For this part, you have 30 minutes to write a short article entitled Who has the most important influence on young people. According to the outline given below, you should write at least 150 words.

1. Some people think that family members have the greatest influence on teenagers.

Some people think that friends have the greatest influence on teenagers.

3. My opinion.

Who has the greatest influence on young people?

Part II Reading Comprehension (Skimming and Browsing) (15min)

In this section, you will have 15 minutes to read the article quickly and answer the questions on the answer sheet 1. For question 1-7, choose the best answer from the four options marked as a), b), c) and d). For question 8- 10, complete the sentence with the information given in the article.

Will electronic medical records improve medical care?

Electronic health records (EHRs) have attracted a lot of attention since the Obama administration provided1900 million dollars of stimulus funds earlier this year to encourage hospitals and health care institutions to digitize patient data and make better use of information technology. However, the health care industry as a whole has been making slow progress in adopting information technology and integrating computer systems, which raises a question, that is, whether the promotion of digitalization will produce information that enables doctors to make more informed decisions, or whether it will produce a large number of unrelated data.

The Medical College of Pitt University (UPMC) knows directly how difficult it is to realize the former, while the EHR plan can easily fall into the latter. UPMC has spent five years investing 1 billion dollars in information technology systems to stay ahead of EHR problems. Although this is more than five times the cost of the hospital system recently estimated, UPMC is a huge project, consisting of 20 hospitals, 400 doctors' offices, outpatient clinics and long-term care facilities, employing about 50,000 people.

UPMC's early attempts to create a universal EHR system, such as its mobile electronic medical record launched from 2000 to 2005, met with resistance because doctors, staff and other users either completely avoided using new technologies or relied on independent and unrelated software and systems implemented by UPMC IT department for many years.

On the mend.

Although UPMC began to digitize some of its records as early as 1996, the turning point of this effort appeared in 2004, when its electronic recording system was popularized in the whole medical care work. ERecord now contains more than 3.6 million electronic medical records, including images and CT scans, clinical laboratory information, radiology data, and a picture archiving and communication system, which digitizes images and makes them available on PC. The EHR system has 29,000 users, including more than 5,000 doctors employed by UPMC or affiliated with the company.

If UPMC makes the EHR system look easy, don't be fooled, Dan Ma Diqi, UPMC's chief medical information officer, warned that IT systems in healthcare work need "huge and continuous efforts" to ensure that these systems can communicate with each other. One of the main reasons is that, like many other health care organizations, UPMC's medical and IT systems use many different vendors, leaving the integration work mainly to IT personnel.

Because doctors are usually unwilling to change their working methods for a computer system, the success of EHR project depends not only on the existence of this technology, but also on the training and use of this technology by doctors. Louis Baverso, chief information officer of UPMC Magee Women's Hospital, said that doctors need to see the benefits of persistent use of EHR system. But he said that these benefits may not be obvious at first, adding, "What doctors see at first is that they are losing the ability to use paper documents, which has been very valuable to them so far."

Opportunities and costs

In view of the lack of adoption of EHR in the whole health care industry, there are many opportunities to do it right (or wrong). According to a study by Ashish Jha, an associate professor of health policy and management at Harvard School of Public Health, less than 10% of American hospitals adopt electronic medical records, even in the most basic way. Only 1.5% people have adopted a comprehensive electronic recording system and decision support system, including doctors' notes and orders, which can remind doctors of potential drug interactions or other problems that may be caused by scheduled orders.

According to Jha, cost is the main obstacle to EHR system, followed by the resistance of doctors who are unwilling to adopt new technologies and the lack of employees with sufficient IT expertise. He pointed out that depending on the size of the hospital, a hospital may need to spend $20 million to $200 million to implement an electronic record system within a few years. A typical doctor's office equipped with an EHR system is estimated to cost $50,000.

The advantages of EHR system are more difficult to quantify. Jha said at the community forum of Harvard School of Public Health on September 6, 2007 that although some estimates show that hospitals and doctors' offices can save as much as10 million dollars each year by switching to electronic health records, simply implementing this technology cannot guarantee cost savings or improve care. Another study on hospital computerization at Harvard University also holds that it is "wishful thinking" to cut costs and improve medical services through existing medical information technology. The study was led by David Himell Stein, an associate professor at Harvard Medical School.

The price of making mistakes

Leonard D'Avolio, deputy director of Biomedical Informatics Center of Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), said that the difference between the estimated cost savings and the actual situation stems from the fact that the EHR technology implemented so far is not designed to save money or improve patient care. On the contrary, EHR is used to record the situation of a single patient, transfer this information between clinicians who treat these patients, prove the rationality of financial reimbursement, and serve as a legal record of events.

This is because if a health care institution has10 million dollars to spend, its manager is more likely to spend it on an expensive laboratory equipment than on information technology, D'Avolio said, adding that the investment in laboratory equipment can be made up by charging patients a service fee. That was not the case. In addition, computers and working equipment used in hospitals and health care institutions are not related to each other, usually made by different suppliers, and there is no standardized communication mode. "It is difficult to standardize medical data because caring for patients is a complicated process," he said. "We need to find a way to cover not only all departments, but also the whole hospital. If you can't measure something, you can't improve it, and without these data, you can't measure it. "

In order to qualify for a share of1900 million dollars provided by the American Recovery and Reinvestment Act (ARRA), medical institutions must prove the importance of their IT investment to ensure that they are "meaningful users" of EHR. The Department of Health and Human Services has not defined what is meaningful use.

Summarize information to create knowledge

Davoglio said that ideally, in addition to providing doctors with basic information about patients, they can also mine new knowledge from the database of vital signs, images, laboratory values, drugs, diseases, interventions and patient demographic information. "As long as several of these databases work together, the power to improve health care will multiply," Davoglio suggested. "What is lacking is a collective awareness that better health care requires better information-not automation of the status quo." He added that in the future, adding genomic information, environmental factors and family history to these databases will make clinicians begin to realize the potential of personalized medicine.