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The article reports on the developments in the disease called tuberculosis among developed countries. This type of chest disease has reported a slight increase in developed countries, particularly the USA, since the mid-1980s. Different treatments for the said disease are discussed. Programs are being held to achieve the complete treatment being led by the World Health Organization.

Objectives: The Massachusetts Veterans Epidemiology Research and Information Center in collaboration with the Stanford Center for Innovative Study Design set out to test the feasibility of a new method of evidence generation. The first pilot of a point-of-care clinical trial (POCCT), adding randomization and other study processes to an electronic medical record (EMR) system, was launched to compare the effectiveness of two insulin regimens., Materials and Methods: Existing functionalities of the Veterans Affairs (VA) computerized patient record system (CPRS)/veterans health information systems and technology architecture (VISTA) were modified to support the activities of a randomized controlled trial including enrolment, randomization, and longitudinal data collection., Results: The VA's CPRS/VISTA was successfully adapted to support the processes of a clinical trial and longitudinal study data are being collected from the medical record automatically. As of 30 June 2011, 55 of the 67 eligible patients approached received a randomized intervention., Discussion: The design of CPRS/VISTA made integration of study workflows and data collection possible. Institutions and investigators considering similar designs must carefully map clinical workflows and clinical trial workflows to EMR capabilities. POCCT study teams are necessarily interdisciplinary and interdepartmental. As a result, executive sponsorship is critical., Conclusion: POCCT represent a promising new method for conducting clinical science. Much work is needed to understand better the optimal uses and designs for this new approach. Next steps include focus groups to measure patient and clinician perceptions, multisite deployment of the current pilot, and implementation of additional studies.

The U.S. Veterans Health Administration (VHA) provides care to some 5.2 million patients spread across the continental United States, Alaska, Hawaii, Puerto Rico, and the Philippines. Sites of care include 157 medical centers, nearly 900 outpatient clinics, long-term facilities, and home care. Over the last 10 years, major changes in the nature of VHA healthcare have imposed a requirement for longitudinal electronic health records and integration of those records across the enterprise at the point of care. VHA has now evolved through three generations of applications that support such integration. This paper reports on the VHA experience, points out lessons learned, and outlines future directions for electronic health record integration in VHA.