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There are new trends in electronic information as precipitated by the U.S. federal government. If we are to keep positively forewarned of changes in our environment we need to pay attention to what is developing, both technologically and regulatory.
Goodman, K. W. (2010), Ethics, information technology, and public health: New challenges for the clinician-patient relationship. The Journal of Law, Medicine & Ethics, 38: 58–63. doi: 10.1111/j.1748-720X.2010.00466.x
What do you think about this and how it is affecting the American public?
There are new trends in electronic information as precipitated by the U.S. federal government. If we are to keep positively forewarned of changes in our environment we need to pay attention to what is developing, both technologically and regulatory.
Goodman, K. W. (2010), Ethics, information technology, and public health: New challenges for the clinician-patient relationship. The Journal of Law, Medicine & Ethics, 38: 58–63. doi: 10.1111/j.1748-720X.2010.00466.x
What do you think about this and how it is affecting the American public?
posted by UTArlington_N5308 at 12:35 PM
53 Comments:
UT Arlington link to this article is:
https://libproxy.uta.edu/login?url=http://dx.doi.org/10.1111/j.1748-720X.2010.00466.x
We need to keep in mind possibilities related to implementation of technology for use in patient medical records. Electronic medical records makes information much more readily available. This information can then be used to facilitate improvements or decision-making. For instance, in New York there is a network of public health clinics that uses electronic patient records to aggregate specific data that assist in determining public policy (Paneth-Pollak, et al., 2010).
Reference:
Paneth-Pollak, R. Schillinger, J., Borrelli, J., Handel, S., Pathela, P., & Blank, S. (2010). Using STD electronic medical record data to drive public health program decisions in New York City. American Journal of Public Health, 100 (4). Retrieved September 18, 2010 from CINAHL database.
Milton, C. L. (2009). Information Sharing - Transparency, Nursing Ethics, and Practice Implications with Electronic Medical Records. Nursing Science Quarterly. doi: 10.1177/0894318409337026. Retrieved from http://nsq.sagepub.com/content/22/3/214.full.pdf
Electronic records provide health care workers instant access to all of a patient’s health records at a glance. No longer will there be multiple paper charts with small portions of information about the patient. There will be a need for tight regulations concerning who can access these records, who can provide documentation, and what their responsibility is to the patient. Patients should have access to their records and should have the right to disagree with information in their health care record and a means of removing unfounded information. Nurses should use nursing theoretical frameworks, principles, and concepts to help them develop policy for ethical issues regarding health record databases and its approved usage. Confidentiality of electronic health care records must protect the patient, and nurses need to be on the forefront of policy making.
Electronic medical records provide many benefits and a few drawbacks. Electronic medical records will require new laws of ethical conduct to protect patient confidentiality. Nurses need to be at the forefront of policy making, and represent the best interest for patients.
Linda
Social & Ethical Issues in Informatics
The benefits of informatics in medical practice are tremendous. The incorporation of information technology into healthcare helps bridge the gap between obtaining, receiving, processing, and delivering medical information in a useful way. While information technology helps provide a great way to store healthcare information, it is still vital to consider the ethical, legal, and socioeconiomial factors required to provide patient care. The authors in this paper reinforce the core ethical principles of the medical profession and how they integrate into medical informatics. Beneficence, Non- malfeasance, autonomy and justice are still foundation principles in providing patient care using informatics. These principles can shown by providing security to the medical record, providing the best quality of the record, reinforcing the integrity of the record, enhancing the usability of the system, and ensuring the accessibility of the record to other providers. It is emphasized that with the constant changes in technology is important to always take into account the core values and integrate them into the system being used to maximize patient care.
Reference
Duquenoy, P., George, C., & Solomonides, A. (2008). Considering something ‘ELSE’: Ethical, legal and socio-economic factors in medical imaging and medical informatics. Computer Methods & Programs in Biomedicine, 92(3), 227-237. doi:10.1016/j.cmpb.2008.06.001.
Jennifer, I agree with information technology would be a huge benefit for patients. The general public's main concern is security and privacy. "Misappropriated or misused, data could, the thinking goes, put patients in peril, especially if specific clinical information gets garbled or lost" (Simpson, 1995). There is a worry that patient's would receive medical treatment because fear of their medical information being an 'open book' (Simpson, 1995) My main concern who is going to provide an efficient security system and who is going to pay for this.
Simpson, R.L. (1995). Ethics in the information age. Nursing Management, 26 (11), 20-23.
While most people are in favor of EMRs, the way with which data is accessed, stored, and maintained is what concerns me most. According to Stoten (2009), the government has not created standards for EMRs or provided any guidance to implement them. So, how are we to go about creating a nationwide database for EMRs?
Melissa
Reference
Stoten, S. (2009). Health policy issue with the electronic health record. Online Journal of Nursing Informatics, 13(2), Retrieved from CINAHL Plus with Full Text database.
According to Milton (2009), the information-age opened the pathway to medical sub specialties, clinical pathways, and processes supposedly designed to improve patient care and outcomes. The author indicated that despite the sophistication and convenience of such technology, the focus should be the patient. Milton purported that the use of informatics and other electronic health information systems operate under the guise of patient care, but some are truly designed as cost-saving measures. Milton expressed that nurses are ethically liable to serve the patient not processes. Despite multidisciplinary patient-care services and planning--ultimately the patient is the expert on whether they want to receive and participate in the care provided. The author further indicated that patients have the right to decide what portions of their health information they want documented and what they do not want documented. This situation presents a two-fold dilemma for health care personnel--especially nurses. Bound by health care organization policy to document, document, document, yet equally bound to serve the patient. What are they to do?
Reference:
Milton, C. L. (2009). Information and human freedom: Nursing implications and ethical decision-making in the 21st century. Nursing Science Quarterly, 20, 33-36.
Jean (2009) asserts that there are both advantages and concerns with electronic medical records. On the one hand, electronic medical records are easily portable and allows for easy access for multiple providers, and allow for disease surveillance. The major concern which still needs to be addressed is that increased accessibility leads to increased chances that the records may fall in the wrong hands. The author does not give a solution for this. I agree with the author when he points out that electronic medical records are the way of the future. The only question now is how to improve the system to ensure patient privacy is protected.
Jean, R. (2009). Personal electronic health records: from biomedical research to people’s health. Informatics in Primary Care, 17, 255-260. Retrieved from Academic Search Complete.
Melissa,
It is concerning how our electronic medical records are being stored. In reading one of the articles posted by Linda, I noticed one of the big concerns is that even we as nurses do not completely understand how the information is stored and how our privacy is kept safe. So how should we expect patients to be okay with it? I agree with Milton (2009) that there needs to be more transparency with the system. Maybe part of the problem is that we have so many different hospitals using so many different systems that it is hard to explain to the public how things really work.
Milton, C. L. (2009). Information Sharing - Transparency, Nursing Ethics, and Practice Implications with Electronic Medical Records. Nursing Science Quarterly.
Moving the Default from Opting In to Opting Out
Physicians and other health care workers have traditionally been charged with both promoting the welfare of individual patients and also promoting the welfare of the general public. Sometimes these two duties come in conflict, as when a health care worker has to balance a patient’s right to privacy against an ethical duty to report a case for the protection of other people. Health care professionals have a unique opportunity to gather data for the purposes of improving the health of entire communities. While there are legitimate concerns for individual privacy, electronic health records offer new possibilities for aggregating data and rendering individual subjects unidentifiable. It can be argued that there is a positive moral imperative to make use of the opportunities for furthering knowledge that this new technology provides. One of the problems we face is that we have traditionally required people to opt in to such things as organ donation or sharing of data for research projects. People tend to be biased toward default positions. If we changed the default position to requiring people to opt out of such things, perhaps we would get more participation in organ donation programs or medical research.
Goodman, K. (2010). Ethics, information technology, and public health: new challenges for the clinician-patient relationship. Journal of Law, Medicine & Ethics, 38(1), 58-63. doi:10.1111/j.1748-720X.2010.00466.x.
Thomas D.
Claudia, I have had a few patients tell me something and ask me to keep it out of the medical record. I have always honored that request. If I have concerns about it, I discuss my concerns directly with the patient, I may even discuss the matter with a physician or team member, but I do keep it out of the record if that is what the patient wants.
The authors focused on ways to maintain ethics and privacy within the developing medical technology. There needs to be a mutual engagement and cross-disciplinary training between technology developers, ethicists, and the medical profession. Even with training, some issues may continue to be ignored due to the difficulty in developing technology but maintaining ethics. This article is an attempt to show the gap between disciplinary cultures. The author’s goal is to expose the two cultures to a better understanding of one another to improve ethical, legal and socio-economic factors in medical informatics.
Duquenoy, P., George, C., & Solomonides, A. (2008). Considering something 'ELSE': ethical, legal and socio-economic factors in medical imaging and medical informatics. Computer Methods And Programs In Biomedicine, 92(3), 227-237.
Julie,
I agree that the records can fall into the hands of anyone. I have taken care of patients that had relatives or friends that have worked at other Texas Health Resources and the relative would go into the chart and look at all of the patient information. Even though this was a voilation of privacy, I don't think the relative really cared. Some people are willing to put their jobs on the line to get the information.
Jennifer Day,
I agree that the EMR is a great thing. However, as you stated we just have to be careful to try to maintain privacy to the patient. In my experience this has been a challenge. I don't think it necessarily the EMR itself. I think people using the EMR have to have morals and values and do the right thing.
Claudia, I agree that we ultimately serve patients, not processes or even the institutions that employ us. As you say, a patient has the right to say what should or should not go in her/his record. Suppose that I am with my nurse and the nurse asks me, "Are you addicted to drugs?" I misunderstand the question and answer yes, but later realize what she was asking and clarify my answer. Suppose the nurse then says, "Well, I believe you really misunderstood the question, but since you said yes, it is my duty to put that yes in your medical record and it will follow you for the rest of your life." Is this situation fair or right? Does it help the patient or anyone else? I have only had a few patients ask me to keep something out of the record. I discuss the matter with them, and suggest that they also inform other people who need to know the information, but I honor their request. I cannot say I would always do this however. There might be situations where complying with such a request could harm third parties. Each case has to be decided on its own.
Thomas D.
Milton, C. L. (2009). Information and human freedom: Nursing implications and ethical decision-making in the 21st century. Nursing Science Quarterly, 20, 33-36.
Tom,
This author feels that patients should have the right to view their medical record and also be able to remove anything they don't agree with in the record. I do believe the chart belongs to the patient,and they should have the right to view their record, with stipulations. (ie. they are mentally competent) This opens up a whole new realm of ethics and standards, for what regulations have to be meet to allow anything to be removed from the chart.
Linda
Elanda, as you say, most of the privacy breaches associated with the EMR have their analogues with the paper medical record as well. Nosy coworkers can leaf through the paper chart of a patient they are not caring for. A paper chart can be accidentally left where a visitor can look at it. Carbon copies of reports can be thrown out in regular trash instead of shredded.
McGraw (2009) discusses the privacy of health information and the law in effect pre-ARRA (American Recovery and Reinvestment Act). It outlines perceived gaps and potential solutions. The author then provides the arguments for and arguments against the possible solutions. Although this is a lengthy article, it is rich in information about the challenges which remain related to a new generation of health privacy.
McGraw, D. (2009). Privacy and health information technology. Journal of Law, Medicine & Ethics, 37 (2), 121-149. Retrieved from CINAHL plus: www.cinahl.com/cgi-bin/refsvc?jid=233&accno=2010398574
Melissa,
You asked how we are to create a nationwide database...we can't! At least not yet. I believe the situation we are currently in the midst of is a "mess", but what we can do is small steps at a time. Hospitals and hospital systems can implement the EHR. I think making that transition, especially for the healthcare providers is the first battle. Once that is in place the government will have to make decisions to guide a "merging" of information.
But the concern of patient privacy is forefront as we do implement EHRs all over the nation without appropriate regulations or guidance of an up to date Code of Ethics. So how do we ensure protection of patient information? Who is allowed to view what portions of the medical record? What rights do others have to access or run reports if it is related to trends or a public health issue?
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sorry for the deleted comment but the blog will not accept my article post! It accepts it if I type in ...... weird!
Computerized teaching allows for just-in-time learning but is it the most ethically appropriate method of patient/family teaching? The author identifies the nurse as having the duties and rights of providing a safe environment with competent care. The patient has the right to a safe environment with adequate preparation of self-care upon discharge (Heiskell, 2010). Without Video On Demand (VOD), nurses can provide teaching when it is convenient for them but often times it is not a teachable moment for the patient and family. Using the technology can be difficult and time-consuming. The author suggests that nurses teach and empower the patient and family on how to access the VOD and provide them with written material to review when they are ready to learn. This allows time for them to ask questions regarding self-care after discharge. Applying the ethical principles of autonomy, beneficence, nonmaleficence, justice, veracity, fidelity, and multiculturalism to both nurse and patient roles, the author identifies the use of VOD and printed materials as a morally justified option in comparison to traditional teaching.
Reference:
Heiskell, H. (2010). Ethical decision-making for the utilization of technology-based patient/family education. Online Journal of Nursing Informatics, 14 (1). Retrieved from http:ojni.org/14_1/Heiskell.pdf
This is a reply to Nokie:
I certainly agree with your position that patients have the "right" to adequate education. However, as a former medical/surgical nurse charged to care for up to eight patients at a time, working short staffed, and stll expected to complete my shift on time--sometimes there is no time for "real" patient education. Often, it was miraculous for me to dispense my medications (though often had to fight with pharmacy to get them)timely. Educational materials were a real source of help for me, but I also made sure that I asked the patients and their families if they had any questions or did they understand the materials they read. If so, I explained as much as I could or if another discipline could help (for example a diabetes educator) I used their services to help with education also. Keep in mind that sometimes these disciplines are only available during day hours, so when you work at night or on the weekends--you are still in a bad position on this issue.
Great article Nokie!
This response is to Rosemarie:
Another issue I think that is important is that many individuals fear that acquisition of their personal healthcare information by corporations or insurance companies will cause employment and insurance discrimination. Though with the recent passage of Healthcare Reform individuals are not to be refused coverage if they have preexisting conditions; however, insurance companies are sure to find loopholes or some mechanism to not insure some indivuduals. I have read numerous articles and it was suggested that some companies are willing to pay fines for not offering insurance to their employees because it is cheaper than insuring them. With news like this being available to the general public, I would be concerned about being "forced" into accepting the idea that all of my healthcare information be in electronic form.
Blogger melissa said...
Boyd, K.M. Ethnicity and the ethics of data linkageBMC Public Health. 2007; 7: 318.doi: 10.1186/1471-2458-7-318.
This article spoke of using the US census data to obtain and link information on health status of the ethnic minority populations. There is limited availability of ethnicity on health information and it is a priority of the Health department to identify health needs of all ethnic groups including minority populations. This article proposes linking the two systems in an attempt to retrieve the most reliable and up to date information. There may some ethical issues involved in this link of information as one is not giving consent for all access to information when filling out census information. I can see how linking the information is beneficial but I do wonder if this is a breach of ones ethical and human rights. for the population that is uneducated and ill informed a person could easily share more information than what they originally planned.
Melissa Stewart
Blogger melissa said...
Privacy and confidentiality are definitely keys to the success of Nursing informatics.It seems so very easy to access and obtain private information of anyone out there, both in the medical environment as well as the social networking end. I do have to admit I do have a fear of sharing tho much information. But I also recognize the advantages of having data so readily available. It is very important in the work place to have a team that monitors the proper use of the medical record meaning only those that need to see can see...without penalty that is. I have worked in several different hospitals where this is in effect and it makes a big difference. I have seen several medical workers get fired for the inappropriate use of the medical record, as they should be.This makes workers more cautious and more apt to do the right thing when they know they are being monitored.
melissa Stewart
Nokie,
Great article choice. I like the idea of using VOD for patient teaching. Are the authors referring to videos that will be accessed following discharge? If so, how would they ask questions if they are getting the teaching after they have gone home? I do agree that patients who are still in the process of recovering have difficulty learning. In my experience, the patients are most interested in just getting home!
Elanda,
On your unit, is there any monitoring of access activity? Like if someone works on a certain unit, but goes to look up their relative's medical history (who was staying on a different unit) does that get flagged? At UT Southwestern, they made a very big deal out of this and told us we were being "monitored" and could not access info on patients we haven't taken care of. I think this rule would make some staff think twice about accessing records out of curiosity. It is definitely a violation of privacy rights in that case.
Reply to Julie:
The author is referring to VOD that can be accessed from their room televisions during their hospitalization and that nurses should teach and empower patients/families to utilize those VODs. It is hard to provide adequate teaching especially when you work on a unit that requires you to have 4-6 patients. There just isn't enough time in the world. So the author says that if patients access those VODs when they are interested in learning, they will benefit more.
The one major advantage of electronic health care records is the easy in which information will be obtained and shared, but that brings up the question of the dangers that are associated with obtaining information easily.
Our hospital tracks who opens up patient records. They told us in orientation that if we open up our own records we will be fired on the spot.
betty
This article discusses how the continual emergence of information technology is allowing more information to potentially be accessible to more and more people. But no only does it address the information be accessible but to who potentially even other physicians. So how much is too much to withhold and how much say so does an individual have regarding what other clinicians can see? What if that particular health information could be impacting their care due to neglect of information being shared that could be vital. As I was reading this article I could help but to think how this might have significant impact of the client-provider relationship and care.
Rothstein, M.A. (2010). The hippocratic bargain and health information technology, 38, 7-13. Retrieved from CINAHL
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Linda,
I think in the future we will see a lot of new policies regarding medical records. Since, eletronic medical records is still just getting started, in the near future newer regulations will have to be implimented. However, knowing that patient records can be easily attainable, do you think that would make health care workers (i.e nurses and doctors) more selective of what they write?
Betty
Curtin, L. (2005). Ethics in nursing administration. Ethics in informatics: the intersection of nursing, ethics, and information technology. Nursing Administration Quarterly, 29(4), 349-352. Retrieved from CINAHL Plus with Full Text database.
This article details the growing controversy regarding healthcare, information and technology. The author acknowledges the growing convince of obtaining patient data with new technology. In many ways technology is useful; it can allow sharing of ideas, ease of information and provide a faster method of communication. However, technology can also bring up the ethical question of how much information is too much and who is allowed access to the information. These are the questions brought up in this article. The author stresses the notion of ethics in informatics. As healthcare grows more towards incorporating new technological methods the growing need for patient data safety becomes a concern. In 2009, President Obama passed a bill that will put millions of dollars into making healthcare records electronic. While this new measure will ensure ease of data collection, the correct framework needs to be taken to make sure that healthcare workers who are able to access these data be held to high ethical standards.
betty
Melissa,
I agree that those who are not aware or educated on the reasoning behind census data. Although, I agree that some disease and conditions are more prevelant in one ethnic group than another, I disagree in grouping care in a population because of it. I guess I am against generalizing health care needs.
People who are not aware of the reason for data collection might give out information that they didn't intend to give.
Tom,
I have always charted knowing that my charting might be reviewed. However, that does not stop me from writing what I need to. However, I have read doctors progress notes that are blunt and straight to the point. I wonder if that will change.
Betty
Reply to Using Rosemarie Parse's Theory of Nursing
I agree that EMRs will impact the care that patients receive, however I don't think changing the 'default position' will affect people's participation in certain programs. I think ensuring that patients are fully educated on both positions would make more of a difference. I worked as a trauma ICU nurse and came across so many patients/families that chose not to participate in organ donation. Over 80% of these people were uninformed and trying to inform someone about this after having lost a loved one or when in the hospital doesn't prove to have the best outcomes. If patients/families are armed with all the information needed they may be better able to make educated decisions. Likewise, I think that the we as nurses need to take responsibility in implementing this educational opportunity. We have to use the internet as a conduit for getting information to the public.
In reply to Linda Koenig..
This is a very interesting concept. Allowing the patients access to their medical records with the option to remove things that they feel are incorrect could pose legal implications for nursing/healthcare providers. I think patient should definitely have the rights to access their medical records, but allowing the option to alter it in anyway is definitely a scary thought for me. If this happens, how are we as heathcare professional going to be protected??
J. Foy
Ja'Neatrius Foy
This article describes a strategy to promote patient safety through an informatics-based approach to nursing education at the Columbia University School of Nursing. They implemented the use of a personal digital assistant (PDA) to document clinical encounters and to retrieve patient safety-related information at the point of care. These practices were used with graduate nurses as well as MSN nurses. The PDAs were used to track care and to document events.
I think this type of system is a great idea but use of handheld devices allows for a breach in patient confidentiality. If there were a fail-safe method of interfacing mobile devices without this risk, this could be yet another INCREDIBLE option for nursing informatics to grow.
Bakken,S.,Cook,S.,Curtisa,L., Desjardinsa,K. Hyuna, S., Jenkinsa, M., Johna,R. W. Ted Kleina, Paguntalana, J.,Robertsa,W., and Soupiosc,M.Promoting patient safety through informatics-based nursing education (2004) International Journal of Medical Informatics. Retrieved from Science Direct on November 28, 2010.
Concerning the idea for a national medical record, as an emergency room nurse I feel that this is entirely essential. Many patients we see are very poor historians and cannot provide medical history that is critically relevant to their care. Most patients are not able to provide medication lists on arrival and if they do often times it is just the drug name and no dosage is given. Another issue we encounter in the ED is that a critically ill/injuried patient may not be able to provide this neccessary information due to their condition. Many times patients have left other facilities recently and come to the ED and we are unable to identify treatments they have recieved and medications they have taken (or gotten an Rx for). A national medical record could greatly improve the ability of an ER care provider to correctly diagnose and treat patients. I gound a medical editorial style article by NewsWeek that reflects this same concept and need for standardized electronic records.
http://www.newsweek.com/2009/05/01/file-under-hodgepodge.html
Lisa,
I think EMR would cut down ER nurses documentation time and even for other nurses. If we can get the patient's history from their previous admissions, it would cut time down considerably. I would love a system where we can retrieve patient's history and home medication. Then all we need to ask if there is no changes. Sometime, actually most of the time when patients come in to the hospital they are scared and not in the right frame of mind. So when asking history they tend to forget certain medical events. I am all for a system were we can get this information!
betty
I agree with Linda that nurses need to be involved in policy making regarding electronic health records because we need to continue to be the patients advocate.
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This article states different methods of ensuring protection and privacy of electronic he medical records. Benaloh, Chase, Horvitz and Lauter
(2009) suggest that one way of ensuring privacy is having patient controlled encryption. However there are many issues with this concept one is that doctor may need to store, manage and protect local copies of the secret keys for each patient.
Benaloh, J., Chase, M., Horvitz, E., Lauter, K. (2009). Patient Controlled Encryption: Ensuring Privacy of Electronic Medical Records.
Nancy Ndinda
Murphy, J. (2010). Nursing Informatics. The Journey to Meaningful Use of Electronic Health Records. Nursing Economic$, 28(4), 283-286. Retrieved on 11/29/10 from CINAHL Plus with Full Text database.
In this article, Murphy (2010), discusses some ongoing regulatory changes regarding adoption of electronic health records (EHR). All hospitals and physician providers are must begin using EHRs in a meaningful manner prior to the year 2015 or else face repercussions. Various reimbursements are available for all who meet the requirements of implementing such EHRs. Subsequently, facilities will be required to report HER quality measures annually. Murphy notes that the main agenda behind the government’s mandate for adoption of HER is to improve health and save on costs.
With these regulations in mind, healthcare professionals must be prepared to adopt health information technology and work towards ensuring their facilities are in compliance. After all, healthcare providers want to be reimbursed for all services provided in order to stay in business.
In response to the Goodman article, I do agree that clinicians need some basic formal training on the use of health information technology. Although different facilities have different types of HER, entry level clinicians must possess basic understanding in order to be compliant with the government’s “meaningful use” policies. In regards to clinicians’ duties to collect and share data, we have to be careful as healthcare providers to collect complete and meaningful information from our patients. This component of the patient-provider relationship can be tedious. Providers can get caught up trying to follow checklists such that they miss other data that the patient is trying to share, or miss responses that need to be elaborated. The usefulness of data stored in HER is comparable to the data’s accuracy and completeness. The format of the HER is also important in assisting the clinicians to capture pertinent information. This can be achieved by including practicing providers in the development of HER templates. In the following article, Petrovskaya et al (2009), emphasize the importance of viewing health as a continuum instead of trying to fit patients into a specific category in the HER.
Petrovskaya, O., McIntyre, M., & McDonald, C. (2009). Dilemmas, tetralemmas, reimagining the electronic health record. Advances in Nursing Science, 32(3), 241-251. Retrieved on 11/29/10 from CINAHL Plus with Full Text database.
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This is a test post, for I have never blogged!
Debra Nation, UTA N5308 Fall 2015
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