cid’ array into an object for this task . below’s my approach just with arrays . it also tests at the very beginning if enough cash is in the drawer before doing any computations . i think the structure is cleaner as the current “beginner code solution” . take a look :
has been “ [ [ “twenty” , 60 . 00 ] , [ “ten” , 20 . 00 ] , [ “five” , 15 . 00 ] , [ “one” , 1 . 00 ] , [ “quarter” , 0 . 50 ] , [ “dime” , 0 . 20 ] , [ “penny” , 0 . 04 ] ] ” . there seems to be a bug in this challenge scenario . this is what i have :
i’ve fixed my own chicken scratch . although i’ve also realized that this challenge is to help one with learning the skills of object oriented programming , i’ve proceeded to solve the puzzle with sequential coding . thus , this following snippet probably qualifies as a very basic - level solution :
this is the first working solution i came up with . feedback always welcome :
i tried to multiply every demical to 100 and divide it by 100 but the bug is still there .
so i just put my code here hope that someone could fix this for me . meanwhile i’d have to copy one of yours to pass the god damn test
why do you divide by a hundred before you finish operations ? doesn’t that defeat the purpose of multiplying by a 100 to began with ? you end up doing a lot of your operations in float anyway , just with a redundant * 100 / 100 . why not multiply by 100 , do all the math operations , then divide by 100 ?
the tofixed method actually returns a string , so i had to convert it back to a number . but this seems to do the trick pretty well .
see my code to see it in action . i only had to use it in one line to fix the problem .
thanks for sharing . i haven’t had time to look at it , but will do later .
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“it’s a compelling tale , under the direction of scott plate , that gets told alternately with humor ( some of it dark ) , pathos , anger and argumentation of the best kind . howey , as herself , penned the tale and certainly knows how to deliver it . ”
with astonishing , visceral imagery and insight , ms . howey , actress and playwright , hews away at her human facade and personal privacy to reveal the terrifying , confusing , brutal and often hilarious musings of a trapped soul as seen through the eyes of a little girl , an adolescent , a mother masquerading as a father and a mature woman bitterly defeated by her awkward unfamiliar femininity .
of noted cleveland actor , journalist and critic christine howey ( formerly dick howey ) .
one - woman tour - de force spiced with political rants , historical reflections , personal stories and an incisive wit that truly packs a punch .
christine howey is a creative workforce fellow for 2014 . the creative workforce fellowship is a program of the community partnership for arts and culture . the fellowship program is supported by the residents of cuyahoga county through a public grant from cuyahoga arts & culture .
“in addition , i want to make the experience of observing this gender journey entertaining , utilizing all the theatrical tools available to fashion a work that engages , amuses and , hopefully , enlightens . ”
“this production lives at the juncture of poetry and performance , tracing a personal journey from man to woman to fully human , which explores the theater of identity .
“gender is one of the universal principles that govern all of life . how much does gender determine our identity ? watching this play evolve , it became clear to me that our bodies are merely the outermost layer of gender’s irresistible force . gender is not our sex , it is our will to be .
“although there are as many iterations of gender as there are people in the world , our common denominator as human beings is that we are all some proportion of the relationship between male and female . we exist along a gender continuum and , as a result , there are no essential differences among us . what we share is simple , and more powerful than what divides us : our wish to be what we know ourselves to be . ”
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i was extremely satisfied with this . it took next to no time to learn how to use the ' special extra ' that makes this miracle work . i have performed it for my wife , father and friends already . the general response is dumbfounded silence and the gentle sound of their brains melting . one star off for the price ( a bit expensive , especially since i don ' t need to use the money clip )
look . . . you can ' t argue with the effect as gregory presents it ; it ' s a truly great trick ! however . . . the unnecessarily cluttered dvd menu makes the actual learning of the trick frustrating , and there ' s precious little attention given to the main mechanics . why isn ' t there a direct download available from the dvd ? and why not have a
learn
video in
mypenguinmagic
. as it stands , watching the dvd is your only option . 4 stars . oh yeah . . . the price is also way off - base ( although mr . wilson claims he should charge more ! ) make that 3 stars .
the production and ideas on the dvd is top notch . in fact second to none . this prop has real value for someone doing walk around or close - up on a regular basis . its a jem , however for the average amateur performer performing for friends , family or even while sitting - i would not recommend this to them .
it ' s all in the presentation - as is most tricks . if presented well this can be a fun walkabout trick to add some wonderment in the audience as to your ' abilities ' . i ' d suggest angling the presentation more toward the magician ' projecting ' ideas and highlighting your own powers more so . that said - it ' s a fun add on trick for some walkabout routines and definitely an adequate filler .
this is trick is way too expensive for what you get . it ' s not a bad trick , but it ' s also not a great one . it doesn ' t make jaws drop the way you would think . it ' s a head scratcher , but it doesn ' t make for great entertainment . at a third the price i would say maybe , but this is ridiculous . save your money !
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© 2002 - 2016 penguin magic . all rights reserved . we hope you found the magic tricks you were looking for !
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“with astonishing , visceral imagery and insight , ms . howey hews away at her human facade and personal privacy to reveal the terrifying , confusing , brutal and often hilarious musings of a trapped soul . [ she ] stands before us with such vulnerability and unvarnished courage , our own aching humanity is soothed and touched .
christine howey is a creative workforce fellow . the creative workforce f ellowship is a program of the community partnership for arts and culture . the fellowship program is supported by the residents of cuyahoga county through a public grant from cuyahoga arts & culture .
christine is the theater critic for cleveland scene and also posts reviews on her blog , rave and pan . she has been named best critic in ohio by both the press club of cleveland and the society of professional journalists . she has had numerous articles published in the plain dealer , northern ohio live magazine , cleveland free times , newsweek / daily beast , nbc urltoken and many other publications .
christine’s poetry chapbook is titled if you find yourself submerged in a pond under ice . her poems have appeared in pudding magazine and muse , and in the collections what i knew before i knew and open earth . she qualified to be on the four - person northeast ohio slam poetry team , lake effect poetry , and competed in the national poetry slam in boston in august , 2013 .
christine is a former stage actor and director , primarily at dobama theatre . her roles included richard nixon in an evening with richard nixon by gore vidal , bitos / robespierre in poor bitos by jean anouilh , givola / joseph goebbels in the resistible rise of artuo ui by bertolt brecht , lucifer in the creation of the world and other business by arthur miller , and god in steambath by bruce jay friedman .
formerly , christine was an award - winning copywriter and creative director at major advertising agencies in cleveland and minneapolis .
the thing that’s really tricky about transformation is that you don’t know what you’re going to become .
christine’s story is really interesting because she started off life as a very defended man because she knew from very early on that she wasn’t supposed to be in that body . she developed these , as she calls them , “steel walls” that are really sardonic , sarcastic exteriors that kept people away , including her own family - her wife and her daughter . but now they’ve got a wonderful relationship and it’s interesting when you meet noelle ; she’ll say “well , my dad she…” in the same sentence and it’s normal and natural and she watches you very closely to make sure that you’re following . the fact that those pronouns are so comfortably interchanged in this family , is really interesting to me . there’s a wonderful acceptance .
i remember getting to know christine as a critic ; she would write reviews of my work whether i was acting or directing and she was always really removed and kind of stand - offish and shy . but i always thought she was a good writer . i didn’t always agree with her assessments but then , what the hell ? so it really kind of startled me when she approached me to do this , and as i began to work on it , i became completely absorbed . it was weird , it happened around december this time last year . we scrounged up rehearsal space , but that’s big box , you just kind of do it however you can . but i remember the sessions and christine’s willingness to go with what i was giving her to do and realizing her life really did depend on this in some way .
what was interesting to me in working with christine on this piece , ( and we’ve laughed about this quite a bit ) is that she’s a lot more comfortable with the male characters . i have more of an affinity with the female characters ; characters that are more female or feminine . i remember trying to coax more femininity out of christine and her kind of squirming , “i don’t want to do this” . i could just see it in her eyes . so it’s an interesting thing for me ; to see what i gravitated toward , what she gravitated toward and that we both began lives as men but she went on and transitioned into being a woman . i think the funny thing , a transformative thing for me , was watching this woman who started life as a man , walk on stage . the big box light plot had a lot of side light which was great , so what you could see was not someone’s face , but the outline of them . it was transformative just to look objectively at a human being and then watch them become what they really are .
“ mariette pathy allen , good friend and photographer who lives in new york city , has captured many compelling images of transgender people in her books . ”
“this is where i was re - born , in the welcoming environment of provincetown at the tip of cape cod , and among the loving and helpful people at the annual , weeklong , seminar - laden fantasia fair transgender event . ”
“this ignorant , mocking and insensitive article about transgender people , written in 2013 and published in the observer in britain , shows why i feel the need to reach out and communicate . ”
as an actor , i kept thinking if i portrayed enough men , different kinds of men ( especially tough men ) i would eventually cobble together a person i could be in real life . but it didn’t work that way . i figured this out and i needed to do something else ; i needed to become a person .
i eventually realized i was sad all the time and i just said , “if i can’t be happy for an hour or for even 10 minutes , how can i be happy for three seconds ? ” i tried to make myself happy and i did it by looking at flowers . i always loved flowers but i never allowed myself to actually have them because that was feminine and therefore , wrong . so i looked at flowers and i completely broke down ; it was an immense shattering experience . i didn’t even have real flowers ; they were on a calendar or something . and that was where i started . and i remember after that i said , “ok that’s 3 seconds . how can i be happy longer ? what can i do ? what can i buy with flowers ? ” because i was still a guy at that point , i was thinking , “i can’t go buy flowers , people will see ! ” so i decided to go to a store like k - mart and buy something with flowers on it . at the store , i see potholders with flowers and it took me 45 minutes to pick up them up . i would push the cart by and say , “oh there’s flowers ! i shouldn’t get the flowers… i should get these other ones because they’re not as effeminate . ” and i pulled the cart back and forth , looking at them and finally , after about another half hour , i threw them in the cart and i quickly pushed the cart over to the automotive section and i threw in cans of oil and a wrench and all this guy stuff , so i could say , “oh , these potholders ? my wife wanted me to get potholders , she likes flowers , i wouldn’t buy these flowers” .
and that was happening all the time , all the time , all the time , all the time , always checking ; “what am i ? how am i standing ? what am i doing ? how do i look ? ” and it’s exhausting . so that’s where it started .
i always liked the name chris . there are so many things to think about . it’s been a whole life of constantly trying to monitor all my actions , all my moves , all my everything , and even now , i still do it because i don’t have that history . i didn’t have a girlhood . so i have to keep track of it because i can easily slip back into guy stuff and that’s not particularly where i want to be ; it’s not how i feel but it’s just there . i learned it all . and i studied , i mean , i studied . you could say i took advanced courses in masculinity and studied men and sports and all that stuff . i built up this wall where nobody penetrated ; nobody could ever guess and nobody ever did . people were absolutely dumbfounded when i told them because i created a pretty seamless , impenetrable disguise . they were shocked .


texas e-health alliance is a 601 ( c ) ( 6 ) corporation founded in 2009 that brings together the provider , corporate , non-profit and academic health care communities with policymakers in order to create an effective e-health policy for texas .

texas e - health alliance

disclosure : stephen palmer serves on the board of the texas e - health alliance .
the texas e - health alliance interacts regularly with the texas legislature , providing testimony in hearings and briefing members on e - health issues . the legislature held interim hearings during 2016 , and teha provided testimony :
the summer certificate program has also benefited from major support and collaboration from key players in the e - health industry and nonprofits , including seton family of hospitals , the texas e - health alliance , the tmf health quality institute and the texas medical association .
the texas e - health alliance is the state’s leading advocate , from local communities to the national level , for the use of information technology to improve the health care system for patients .
the texas e - health alliance is the premier entity that leaders in the texas legislature , the governor , and various state agencies refer to on matters related to all aspects ofe - health , from health information exchange to telemedicine to remote monitoring .
due to the amount of health care regulation at the state level , there is a significant opportunity to improve the regulatory environment for e - health technologies and services by engaging in state - level e - health advocacy . in texas , the texas e - health alliance ( teha ) has been doing just that for the last 6 years and has achieved a number of wins for the e - health community . e - health communities in other states have the opportunity to mimic the teha strategy at the state level and achieve similar successes in their own states .
the texas e - health alliance is proud to represent the people and companies that make up the health information technology community in texas . we live here , we do business here , and we’re all pitching in to help as texas recovers from hurricane harvey . below is a list of hurricane resources that are related to e - health services , customers and initiatives .
the belief that patients should have quick and easy access to their medical data was behind a texas e - health alliance push behind a health care privacy bill passed in 2011 meant to protect patient data and to help patients get copies of their electronic records more quickly .
the texas hospital association often publishes white papers on issues affecting texas hospitals and the health care of texans .
teha is also the leading resource on what’s happening in the e - health industry . as “the” source for comprehensive information on state issues affecting health information exchanges , telemedicine , remote monitoring , and other e - health issues , teha puts you in the know and at the table to influence the ever evolving world of e - health .
promoting improved healthcare in texas and nationwide by providing vendor - neutral , objective information and resourcs to educate texas policymakers , political leaders and others regarding the role of e - health in the health care delivery system .
texas health services authority : texas’ state hie is working with local health information exchanges in the affected areas . for more information , see here .
nora belcher , executive director of the texas e - health alliance , has been watching the ehr market long enough to come to some very definitive conclusions : it’s typically not medical records themselves that create problems , but more importantly it’s the systems behind them that are difficult .
before getting much further into the discussion , it is important to make sure that we’re on the same page with respect to terminology . by ‘e - health’ , i mean a wide range of information and telecommunications technologies that can enable and support the delivery of health care services . key examples of e - health under this definition include electronic health records , health information exchange , and telemedicine , and a sound e - health policy landscape is a set of laws and public programs that impose minimal restrictions on the appropriate use of e - health tools and services to enable and support the delivery of care .
in addition to policy planning , teha works with the texas medical association on provider education initiatives and is an active participant in the development of health information exchange planning and implementation with the texas health and human services commission and the texas health services authority .
state health information exchange planning and implementation process . teha is a voting member of the texas health services authority’s collaboration council .
the institute of medicine has recently reported that $ 750 billion dollars is wasted in the health care system on an annual basis . that’s one out of every three dollars spent in the united states on health care . members of the texas e - health alliance are committed to implementing technology that improves the health care system for patients . part of that mission includes sharing industry expertise and experience with policymakers , and spreading the message that investing in health information technology makes good financial sense .
students gain experience in the health information technology learning laboratory at the clinical education center at university medical center brackenridge , a member of the seton family of hospitals . they also engage in a two - week practicum with texas - area e - health companies .
teha members gain access to updates on emerging trends that impact the industry through educational sessions , expert presentations , and informational updates on e - health issues .
1115 medicaid transformation waiver : learn how the transformation waiver is making health care in texas more effective and efficient and why renewal is so important for texas hospitals . learn more
provider education initiatives . teha partners with the texas regional extension centers and the texas medical association to improve provider adoption of digital tools .
provider education initiatives . teha partners with the texas regional extension centers and the texas medical association to improve provider adoption of emr / ehr .
teha membership gain access to updates on emerging trends that impact the industry through educational sessions , expert presentations , a speakers’ bureau , and information updates on e - health issues .
rock health : with $ 3 . 4b raised so far , digital health looking strong in 2018
the university of texas at austin certificate program is the first in the nation among those receiving onc health information technology funding to graduate students .
joey berlin , associate editor of texas medicine , prepared this special supplement to action .
“we are thrilled to have gary join our board , ” stated nora belcher , executive director of teha . “his leadership skills and experience in building ica into a successful health information exchange company will be highly valued as we continue to move forward ensuring that the state of texas remains a leader in developing rational health information technology and e - health policies . texas and tennessee are both nationally recognized as leaders in healthcare and gary’s depth of knowledge in healthcare technology and policy will be a great addition to our board . ”
the students were particularly effective because they had gained skills using six different electronic health record systems donated by industry partners , including allscripts , eclinicalworks , e - mds , inc . , ge healthcare , nextgen healthcare and sage .
teha provides various benefits to members including : advocating on behalf of e - health to the legislature and state agencies , providing timely news and updates to members , and facilitating communications efforts with the media and the general public .
the texas hospital association would like to hear from both its members and from the public for whom texan hospitals and health systems work to keep healthy .
tma physician leaders already are working on behalf of their profession and their patients to improve texas health care system . during the upcoming legislative session , tma councils and committees are locking down and promoting health care policies to ensure texas’ patients have access to affordable and high quality health care . here are tma’s testimonies , comments , and letters to state lawmakers . read more
urltoken the main web portal for the state of texas has a hurricane resource page at urltoken .
texas medicaid in perspective : texas medicaid , operated in partnership with the federal government , serves primarily low - income pregnant women and children but also individuals with disabilities and older adults . learn more
jenny currently serves as corporate director , ehealth , for the franciscan missionaries of our lady health system , where she is responsible for the development and implementation of a system - wide e - health and e - business strategy . jenny is also the immediate past chair for the louisiana taskforce on telehealth access . jenny received her bachelor of science degree in information systems and decision sciences from louisiana state university , and her masters degree in information systems with a secondary in accounting from middle tennessee state university .
health information technology program receives $ 2 . 7 million in federal funding , graduates first class of students this summer | ut news | the university of texas at austin
the university of texas at austin ' s new health information technology program has received $ 2 . 7 million as a part of the professional university resources and education for health information technology ( pure hit ) consortium project supported by a grant from the u . s . department of health and human services office of the national coordinator ( onc ) for health information technology .
texas state university is the lead institution for the pure hit consortium and the university of texas school of biomedical informatics is also a partner . total funding for the consortium is $ 5 . 4 million , the largest award in the nation funded for university - based education in health information technology .
digital health solutions are being used across texas as part of the response to hurricane harvey . if you have a story you’d like added to this list , email it to info @ urltoken
expanding telemedicine access . teha works with telemedicine stakeholders and the texas medical board to ensure that telemedicine services are available to patients in need with a focus on those areas that have provider shortages . teha also sits on the governing board of the texla telehealth resource center at texas tech , which is devoted to promoting telehealth in texas and louisiana .
with the passage of the hitech act as part of arra back in 2009 , and the more recent passage of the medicare and chip reauthorization act ( macra ) in 2015 , and just last week of the 21 st century cures act , it can seem like most of the action with respect to e - health policy occurs at the federal level . in a narrow sense , that may be true , but considered more broadly , it is clear that state - level policy - making has a critical and often under - appreciated role to play in enabling a sound e - health policy landscape .
if you’re interested in learning more about teha or becoming a member , please contact nora belcher , the executive director of teha , at nora @ urltoken . if you need assistance developing a plan for state - level e - health advocacy , please contact stephen palmer at stephen . palmer @ urltoken .
medicaid / chip health information exchange at the texas hhsc . teha represents industry as a member of the hhsc advisory committee for this hie project . over 3 million clients served by hhsc will be affected .
the summer certificate program is nine weeks of intensive study training students in fundamental concepts in health information technology , project management and workflow redesign , operational models of health care practice and skill development in the use of various electronic health record systems .
teha promotes awareness and understanding that commercial health information technology delivers measureable economic value .
without continued chip funding , congress risks adding to the uninsured in texas – already the largest number in the nation — and undermining the long - term health and wellness of our nation’s most v . . .
tracie ingram is the rural health officer and state office of rural health program manager for the bureau of primary care and rural health . she has held that position since 2009 and has worked over 27 years in state government . tracie’s experience includes healthcare safety net development , disability services , and community development . she is a specialist in rural health matters , rural health clinics and federally qualified health centers and serves as a primary technical assistance person between the federal department of health and human services and rural louisiana providers . tracie has served on the louisiana telehealth task force for 4 years .
the monetary gap between the house and senate versions of the state budget isn ' t overly large — a separation of about $ 400 million in all funds and $ 2 billion in general revenue . but both plans feature provisions concerning to medicine . so tma highlighted
medicine ' s recommendations for crafting a biennial budget that will promote a healthier texas
in a letter last week to conference committee members , cowritten with the texas pediatric society , texas academy of family physicians , and several other texas physician organizations .
a pilot project in north texas has been focusing on using health information technology to lower chronic heart failure ( chf ) readmission rates . at most hospitals , chf is the no . 1 reason for hospital readmissions .
occupational licensing : texas governor greg abbott has temporarily suspended all necessary statutes and rules to allow licensed health - care providers employed by a hospital and in good standing in another state to practice in texas to assist with disaster response operations . this suspension is in effect until terminated by the office of the governor or until the hurricane harvey disaster declaration is lifted or expires .
deborah has been involved with patient care via telehealth for eight years . currently , deborah is the facility telehealth manager for the thomas e . creek va healthcare system in amarillo , tx . deborah oversees three modalities of telehealth at the va – home telehealth , clinical video telehealth , and store and forward telehealth . previously deborah was employed by texas panhandle centers ( mhmr ) as the telemedicine nurse for rural patients in a 26 county catchment area . deborah holds a bachelor of science degree in nursing from west texas a & m ; university
the texas association of business , a lobbying group that represents the state’s employers , is joining the pro - telemedicine camp : the group just released two surveys ( one of its members , one of the voting public ) totaling more than 750 people that serve as a support to legislation that would allow telemedicine to operate more freely in the state . “texas health care consumers are calling for new . . .
but the biggest problem many see in the industry has been a lack of clear standards and a lack of portability for medical data , sometimes held up for competitive reasons , other times simply a symptom of technical incompatibilities . cerner and epic have made efforts to standardize their ehrs with commonwell health alliance and carequality , which over the last few years have begun to tackle the huge problem of creating open , interoperable platforms that don’t sacrifice privacy and security with lots of work left to do .
a not - for - profit , integrated health system with over 1 , 500 physicians , a medical center , seven regional community hospitals , 140 different service sites , a large multispecialty medical group and a nationally recognized health plan used a health information exchange platform to improve the delivery of lab reports and results .
providers and their staff rely on information available in the electronic medical record ( emr ) system to track and assess the patients’ health and care . modern emrs are connected and have the ability to obtain available patients’ health information from other providers . but even with the advancement in health information exchange capabilities , the information available remains somewhat limited . having access to claims based health information can enhance the information available to providers .
health information technology program receives $ 2 . 7 million in federal funding , graduates first class of students this summer
teha is open to all stakeholders and is constantly seeking to add to the diversity and richness of the health information technology community .
getting acclimated to the regulatory and reimbursement environment for health information technology , especially if you’re new to doing business in texas , can be a real challenge . here at teha , we’ve put together a list of resources to help get you oriented . if you still have questions , reach out to us through our contact page .
a forum - and a podium - for our members to contribute their individual voice to the broader conversation about hit and health care .
the letter vigorously opposed the senate ' s proposed $ 410 million general - revenue reduction to medicaid , as well as the house ' s $ 450 million general revenue cut from health and human services commission contracts , which would heavily affect medicaid managed care and , hence , physician fees . among other requests , it also urged strengthening of the state ' s public health defense and mental health systems .
in the state of texas , a major piece of telemedicine legislation is sitting on governor greg abbott’s desk . known as senate bill 1107 and house bill 2697 , the bill abolishes the requirement that patient - physician relationships be established with an in - person visit before telemedicine can be used . ( update : as expected , abbott signed the bill on saturday . ) texas is the final state of 50 to abolish . . .
teha is a connecting point for health information technology stakeholders to come together and share ideas , gain insights , develop partnerships , and collaborate on solutions .
in addition to its battle to preserve public health funding in the state budget , tma maintained its push for its foremost public health priorities — in some cases , in the face of staunch opposition . unfortunately , some of tma ' s priority measures didn ' t survive last week ' s house deadlines :
beginning in 2006 and continuing through 2009 , the health it industry ramped up , establishing major players in the effort to bring traditional health records to the digital age . the u . s . government’s investment in the space catapulted the industry into a higher gear , speeding adoption of large and complex systems significantly .
editor’s note : in upcoming issues of texas hospitals , we examine the current state of emr implementation as well as what industry experts believe the future of these platforms will look like . this is the first in a series exploring leadership - level concerns as we examine how the last 10 years have played out and why the rollout of digital health records has been so tumultuous , costly and inefficient .
mari robinson recently joined university of texas medical branch as the director of telehealth . in that role , she is assisting with the roll out of the virtual health network , a project to link all ut systems medical campuses to allow for the shared provision of telemedicine throughout the state . prior to joining utmb , she was executive director for the texas medical board , a role in which she oversaw the agency in general , as well as in particular the legal and administrative issues within the agency , to include a staff over 200 , and a budget of over 22 million dollars . before that , she worked for a short time in private practice in the area of civil litigation as well as for the attorney general’s office . she has a law degree from the university of texas school of law , and has previously served as an adjunct instructor in the school’s advocacy program .
membership is open to companies working in health it , as well as provider organizations , nonprofits , and other stakeholder groups . we invite you to join the over 70 organizations that are defining the path forward , for our members and customers across the state of texas , through collaboration and advocacy . we welcome your participation . for more information on becoming a member , go to our member signup page .
to support disaster recovery efforts , healthcare ready , an organization of private health care stakeholders and government response entities , is coordinating with local and federal agencies to ensure that medical gaps in the areas impacted by hurricane harvey are addressed . healthcare ready’s rx open map has been turned on and will provide pharmacy status information for texas and louisiana . sign up for notifications to stay current on their activities here .
by using telemedicine , emergency psychiatrists are always available to this large rural texas region , and response times are typically shorter than emergency programs with onsite psychiatrists . telepsychiatry is a viable solution to many locales around the country that face shortages in psychiatrists .
hospital financing overview : this document is intended to provide a high - level overview of the hospital financing system in texas and the challenges that exist – challenges that threaten hospitals’ continued ability to provide the highest quality care for all texans . learn more
house calls , yoga classes , and community networks are among the value - based innovations making medicaid more patient - centered and more penny - wise . plus . . . recent complaints suggest threats to texas ' ban on corporate practice . read the latest issue
on the maintenance of certification ( moc ) front , tma is hoping senate bill 1148 by sen . dawn buckingham , md ( r - lakeway ) , will soon make similar progress . sb 1148 would prohibit hospitals and health plans from discriminating against physicians based solely on moc and would also bar the texas medical board ( tmb ) from requiring moc for licensure or license renewal . rep . greg bonnen , md ( r - friendswood ) is sponsoring the bill , which was heard in the house public health committee on may 9 . a substitute for the bill is expected to move forward soon .
dr . hall - barrow is the vice president , virtual health and innovation for children’s health , dallas , tx . children’s health is one of the leading pediatric health systems in the country and is utilizing technology to reach children wherever they may be located . since 1997 , dr . hall - barrow has provided leadership in healthcare transformation which has included corporate health , chronic diseases management and telemedicine . she has served as a national and international expert in the field of telemedicine including but not limited to pediatrics , neurology , emergent delivery methods and healthcare mobility . dr . hall - barrow is the immediate past chair of the american telemedicine association pediatric special interest group . in this role , she continues to provide leadership to both new and existing telehealth programs through education , research and service . she has provided guidance on legislation , outreach and collaboration with national organizations including the american academy of pediatrics . she led the first state - wide tele - stroke program for arkansas and initiated the first state - wide image repository and currently oversees the largest school telemedicine program in the country . dr . hall - barrow has published her research in peer reviewed journals , presented nationally and internationally and most recently named one of the most powerful women in health care it by health data management . she holds a doctorate in higher education administration , master’s in kinesiology and bachelors in health education .
students are given opportunities to enhance their professional communication and career development skills . graduates of the program are awarded a certificate as a
health information manager and exchange specialist .
with this system , the physician can see similar information a pharmacist sees when submitting a prescription to the health plan for coverage verification . delivering this vital information directly within the physician’s workflow before the prescription is submitted can be a catalyst to dramatically improve adherence , enabling the physician to identify and address prescription - fill barriers that may hinder pick up at the pharmacy ( e . g . product not covered , prior authorization required ) . in addition , the pharmacy receives direct benefit as they do not have to step out of work flow to address these issues that have been handled upstream before the patient arrives at the pharmacy . the result bridges a significant gap in patient care .
2017 texas hospitals’ policy priorities : hospitals also are required by federal law to provide , at a minimum , a medical screening to anyone who seeks it and to provide stabilization and treatment services for an emergency medical condition , regardless of a patient’s ability to pay . learn more
the health passport is a patient - centered , internet - based , health record system that a health plan in the south - central region of the united states began using in early 2008 . it makes a foster child’s information available to authorized physicians and other stakeholders involved in the child’s care . while the data stored in the passport do not encompass all information included in a complete medical record , it does contain information on patient demographics , physician visits for which claims have been submitted , allergies , lab test results , immunizations and filled prescriptions .
security , however , has been the primary deciding factor for opting out of electronic health records . the practice’s website has been hacked repeatedly , but its sensitive paper records have not .
the 2009 american reinvestment and recovery act , also known as the 2009 stimulus package , created the “meaningful use” standard for health care records , but also planted the problematic seeds that continue to plague implementation .
for example , students in their practicum this summer at the gulf coast regional extension center in houston were deployed by dr . kim dunn to a local nonprofit clinic called shalom that relied completely on paper health records . the students were given one day to overhaul shalom ' s system for monitoring patients with diabetes . they created a new database system for the clinic to add patients and track their health over time .
a large state health information exchange selected a consulting firm to perform a review of all existing state and federal standards , as well as industry developed standards , for healthcare information technology . this landscape review met a critical need for the state’s planners : to identify the relevant architecture , data , exchange , and security standards , models and profiles that support the secure , interoperable exchange of health information among unaffiliated organizations .
health it certificate students participate in a mock clinic in the learning laboratory at the clinical education center at university medical center brackenridge . from left to right : sean el haj , sachin chopra and dustin murders .
workforce plan development to support provider transition to meaningful use . teha is actively engaged in workforce issues in conjunction with other stakeholders such as universities , community colleges , and trade associations . as a result of our work , texas has a coordinated state hit workforce planning process to ensure we have the right workforce for the future .
in addition , meaningful use standards require hospitals to prove that 5 % of their patients engage with their given health portals . with many health portals , the lack of engaging content does not foster a user experience that keeps users coming back . automated delivery of patient - centric content through a technology partner , written at an appropriate level , reduces the administrative burden on providers while helping them to meet required standards for patient engagement .
silverberg believes digital records shift power to insurance companies and the government and don’t offer enough benefits to justify their cost , at least for a practice such as his . texas fertility clinic has tested out systems geared toward infertility practices and silverberg says they were all lacking . and it’s not , he insists , because he’s a luddite .
a groundbreaking transformation is occurring in the delivery of health care in the united states ,
says field .
the college of natural sciences and the school of biological sciences are rapidly responding to this need .
teha is a bipartisan , nonprofit organization committed to being our state’s leading advocate , from local communities to the national level , for the use of information technology to improve the health care system for patients . we are :
the latest legislative effort to establish telemedicine guidelines in texas may finally be what everyone has been waiting for . senator charles schwertner submitted a bill this week created out of months of negotiations between various medical boards , regulatory agencies and industry groups , and it contains a compromise that may finally bring an end to the longtime telemedicine standoff in the . . .
among the problems that emerged after the 2009 - 2011 boom in new ehr software were competing platforms that could not transfer complete medical information with each other , leaky security and tough - to - use software that caused health professionals to spend too much time staring at screens and training instead of treating patients . the wall street journal reported the university of texas md anderson cancer center , for example , cut about 5 percent of its workforce and attributed the decision to expenses caused by implementing an ehr rollout from madison , wisconsin - based epic systems corp , another leading company in the space .
a provider in north texas was seeing a 64 year old female patient , with primary biliary cirrhosis and concurrent alcohol abuse . she was not compliant with office follow up for two years and presented to the office on 12 / 2 / 09 with her daughter manifesting jaundice and confusion consistent with mild hepatic encephalopathy . the patient’s confused mental status prevented a reliable history and the daughter was unaware of medications or pertinent medical history .
installation and deployment of a fully integrated electronic medical records system and a practice management system has had a number of positive effects on a central texas family medical practice . the system provides the practice with electronic charge capture at the point of care which , when combined with integration to a claims clearinghouse , has reduced collection days ( the time from date of service to receipt of funds ) by more than 70 % , from 72 to 20 days .
our first graduates are really impressive ,
says dr . leanne field , director of the program .
they are entering a field that is rapidly growing and will only continue to gain importance as we move toward electronic health records across the country . the industry demand is very high .
health and human services : hhs has applied for waivers from certain conditions on benefits and for extended benefits for harvey’s victims who need help . hhs is also working with the federal government to get approval to issue disaster snap food benefits and emergency snap benefits for people in counties with a federal disaster declaration .
costs were reduced or saved as a result of the information being available at the time of visit with her gastroenterologist . the diagnostic tests that would have been potentially ordered and the costs associated are $ 15 , 191 at the medicare fee schedule for tarrant county , texas in 2010 and the commercial insurance reimbursement ( assumed at 140 % of medicare ) within the community was $ 24 , 086 . since the needed clinical information was available via the hie these expenses were not incurred .
if we are to save critical access hospitals in texas for those who desperately need them , we must do better at supporting those who keep people out of the hospital with telemedicine policies that do not handcuff contracted physicians . to be clear , i would be delighted if the payers would pay a covered service delivered via telemedicine with parity , but i would be satisfied if payers simply allowed physicians to explore telemedicine options without risking their contract and negatively impacting their entire panel of patients .
not only does such a system not exist in 2017 , but some in the health industry think it’s a bad idea entirely . some question whether a trove of information such as this wouldn’t be sure to draw cybercriminals and whether its benefits outweigh costs and disruptions for physicians , hospitals , it departments and even patients .
a large integrated delivery system has been able to show that their patients with chronic conditions can manage their health and avoid hospitalization by using telehealth equipment in their homes . given their rapidly aging patient base , the system has chosen to prioritize working with patients to manage chronic conditions such as diabetes , hypertension and chronic heart failure .
zane burke , president of kansas city - based cerner corp . , which leads the electronic health records space with annual revenue in the billions , says that while the stimulus package was well - intentioned , and created a medicaid - and medicare - incentivized boom in the market from which cerner benefited , it also had unintended effects .
earlier this month , at the final first tuesdays at the capitol event of the 2017 legislative session , tma lobbyist darren whitehurst told physicians he could see the light at the end of the tunnel , but that he ' d have to wait until session was over to say
whether it ' s a train or not .
whether it turns out to be a train or a shining , promising new destination for texas medicine , that mysterious light is now even closer as just two weeks remain until the session adjourns .
this approach has been integrated into a large healthcare system within the state of texas . patients referred to the quitline are proactively contacted and enrolled in free tobacco cessation counseling . nicotine replacement therapy is also available to qualified patients . the project involves an ongoing , collaborative effort with a healthcare system and its ehr vendor to train providers on the proper implementation of an ehr version of the ask - advise - refer method . project outcomes , including referrals to quitline , were monitored by the ehr vendor and compared to state - level quitline enrollment reports .
in rural east texas , a comprehensive psychiatric emergency service is providing 100 % of its psychiatric care via telemedicine . within 15 minutes of arrival at the provider site , a patient is assessed by a registered nurse and a licensed counselor or social worker to determine appropriateness for admissions . the patient is scheduled to see the psychiatrist within 30 minutes via videoconferencing regardless of the hour of day or day of the week . the psychiatrist is also available by phone within 5 minutes . these are maximum response times , and the actual response is often much faster .
in 2013 , dr . kaylen silverberg wrote a blog post on the texas fertility clinic’s website titled , “why doesn’t tfc use electronic medical records ? ” in the post , he listed costs , waste in electronic records that end up printed out on paper anyway , lack of security and an adverse impact on the patient - doctor relationship as factors for opting out entirely from ehrs . more specifically , he says , the systems typically built to handle ehrs are meant for mainstream practices , not for a fertility practice with specialized needs and an even greater need for privacy .
the situation in the field right now is really poor ,
says daniel fritz , one of the summer program graduates who interned with dunn .
these health clinics really need major changes , but if you really sit down and think about the problem you can come up with a solution . we started that day with nothing and came away with something great .
a large state medicaid program was directed by their legislature to develop a claims based electronic health record system , which is available to medicaid providers today . providers can access the information online or download it for offline use or for importing into their own emrs . the information available in the system is used in parallel to information available in the providers emrs and offers the following advantages :
tha is soliciting donations for their tha hospital employee assistance fund , which was established to provide financial assistance to employees of hospitals located in one of the fema - designated disaster areas who experienced significant property loss during hurricane or tropical storm harvey or the ensuing floods . by creating a centralized fund focused specifically on the needs of texas hospital employees , tha will ensure that donations go where they are needed most . in the coming days , tha will share programmatic details as well as materials hospitals can share with employees . in the meantime , donations can be made at tha’s website here .
the program monitors chf patients remotely for 90 days after their hospital discharge . patients are equipped with tools to help identify potential complications that can result in readmissions . they are given vital - sign monitors , tablet devices and applications that link the data to the patients’ electronic health records ( ehr ) . the wireless devices include a pulse oximeter , blood pressure cuff , and weight scale .
to accommodate the multiple care locations and diverse levels of technology maturity that exist across the health system , the system leveraged hie technology using the same data feed to provide information via the web and via auto - print to paper - based physician offices – while offering discrete data integration with a myriad of ehrs to providers who were farther along the adoption curve and had successfully automated their practice and clinical workflow .
the market for electronic medical records ( emrs ) and electronic health records ( ehrs ) is currently about $ 28 billion with more than 1 , 000 companies creating software and systems to manage them . over the last 10 years , the efforts to make digital records happen has mirrored , and in many ways lagged behind , the technological revolution that has put smart phones in every pocket and the internet of things in our homes .
tma is also tackling the corporate practice of medicine with its support of senate bill 833 by sen . bryan hughes ( r - mineola ) , which provides protections for physicians who report that their corporate employer is interfering in the practice of medicine . currently , tmb collects information on these nonprofit health corporations but does not investigate allegations of corporate interference . the legislation is sponsored by rep . morgan meyer ( r - dallas ) .
the project involved using technology to obtain data from the home such as blood pressure and blood glucose , along with other patient information , and then merging that data into their electronic medical records system . this allows the patient’s health care team to monitor , anticipate and prevent avoidable problems . a recent study of the project , looking at health outcomes from 17 , 025 home telehealth patients , found a 25 percent reduction in the average number of days hospitalized and a 19 percent reduction in hospitalizations for patients using home telehealth . the data also showed that for some patients the cost of telehealth services in their homes averaged $ 1 , 600 a year – much lower than in - home clinician care costs . in addition to cost savings , this type of partnership between patients and their medical team can delay the need for institutional care and help maintain independence for an extended time .
a health information exchange ( hie ) provided a wealth of clinical information at the time and place of service allowing for a more accurate assessment of the patient’s medical status during the office visit and prevented the expense of duplicate diagnostic and imaging studies . further , the available laboratory studies available provided a baseline for comparison of subsequent studies . from the medication list it was determined that doxepin was a likely contributor to the patient’s progressive encephalopathy and it was discontinued .
healthcare providers and delivery systems are ideal intervention sites for conducting the recommended ask - advise - refer tobacco cessation protocol with patients . this protocol has implemented in a project designed to improve healthcare provider referrals to a state - funded quitline . the quitline is an evidence - based tobacco cessation intervention that assists patients ready and willing to quit tobacco . the project uses electronic health records ( ehrs ) to assist clinicians with providing tobacco cessation and referral options to patients .
before this program was implemented , data released by the state demonstrated that foster children were being overprescribed psychotropic medications . because these children are repeatedly relocated , physicians are frequently unaware of a child’s existing medication regimen and often prescribe another treatment beyond current therapy . the state had established a practice parameter regarding psychotropic medication use for foster children , and the health plan involved was tasked with monitoring the use of psychotropic medications in the foster care population in direct comparison with state parameters .
the prescription drug monitoring program ( pdmp ) mandate fight is still on . after the sunset advisory commission recommended a sweeping mandate for physicians to check the pdmp before issuing prescriptions for any controlled substances , tma went to work to prevent such burdensome requirements , instead proposing more reasonable solutions to combat drug diversion and doctor - shopping . many of those technology - based solutions are part of senate bill 316 by senator hinojosa , which was awaiting a hearing before the house public health committee at press time .
imagine an online service that could show you a comprehensive , continually updated portrait of your health history . every childhood vaccination , notes and treatments for an emergency hospital stay while on vacation 10 years ago , several years’ worth of psychiatrist visits , even current progress being made for a 10 , 000 - steps - a - day goal from a fitbit fitness tracker . it would be secure from hackers , accessible from any device for you or any medical professional treating you , and very easy to use .
has opened a 24 - hour crisis line for all texans affected by the storm and its aftermath . the toll - free number to access free , confidential counseling services is 1 - 800 - 327 - 7451 . magellan will provide free , confidential counseling services and other resources , such as referrals to local non - profit organizations , shelters and additional community - based support to assist texans as they work to cope with the feelings of fear , sadness , anger and hopelessness related to these kinds of natural disasters . in addition , tip sheets with resources specific to hurricane preparedness , response and recovery can be found on magellan health’s website .
dr . dunn is recognized by her peers as a visionary leader for healthcare reform using quality , information systems and telemedicine . she is a practicing general internist who serves as adjunct faculty at the school of biomedical informatics ( sbmi ) . she founded your doctor program , l . p . ( ydp ) to support a model for accountability in healthcare using standards of practice for information management for quality management while incorporating comprehensive framework for telemedicine into care . prior to joining the sbmi faculty , she was vice chair of internal medicine at utmb and played a leading role in developing the telemedicine program and outcomes management program for the texas prison system . she established the first national center for quality and outcomes research in correctional healthcare . while at sbmi , she lead the development of the applied informatics program with a focus on telemedicine and quality using information systems . she lead the establishment of the regional extension center program at sbmi to incorporate electronic medical records into 1800 practices in 2 years .
optum is offering a free emotional - support help line to affected individuals . the toll - free number , 866 - 342 - 6892 , will be open 24 hours a day , seven days a week , for as long as necessary . the service is free of charge and open to anyone . specially trained optum mental health specialists help people manage their stress and anxiety so they can continue to address their everyday needs . callers may also receive referrals to community resources to help them with specific concerns , including financial and legal matters . along with the toll - free help line , emotional - support resources and information are available online at urltoken .
on a tight time schedule , the firm was able to provide a report to the client regarding standard review findings and then developed an enterprise architecture blueprint ( eab ) for the health information exchange domain over a six - year vision , and an eab lifecycle management plan that ensures certain levels of backwards compatibility as standards evolve . in addition , the firm developed an implementation specification document that can be used by local and regional hies as a technical reference for hie implementation . development of these resources in a timely fashion has allowed the state hie , within limited resources , to establish a state framework that is flexible to allow for local needs , and a life - cycle that will allow the hie to adjust to changes in technology .
may 9 brought another major incremental victory for medicine as senate bill 680 by senator hancock won approval in the house . sb 680 would allow physicians to continue prescribing an effective medication even if a health plan ' s step therapy protocols call for a change in medication . it also would expedite the step therapy override process from 52 days to three days . the house made some changes to the version that passed the senate last month . it now only needs agreement between the two chambers before it can head to governor abbott . the house also ok ' d a measure that would help medicine collaborate on care on may 6 when it passed tma - supported house bill 3124 by rep . lance gooden ( r - terrell ) . hb 3124 would allow physicians in doctor - led accountable care organizations to receive and share physician - specific comparison data and information .
superior health plan is partnering with rubiconmd , a platform that allows primary care providers to access same - day econsults from top medical specialists to improve patient care . through rubiconmd’s digital platform , primary care doctors share relevant , anonymized patient information , ask clinical questions , and receive responses from specialists in over 150 different specialties within hours . this streamlined process enables primary care providers to use these insights to make faster , more informed decisions for their patients . primary care providers who submit econsults on the rubiconmd platform report that doing so often allows them to avoid unnecessary referrals , procedures , and tests , and provide better overall care to their patients . to help with some of the healthcare access challenges that the medical community in areas affected by hurricane harvey will be facing , they are opening up rubiconmd’s econsult platform at no cost for houston - area primary care physicians , nurse practitioners , physician assistants and other relevant clinical first responders through the end of the year . providers can use this link to sign up directly for free access .
we couldn ' t have accomplished this without the incredible support from these partners ,
says field .
teha is a trusted advisor to elected officials and local , state and federal agencies that provides decision makers with objective and relevant feedback on policy and regulatory proposals .
teha is a venue that creates visibility and relevance for its membership by providing them with multiple opportunities for interaction with stakeholders , customers and partners .
a credible industry voice within our state , with a track record of positively impacting public policy .
a guide and a resource when our members are faced with regulatory uncertainty or a lack of information about the state’s hit marketplace .
an active force in that marketplace - one that’s not just reporting the story but actually influencing the state’s policy framework and decision making process .