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Key things you need to know aboutDr. Utech:
Dr. Utech's Experience
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- Family Medicine
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Hospital Quality
The right hospital is as important as the right doctor
- Abbott Northwestern Hospital
- 800 E 28th St
- Minneapolis, MN 55407
- AllinaHealth - United Hospital
- 333 Smith Ave N
- Saint Paul, MN 55102
9 Facts About Hospital Quality
Patients' risk of dying during a hospital stay for heart bypass surgery could be 87.4% lower, on average, at a hospital rated 5 stars compared to a hospital rated 1 star for that procedure. Choosing the right hospital is critical to your health. View Slideshow
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Patients' feedback on their experience with Dr. Utech
Likelihood of recommending Dr. Utech to family and friends is 4.7 out of 5 5 1 15
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Accepting new patients?
- Yes
- 21260 Chippendale Ave W
- Farmington, MN 55024
- (651) 463-7181
- Directions
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|Numķro de publication
|Type de publication
|Numķro de demande
|Date de publication
|25 sept. 2007
|Date de dķp¶t
|5 dķc. 2001
|Date de prioritķ
|22 dķc. 2000
|╔tat de paiement des frais
|Autre rķfķrence de publication
|Numķro de publication
|Tony Brummel, Carl D. Dvorak, Khiang Seow, Daniel Bormann, Steve Larsen, Andrew Ma, Aaron T. Cornelius
|Cessionnaire d'origine
|Epic Systems Corporation
|Exporter la citation
|BiBTeX, EndNote, RefMan
|Citations de brevets (123), Citations hors brevets (58), Rķfķrencķ par (59), Classifications (22), ╔vķnements juridiques (3)
|Liens externes: USPTO, Cession USPTO, Espacenet
This application is a continuation-in-part of, and claims priority to, U.S. Provisional Patent Application Ser. No. 60/257,970, entitled "Seamless User Interface Built on a Single Data Repository for an Integrated Electronic Health Care Information System," filed Dec. 22, 2000, the disclosure of which is hereby expressly incorporated herein by reference.
The present invention relates generally to health records management, and more particularly, to a seamless user interface adaptable to an integrated electronic health care system.
Electronic medical record and practice management information systems store, retrieve and deliver information to a health care enterprise. Some systems address only one type of information necessary for clinical and practice management, for example, outpatient billing information records, outpatient medical records information, etc. Such systems feature single user interfaces, each allowing entry of only one limited type of information, and are combined with a single data repository that is similarly limited. The data repositories utilized by these systems can be difficult to interface with one another, and typically include duplicate information.
Other systems allow multiple user interfaces to access a single data repository, however the multiple user interfaces are disparate in operation and appearance. Facilities implementing such disparate interfaces must expend significant time and effort to train users for each of the confusing variety of applications with unrelated user interfaces. In addition, such systems typically limit users' ability to move freely within one application requiring, for example, that users complete a specified task before moving on to another. Further, such systems typically require that two individual programs run simultaneously on one machine when switching between applications.
The systems mentioned require complicated deployment of multiple user interfaces and/or data repositories to different system users and access terminals throughout the health care facility. Health care enterprises utilizing such systems risk non-compliance with health care regulations and best practice guidelines, due to the inflexibility of the multiple interfaced applications with different system user security records and alerts systems. Additionally, the health care enterprises incur unnecessary administrative overhead created by the poor communication capabilities between the multiple interfaced applications, for example, poor or non-existent clinical decision support, or billing applications that contradict diagnostic decisions already filed in the enterprise's medical records application.
An electronic Health Care Information System (HCIS) is provided including a modular framework and a display in communication with the modular framework for providing a graphical user interface to a system user. The modular framework includes a plurality of activities, where each activity provides an aspect of patient care. Activities for providing aspects of patient care include, but are not limited to, activities used in the providing of health care to a patient (for example, which provide a care provider with patient medical information such as a patient history activity and a chart review activity, etc.) and activities used in the management of health care for a patient (for example, registration, patient demographics, etc . . . activities). The graphical user interface is adaptable for displaying information corresponding to one or more of the activities, and includes a common menu format for communicating available operations in the graphical user interface, and common visual components for displaying information to a system user.
The modular framework allows additional activities to be added to the system without the difficulties associated with interfacing and configuring the activities to work with the HCIS and with each other. Further, the ease of integrating applications due to the modular framework results in a high rate of compliance with government regulations. The common menu structures and common visual components provided by the graphical user interface provide system users with a consistent interface for the HCIS, reducing the training requirements of system users who might otherwise be cross trained on multiple user interfaces. Additionally, the graphical user interface and modular framework allows system users to freely switch between activities available within the HCIS, even before completing a particular activity. The system users are therefore not forced into finishing a particular activity before gaining access to another activity, allowing for example, emergency situations to be addressed immediately without loss of information or work flow in an interrupted activity. Further, the graphical user interface and modular framework facilitates the combining of heterogenous, but related, activities within particular workflow (for example, work space).
In further embodiments, a single information database is provided for use by the activities, reducing if not eliminating data duplication between activities, and the difficulties with interfacing multiple databases having varying structure or format. Additionally, the single information database allows a common security record to be kept for system users, facilitating uniformity of security access for system users across all activities of the HCIS, ease of setting security requirements for new system users, and reduced probability of granting mistaken security privileges as security information for all activities need be entered but once. Further, the single information database and modular framework allows an alert system to be provided to warn system users where information entered in an activity conflicts with other information for a particular patient in the information database. Additionally, system users are provided the ability to configure the graphical user interface, giving the flexibility of tailoring the graphical user interface to offer functionality and information to better serve their specific needs. In addition, a workflow management tool is provided as an Electronic Messaging and Workflow System, further discussed below.
Referring to
In a preferred embodiment, the single data repository 20 is a server, where the enterprise database 24 and the activities database 26 are embodied in a storage device, for example a hard drive, within the server. The functionality provided by the information provider 30 and the plug in framework 28 are programs running on a suitable processor within the server. The program identifications are program modules for forming specific functions which may be combined to form the functionality for a particular activity. The plug-in framework receives these program modules, or program address links for accessing the program modules, along with the data corresponding to the data requirements for the particular activity, and is able to provide the particular activity to the system user via the graphical user interface.
The HCIS graphical user interface 22 communicates with the data repository 20 via the communications link 23, allowing system users to access various activities provided by the HCIS system. The communication link 23 may represent the internet, a dedicated data bus, or any other means for communicating information between the HCIS data repository 20 and the HCIS graphical user interface 22, as would be appreciated by one skilled in the art. The HCIS graphical user interface 22 includes a menu 32 in a common menu format across activities and operations (workspaces), providing the system user with options for opening various workspaces, for example the workspace 34. The workspace 34 may allow handling of operations in a particular system user environment, for example handling patient admission and other patient encounters, scheduling, etc. as discussed below. The workspace 34 includes an activity toolbar 36 listing activities available to the system user within the particular workspace, where a particular activity selected by the system user is displayed in an activity display area 38. Activities may be nested within the work space 34 and are typically dynamically built according to information the InfoProvider 30 delivers from the universal patient record and user security record of the enterprise database 24 and the activities database 26. Users may select tabs on the activity toolbar 36 to move freely between any combination of available activities without closing the workspace 38 or reentering information that is already available within the workspace context. Certain data combinations in the patient record may trigger alerts and requests for further data entry. These requests may automatically open new activities for the user, compelling compliance with enterprise-defined guidelines. Further, access to viewing and editing information may also be limited in accordance with the system user's single user security record. Operation of and interaction between the HCIS data repository 20 and HCIS graphical user interface 22 are described with respect to
Referring to
Upon selection of an activity, the activities database 26 is queried to determine which information is needed to run that particular activity, for example which program identifications and data requirements, step 52. In step 54, the information provider 30 is requested to call the appropriate services for transferring the data needed for the particular activity to start up. For example, the information provider 30 may call services which search the enterprise database 24 for the necessary data. Where the data is not present in the enterprise database 24, the information provider 30 may call services to prompt the system user for the information. Additionally, the information provider 30 may determine data using other activities open within the workspace. For example, where a new activity requires a patient identification to open, the information provider 30 may determine the patient identification from other activities open within the workspace. The information provider may then attain additional data by transferring the data from the open activity to the new activity, or for example, by searching the enterprise database 24 using the patient identification to determine the necessary data.
The necessary data is provided to the plug-in framework 28, which utilizes the program identifications from the activities database 26 and the data from the information provider 30 to open the new activity in the activity display area 38, step 56. The activities database includes interchangeable program identifications for the activities, allowing the plug-in framework to maintain a common menu format and common visual components when causing information to be displayed on the graphical user interface 22. The graphical user interface 22, because of the common menu formats and common visual components, allows system users to intuitively switch between workspaces and activities without additional and time-consuming training for each activity, unlike the disparate menu formats and visual components utilized by the multiple interfaced systems of the prior art.
Additionally, the plug-in framework 28 and single data repository 20 allow additional activities and workspaces to be easily integrated with the HCIS. The new activities and/or workspaces with corresponding required program identifications are added to the activities database 26 along with the data requirements for the new activities. Utilizing such a modular structure facilitates adding activities to the system without the difficulty of interfacing several separate user interfaces, and further, having a single data repository overcomes the difficulties of interfacing various separate databases. Further, as discussed above, utilizing the activities database 26 with interchangeable program identifications allows a common menu format and common visual components to be used in various workspaces and activities, reducing a health enterprise's overhead associated with training users on a health care information system.
In another embodiment, the system user may open multiple workspaces at one time, and switch between the workspaces as desired utilizing, for example, the mouse, a predetermined key, or a stylus (where a touch sensitive screen is provided) as discussed above. Further, multiple activities within a single workspace may be opened, where the user may similarly switch between the opened activities at any time. Thus, the system user is allowed to freely switch between available activities and workspaces at any moment, whether or not a particular activity is complete. This provides the system user with flexibility to immediately handle various situations and circumstances which may arise, for example emergency situations, without having to complete a current activity, and without loss of information or work progress within an interrupted activity.
In another embodiment, in addition to a user selecting activities to be displayed within the workspace, the HCIS system may cause an activity to open responsive to information entered by the system user. For example, information entered by the system user indicating an emergency disposition in a patient call documentation activity of a patient call workspace may automatically cause an activity for scheduling an emergency room visit to open on the graphical user interface. Additionally, information entered by the system user in combination with data already present in the specific patient's record may trigger an alert in the HCIS system, automatically opening another activity on the graphical user interface 22.
Where the system user is in a workspace with a number of activity options displayed in the activity toolbar 36, step 60, the system user performs a task within the activity that is currently open in the activity display area 38, step 62. This may occur, as shown in
In step 76, the system user enters the required information, and the system opens the new activity, step 78. The information provider 30 is capable of obtaining the information that a particular activity needs to open in any context by calling the particular service that provides the information to the activity from a variety of sources, for example workspace context, database, user entry, etc . . . , allowing the user to move with total flexibility from one activity to another, and from one workspace to another. Where an activity is selected in any context, the information provider 30 needs just be informed of the data requirements for the activity, and the information provider is wholly responsible for and adaptable to obtaining the information, at which point the activity opens.
Thus, from the menu options of the menu 32, the system user may open and maintain multiple workspaces simultaneously in the graphical user interface 22, where each workspace may draw on the same or a different patient record. Further, within each workspace, the system user may select any activity listed in the activities toolbar 36. The activities can be opened in any order as many times as the system user desires, providing total flexibility in accessing all activities. The workspaces and activities included and shown in
In accordance with another embodiment of the invention, the workspaces and/or activities may be user-defined. For example, the system user may define the activity tabs that appear in the activity toolbar 36. Activities may be disabled from appearing in the activity toolbar for a particular workspace, or activities from one workspace may be user-defined by the system user to appear in the activity toolbar of another workspace. Additionally, when an activity is launched, the system user may user-define what data fields are displayed within the activity display area. For example, the system user may eliminate certain data fields from appearing within a launched activity, or, may user-define specific activities to display data fields which would normally not be displayed in the activity. User-defined preferences for a system user may be stored, for example, within the HCIS data repository 20, and more specifically, may be stored in the enterprise database 24, as part of, or corresponding to, a record for the system user.
Any enterprise added activity 148 may be plugged into the HCIS graphical user interface due to the plug-in framework 28, providing additional activities (such as, for example, a call center utilizing specially customized forms such as Epic Smart Forms to collect the call information, an Intranet page for a particular organization, or other facility-specific activities). For example, upon opening a patient workspace via call center, a call center encounter is created in the patient record, which can be viewed by any authorized system user at any location utilizing the chart review activity 142. Further, the patient call documentation activity 144 may be triggered, where clinical documentation 150 and/or customer service documentation 152 is entered. The system users may create customer service encounters in a call center environment using, for example, the customer service activity 174 where the encounters may be accessed via the messaging activity 178, or through relevant activities available to system users with the appropriate role-based security clearance. The entry of clinical documentation 150 may include entering a patient disposition 156, and scheduling information 162. Disposition 156 may include, but is not limited to, urgent care 158 and emergency department 160 dispositions. Entry of an urgent care disposition 158 may cause an urgent care window (not shown) to automatically open, where patient demographic information is pulled from the patient record of the enterprise database 24, and automatically displayed in relevant fields of the graphical user interface 22. System users may view arrival lists at urgent care facilities that have other products installed, and place patients on arrival lists from the patient call center environment. Where the emergency department disposition 160 is entered, an expected ER arrival window (not shown) may open, where users at the call center may enter relevant information for the patient, and place the patient on the ER arrival list at facilities where products (including Epic products) are installed directly from the call center.
Where scheduling information 162 is selected, an appointment may be scheduled via schedule appointment 164, or advanced scheduling may be jumped to as shown at box 166. System users may schedule an appointment at box 164 for the patient directly from the call center, where the appointment shows up on the provider's schedule as viewed from an Epic (or other companies) product provided within the health care information system that allows access to the patient and/or provider record. As shown at box 166, users with proper security may jump to an advanced scheduling activity, for example, included within appointment entry 172 to access more detailed scheduling tasks.
The patient demographics activity 146 maybe opened for entering/updating patient demographic information, and an order entry activity 154 may be opened, where call center system users are able to place orders that are administered at a different location, for example a flu shot. Once the order is filled, the patient record may be immediately updated to reflect the order, and health maintenance records for the patient are updated. Charges are dropped for the order, checked for correct coding, and matched to payor/plan information for the patient. Further, benefit and billing information may be handled by the relevant activities available to system users with billing security clearance using, for example, the account maintenance activity 176.
Users handling patient calls in a triage environment are able to access a patient's complete medical record, and enter information into the record in real time, so that users working at other locations and/or roles within the enterprise can view new patient information simultaneously. Specially customized forms may be used as an enterprise-added activity 148 to record call specifics. Providers can view and graph from these forms directly from the patient record as needed. Additionally, call center users can have more than one workspace open on their user interface at the same time for handling a single or multiple patients, allowing them to move between the workspaces with multiple calls quickly without losing the context and correct activity structure for each workspace (for example the workspace is rebuilt and displays correctly each time a user returns to it from another workspace). The "plug-in" design of the HCIS user interface allows each organization to determine which activities they want to use in their call center environments. For example, some organizations could choose to collect call information via customizable SmartForms, which would then appear as another tab on the activities toolbar 36, while others might use protocols that are included with the call center application.
Upon initiating the opening of the registration activity in step 210, the activities database 26 is queried to determine what data is necessary (the data requirements) to open the new activity, for example is a patient identification required to run the activity, as shown in step 212. The information provider 30 checks the current activity and workspace context for the necessary information, for example whether a patient is open in the current activity, step 214. Where the necessary data is not present in the current activity, the information provider 30 calls a service that prompts the user for the necessary information, step 216, and the user enters the required information as shown in step 218. The information provider's prompt to the system user may be, for example, a dialog box displayed in the workspace requesting the information from the system user. The system then opens the registration activity as shown in step 220. However, where the necessary information is present in the current activity in step 214, the information provider 30 calls services that transfer the necessary information to the new activity, as shown in step 222, and the workflow continues as shown in step 220 where the system opens a registration activity.
Referring to
Although now shown, if the necessary information is not present within the current activity and work space context in box 230, services may be called to prompt the user for necessary information, where the user enters the necessary information similar to as discussed above with respect to boxes 216 and 218 of
As shown in step 250, the system user working in the orders activity selects an order, step 252, and enters a diagnosis and associates it with the order, step 254. In step 256, the system performs a medical necessity check, drawing on preloaded LMRP information which compares the order and associated diagnosis to matches approved by LMRP edits. To comply with the CMS's CCI, the LMRP edit information can be checked from activities associated with orders and billing, helping clinicians to comply with medical necessity guidelines, and preventing clinicians from placing orders with diagnosis associations that might not be covered by insurance. It is determined whether the order and associated diagnosis match is covered. Where the match is covered, the system user files the order, step 258, the charges for the order are then sent to billing and the order undergoes order transmittal, step 260 and 262, respectively. However, where the match between the order and associated diagnosis is not covered, the system warns the system user that the associated diagnosis is not covered by LMRP and queries the user whether to accept the order and associated diagnosis, step 264. Where the order is accepted, flow returns to step 258 where the system user files the order, and charges for the order are sent to billing and the order undergoes order transmittal, steps 260 and 262, respectively. However, where the order is not accepted, the system user changes the diagnosis associations, step 272, and the workflow returns to step 256. Alternatively, the workflow returns to step 252 where the system user selects another order. As a further alternative, flow returns to step 258 where the system user files the order, and charges for the order are sent to billing, and the order undergoes order transmittal, steps 260 and 262, respectively.
As shown in
In an alternate embodiment not shown, where an Epic Care medical record review is utilized, the placing of changes in change review of box 292 is done automatically by the HCIS, and thus need not be done by the system user.
The ability to conduct LMRP checks from multiple activities, which can alert various users to the same irregularities, is just one example of the integrated way in which an enterprise may use the invention to achieve a high rate of compliance with regulations that simultaneously affect disparate aspects of the health care enterprise.
The workflow management tool discussed above is provided as an Electronic Messaging and Workflow System. The Electronic Messaging and Workflow System (i.e. In Basket) enhanced by this invention is a comprehensive integrated interface that provides information, makes users aware of alerts and tasks that require their attention, and accesses relevant features of their applications.
In Basket is a feature which may be shared by Epic applications, and typically appears in various forms in all interfaces, including the EpicDesktop. While its basic function is to communicate messages to recipients, there is a great deal of specialization in terms of how messages are generated, and what users can do when they receive them. A plurality of specialized message types available, with some providing general features, for example, entering phone messages into In Basket resembling the common 'While you were out . . . ' forms, and others being specialized in nature, for example, allowing the revision of orders for lab tests after the order has been sent to the lab.
As an Electronic Messaging System, In Basket may collect messages sent to a system user and display them. Many messages require little or no action and are, in essence, reports. Common messages of this type include, for example, staff messages, phone calls, test results, and the 'covered work' message from the patent.
As a Workflow System, In Basket may make available a cross-section of features from Epic's applications provided by the health care system. Many 'messages' contain a link to some area of an application, or present their own interface for the recipient to take action. A common message of this type may provide a link to an encounter and ask the recipient to cosign an order for a medication. In this example, the message appears in an In Basket interface on the graphical user interface, and opening the message also opens a patient's medical record associated with the order. In another example, a similar message opens an incomplete telephone encounter so that the system user can address the issues raised by the phone call. Messages can be sent, for example, to a system user personally, to a group to which a system user belongs, to the workstation at which a system user is working, to any system user who has a particular patient's record open, and may be sent using other methods of identifying recipients. Many applications provided by the healthcare system have features to generate electronic messages. When results (i.e. blood sugar, blood pressure, etc . . . ) are entered (or received from a lab) for a patient, messages may be automatically generated to report those results to the provider who ordered the test. Such messages may be generated based on an urgency level of the test results. For example, messages may be generated any time test results are obtained for the patient, generated when the test results fall within a predetermined range defined as 'abnormal', or generated when the test results fall within a predetermined range defined as a 'panic' range, where the system user is able to configure the urgency level at which the message(s) will be sent.
Further, paging capabilities may be incorporated in, or linked with, the system to allow system users to be paged when a message is received for that system user.
The electronic messages are typically completed when the action required by the message is taken. For example, for report-type messages, a system user receiving the message merely needs to read the message and mark the message as 'done.' For other messages, a system user may need to take some specific action, such as cosign an order or schedule an appointment before the electronic message is complete. When the information displayed is refreshed, completed messages are no longer displayed.
The functionality provided by the messaging and workflow system may be preferably embedded within the health care system, or operate as stand-alone functionality in conjunction with the health care system. Further, the messaging and workflow functionality is typically supported by the various parts of the HCIS data repository 20, as would be appreciated by one skilled in the art. For example, the enterprise database 24 may maintain various files of information (i.e. threshold values defining urgency level of test results, defining message distribution lists, etc . . . ). The activities database 26 may include program structure to provide the messaging functionality along with the other various activities offered by the health care system, including (but not limited to) performing checks on information entered (or received) into a particular patient record which may necessitate automatic generation of a message to a system user. Many messages provide system users with the option of accessing one or more activities. The options are defined in terms of the activity which is made available, in that the option (typically a button or menu selection) is based on a Menu record recording the activity launched when the button is clicked or the menu option is selected. The info provider 30 may operate in conjunction with the activities database 26 in providing the messaging functionality with any required information. If the activity provides patient-specific information, the info provider, having identified a patient as the topic of the message, passes that patient to the activity. This allows the activity to open without first prompting the user for a patient. The plug-in HCIS framework 28 may allow the messaging and workflow functionality to be displayed or otherwise presented to a system user within the HCIS graphical user interface 22.
The invention has been described in terms of several embodiments, including a number of features and functions. Not all features and functions are required for every embodiment of the invention, and in this manner the invention provides a flexible system by which the plug-in framework allows additional activities to be added to the system without the difficulties associated with interfacing and configuring the activities to work with the HCIS and with each another. Further, the ease of interfacing applications due to the plug-in framework results in a high rate of compliance with government regulations. The common menu structures and common visual components provided by the graphical user interface provide system users with an intuitive interface with the HCIS, reducing the training requirements of system users. Further, the graphical user interface and plug-in framework allows system users to seamlessly switch between activities available within the HCIS, not requiring exiting of one program and entry into another program. Additionally, a single data repository used by the activities virtually eliminates data duplication between activities, and eliminates the difficulties associated with interfacing multiple databases having varying structure or format. In addition, the single data repository allows a common security record to be kept for system users, facilitating uniformity of security access for system users across all activities of the HCIS, ease of setting security requirements for new system users, and reduced probability of granting mistaken security privileges as security information for all activities need be entered but once. Further, the single data repository and plug-in framework allows an alert system to be provided to alert system users where information entered in an activity conflicts with other information for a particular patient in the data repository. In addition, system users are provided the ability to user-define the graphical user interface giving the flexibility of tailoring the graphical user interface to offer functionality and information to better serve the user's specific needs.
Although the single data repository has been described as a server in the preferred embodiment, one skilled in the art would realize that any application specific programming language, hardware, processor(s), and memory may be combined to perform the functionality of the components for the single data repository. Additionally, the enterprise database and the activities database may reside on the same storage device, or separate storage devices in communication with the information provider and the plug in framework while still being accessible and usable for all activities, where the communication link may be the internet, a data bus, or any other means for communicating information, as would be understood by one skilled in the art. Further, although the enterprise database 24 has been disclosed in various embodiments as including data collected for each patient in a single record, one skilled in the art would realize that advantages may be achieved from at least the common menu format and visual components provided by the graphical user interface as discussed herein where information for patients and/or security information is stored in more than one record per patient. In addition, the graphical user interface may be displayed on any display device, including a cathode ray tube device, Liquid Crystal Display, or any other device capable of conveying information to a system user, where the display device may be associated with a personal computer, server, handheld electronic device, etc . . .
The features discussed herein are intended to be illustrative of the features that may be implemented, however, such features should not be considered exhaustive of all possible features that may be implemented in a system configured in accordance with the preferred embodiments of the invention.
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Owner name: EPIC SYSTEMS CORPORATION, WISCONSIN
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:BRUMMEL, TONY;DVORAK, CARL D.;SEOW, KHIANG;AND OTHERS;REEL/FRAME:012730/0237
Effective date: 20011108
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Year of fee payment: 4
|24 mars 2015
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Year of fee payment: 8

subset: commoncrawl


text:
Set on an earth devastated by a catastrophic event centuries ago, Stormrise sees the Echelon and the Sai battling to survive in a hostile and uninhabitable wasteland. Apparently, uninhabitable wastelands are always very gray. Minor palette criticism aside, the game seems to be shaping up quite well for such an early stage of development.
Check out the trailer below.
If you want to learn more about Stormrise, be sure to check out our E3 preview right here.


text:
The current population of Sheridan County is 1,333 with the median age of 53. Sheridan County's median household income is $43,675, and the average household net worth is $260,198.
|Sheridan County
|North Dakota
|United States
|Median Household Income
|Average Household Net Worth
|Median Age
|53 years
|35 years
|37 years
Age distribution represents the distribution of the population in Sheridan County by age group. In Sheridan County, the male-to-female ratio is 673:660, which is 3% lower than the ratio of North Dakota, which is 392,067:374,251. Age demographic data is sourced from census, 2015.
Crime rate index represents the average crime rate for a local area in comparison to nearby areas and the national average. A crime index of 100 represents the national average. North Dakota, has 41% less property crime than the national average, and has 60% less personal crime than the national average
Marital status represents the percent of residents in Sheridan County that are single, married, widowed and divorced. In Sheridan County, 84% of people are married and 16% of people are single. The percent of people married is 4% higher than the ratio of North Dakota, which is 80%. Marital data is sourced from census, 2015.
Household income distribution represents the distribution of Sheridan County income brackets at the household level. Overall, the median household income for Sheridan County is $43,675, which is 20% lower than that of North Dakota ($54,792). Income data for Sheridan County is sourced from census, 2015.
Education data represents the highest level of education attained by residents in Sheridan County. In Sheridan County, 23% of residents 18 and over graduated from high school and 17% completed a Bachelor's degree or higher, which is 13% lower than that of North Dakota. Education statistics is sourced from census, 2015.


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Retrieve files after system crash in just few minutes using Remo Recover Software!!! You can also get back files from crashed, formatted, corrupted and inaccessible hard drive on Windows and Mac systems.
System crash is associated with serious computer failure. After a system crashes, the computer hangs or freezes a running program. Under such instances, you are forced to shut down your system because a normal shut down is not possible. Either there is a severe software bug or malfunctioning hardware that leads to the crash. Whatever the reason, system crash results in major loss of data.
Before a computer crash, there are some signs exhibited which you can watch out. Your computer screen may turn blue, the operating system takes a long time to boot, the system is too slow in displaying files or applications which are opened, etc. So it is advised to have a backup of important files especially when you start experiencing such signs. But there are times when your system might crash without exhibiting any indication. There are many reasons for this.
Few instances which lead to system crash are mentioned below:
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Remo Recover tool to retrieve files after a system crash:
Remo's Data recovery software is built to restore data lost because of a computer crash. It can also recover files when a hard drive crashes or refuses to boot. A deep scan of the hard disk is performed in order to retrieve entire data stored in it. The application is also capable of retrieving files that are deleted or lost due to formatting errors, corrupted partitions, and so on.
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THIS COMPETITION HAS NOW CLOSED. Please visit our competitions page for more fantastic prizes you could win!
Enter our competition to win five nights plus a cooking class and massages for two at Mia Resort on Nha Trang Bay, Vietnam.
This heavenly hideaway of chic, modern villas looks out over the China Sea on the South Central Coast of Vietnam. It's hard not to be relaxed here, especially when enjoying a treatment at Mia's Xanh Spa, which practises a combination of ancient and contemporary therapies.
If you're the lucky winner of this competition, you can count on feeling refreshed after a 60-minute body massage, a Vietnamese cooking class and five nights in a spacious Garden Villa just moments from Mia's private beach.
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The lucky winner will receive:
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To enter the competition simply fill in the short form below
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What is one of Xanh Spa's signature treatments? Click here for a hint>>
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Please note: by entering this competition, you are agreeing to sign up to receive information and special offers directly from Condé Nast Johansens.
Competition closing date: 15 September 2014


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Product Description:
Women's prAna® Gabi Legging :: The prAna® Gabi Legging's wide waistband and compression Chakara performance fabric create a flattering fit, emphasized by a contrast grey on black. Quick-dry stretch material is complemented with a gusset for a complete range of motion. bluesign certified.
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A truly outstanding living space
The Sandringham is a light and airy park home, with full-length windows and an extended curved dining area complete with French doors. This unique feature allows light to flood into the home, giving a truly outstanding living space. The stylish 'L' shaped, open-plan lounge and dining area, lead on to a fully fitted kitchen with integrated appliances including fridge-freezer, washing machine, dishwasher and gas hob. The comfortable master bedroom has fully fitted wardrobes and an en-suite with a corner shower. If you love to see the outdoors from the comfort of your home, you'll love the Sandringham!
Please note: Specifications and layouts may differ and some photos may include optional extras. For full details please contact our sales team.
|50' x 20'
|'L' shaped lounge / diner, utility & study
|40' x 20'
|'L' shaped lounge / diner
|36' x 20'
|L' shaped lounge / diner
|34' x 22'
|'L' shaped lounge / diner
Prices and other sizes are available on request.
- Built to BS 3632 and protected by a 10-year Gold Shield structural warranty
- High pitched tiled roof with roof dormer - guaranteed for 40 years
- PVCu double glazed windows with Georgian bar (10-year frame warranty + 5-year glazing warranty)
- Large curved bay windows
- Corner quoins and feature lintel and pilasters
- Feature front door and French doors to dining area
- Gas central heating
- Feature Bow front with French doors to the dining area
- 'L' shaped living space with lounge and dining areas
- Shannon style lounge suite
- Co-ordinating coffee table, lamp table and circular dining table with chairs
- Full length, fully lined curtains
- Feature fireplace with electric fire
- Fitted carpets throughout
- Study on selected floor plans
- Fully integrated fridge-freezer, washing machine and dishwasher
- Fitted kitchen units with Cologne style kitchen doors and drawers
- Stainless steel gas hob and extractor hood
- Single electric oven
- Lined Roman blind
- Ultragrip Vinyl flooring
- Double bedrooms with fitted furniture
- Wall-mounted headboards and coordinated bedding
- Fully lined curtains in bedrooms and lined Roman blinds in bathroom and en-suite
- Fitted carpet to the bedrooms and Ultragrip Vinyl to the bathroom and en-suite
- Bath to main bathroom and walk-in shower to en-suite
- Porcelanosa wall tiles to bathroom and en-suite
Find out more
If you have any questions about the Sandringham or any of our products please don't hesitate to contact us on 01842 810673, email firstname.lastname@example.com or use the appropriate enquiry form:


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Boundary Village Apartments and Townhomes
503 Culpepper Hill Court Cary North Carolina 27513
Are you the property manager?
Welcome to Boundary Village Apartments. Cary's Best-Kept Secret... close to everywhere you'd want to go, including I-40, RTP, the Beltline, shopping and entertainment, but nestled in a serene neighborhood environment where you'll be able to unwind when you get home. Come join us. Please call for an appointment today.
Other Apartments Nearby
The Franklin at Crossroads
Zip Codes Near Cary, NC
Cities Near Cary, NC
Neighborhoods Near Cary, NC
- North Raleigh
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- All Cary Neighborhoods
Colleges Near Cary, NC
- Duke University Divinity School, NC
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- Art Institute of Raleigh Durham, NC
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- Miller Motte College Cary, NC
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- Apex School of Theology, NC
- Wake Technical Community College, NC
- Durham Technical Community College, NC
- North Carolina Central University, NC


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Things to see and do - Ascoli Piceno
Leaving for Italy
Modify the search
Tourist attractions
Tourist attractions Ascoli Piceno
Results 1 to 13 on 13
Sort by :
- distance
- rating
1 Piazza del Popolo (Place du Peuple)
Architecture, castles and historic districts
Piazza del Popolo I - 63100 Ascoli-Piceno
This elongated and harmonious square paved with large slabs is surrounded with Gothic monuments (palace of the Nation's Captains, S. Francesco church, Traders' lodge...) and Renaissance monuments and is enclosed by elegant arcades. It is customary fo..
2 Palazzo dei Capitani del Popolo
Architecture, castles and historic districts
Piazza del Popolo I - 63100 Ascoli-Piceno
This palace was built in the 13C and then modified in the 16C by various architects who brought the building to its current specification, led by Cola dell' Amatrice who is credited with the austere rear façade. Inside, there is an attractive arcaded..
3 S. Francesco (Saint-Francis Church)
Religious buildings
Piazza del Popolo I - 63100 Ascoli-Piceno
Built between the 13th and 16C, this church has certain telltale signs of Lombard influence. On the right, beside the elegant loge des Marchands, there is a beautiful 16C portal surmounted by a monument dedicated to Julius II. On the left flank, ther..
4 Corso Mazzini (Cours Mazzini)
Architecture, castles and historic districts
Corso Mazzini I - 63100 Ascoli-Piceno
Palaces from a variety of periods flank this street with façades decorated with maxims written in Latin and the popular language. Along this street, known as the noble street, you will find Malaspina palace ( No. 224), with its elegant arcades and tr..
5 S.S. Vincenzo e Anastasio
Religious buildings
Piazza Ventidio-Basso I - 63100 Ascoli-Piceno
Of early-Christian origin, this beautiful example of Romanesque architecture stands out for its façade of 64 panels, previously covered by frescoes. Inside there is a 6C crypt containing some Fresco fragments from the 14C.
6 Ponte romano di Solestà (Roman bridge of Solestà)
Archaeological and historical sites
Ponte di Solestà I - 63100 Ascoli Piceno
Built under Augustus, this audacious bridge is made up of a single arch more than 25 metres long. In front of it, there is a 14C door with a 16C washhouse close by.
7 Pinacoteca (art gallery)
Museums and art
Piazza Arringo I - 63100 Ascoli Piceno
Set up in the noble setting of the town hall, the museum accommodates a large collection of paintings and sculptures completed between the 15 and the 19C. The painting of the Marches is represented in the works of Cola dell'Amatrice, Carlo Crivelli a..
8 Cathedral (Duomo)
Religious buildings
Piazza Arringo I - 63100 Ascoli-Piceno
Built in the 12C, this Cathedral is fronted by a grandiose Renaissance façade designed by Cola dell'Amatrice. On the left side, notice the Door of the Muse, which is a graceful work of the late Renaissance. Inside there is a magnificent polyptych by ..
9 Caffè Meletti (Café Meletti)
Architecture, castles and historic districts
Piazza del Popolo I - 63100 Ascoli Piceno
Situated in the arcades of the piazza del Popolo, this caf, open in 1904 is a jewel of Liberty style - the Italian Art nouveau. The fame won by this cafe was helped by its "anisette" and a film (Les Dauphins, by Citto Maselli in 1960).
10 Museo archeologico (archaeological museum)
Museums and art
Piazza San Francesco 45 I - 63100 Ascoli Piceno
Situated in the Panichi palaces, opposite the town hall, this museum harbours pieces from the Picine period ( (9-6 BC) as well as Roman mosaics from the 1st century AD.
11 S. Agostino (Église Saint-Augustin)
Religious buildings
Corso Mazzini I - 63100 Ascoli-Piceno
Built in the Renaissance, this church harbours a fresco by Cola dell'Amatrice and a 14C Madonna of Humility, which evokes the Fabriano school.
12 Via delle Torri (Tower street)
Architecture, castles and historic districts
Via delle Torri I - 63100 Ascoli-Piceno
They were many towers that used to stand here, hence its name. The 12C twin towers, which remain to this day, help you conjure an image of how it once looked. The 14C Church of Saint Peter is located at the end of the street.
13 Via dei Soderini (Soderini street)
Architecture, castles and historic districts
Via dei Soderini I - 63100 Ascoli-Piceno
The main street of the medieval town is bordered by many palaces, feudal towers, and intersected at right angles by narrow picturesque streets. Don't miss the small Lombard palace (palazzetto Longobardo) built in the 11 and 13C flanked by the elegant..


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no worrys bumper IMHO its no rush anyway , and thanks for the update on status .
This is a discussion on The move to DefensiveCarry.com within the Old Forum News, Feedback, Problems & Comments forums, part of the DefensiveCarry.com Forum Office category; The move to the new domain will probably not happen now until next weekend. I just found out that a new version of vBulletin came ...
The move to the new domain will probably not happen now until next weekend. I just found out that a new version of vBulletin came out today which puts us two versions back. Since I already have the software installed over there I will have to install the upgrade over there first, then retest the scripts and plugins. I will do that this weekend and do the move next weekend. With Mother's Day this weekend, I might not have had adequate time to get it completed anyway. It won't be long, though.....
Coimhéad fearg fhear na foighde; Beware the anger of a patient man.
no worrys bumper IMHO its no rush anyway , and thanks for the update on status .
Make sure you get full value out of today , Do something worthwhile, because what you do today will cost you one day off the rest of your life .
We only begin to understand folks after we stop and think .
Criminals are looking for victims, not opponents.
Worth the wait to get it right, hope it all goes smooth for you.
Enjoy Mother's Day...the upgrade can wait.
noli nothis permittere te terere...
What did I miss? I go away for a couple of days and y'all are movin' the house?...is it me?
Hey Bumper,
Thanks for the heads up on the move but like the others said, Relax this weekend, it's Mothers Day. So get out and have fun.
awwwwww,,, Sigguy found us. I guess we have to let him come with us. LOL. Just Kidding!
Yeah, no need to get all defensive about it.
Liberty Over Tyranny Μολὼν λαβέ
Sounds good, Bumper. Keep us posted as always.
Walk steathly - and carry a big Springfield.
Rhetorical question since I've not been keeping up on the move discussion :( Will we be automatically re-directed when logging onto combatcarry? Will we need to recreate avatars, signatures, etc?
BE PREPARED - Noah didn't build the Ark when it was raining!
Si vis pacem, para bellum
NRA Life Member
Center the banner...
Really, thanks for your efforts!
Proverbs 27:12 says: The prudent see danger and take refuge, but the simple keep going and suffer for it.
Certified Glock Armorer
NRA Life Member
Prior to Bumper commenting - AFAIK all will appear the same .... as it will be pretty much a mirror of this, except be an unpgrade too. The CombatCarry URL should pull up a redirect.Will we be automatically re-directed when logging onto combatcarry? Will we need to recreate avatars, signatures, etc?
Membership should not notice too much difference.
Chris - P95
NRA Certified Instructor & NRA Life Member.
"To own a gun and assume that you are armed
is like owning a piano and assuming that you are a musician!."
http://www.rkba-2a.com/ - a portal for 2A links, articles and some videos.
It's Mom's day weekend, update when you get some free time, We're cool.
After the move, would it be wrong to; on occasion refer to ourselves as "D C Guns"
"fundamental principle of American law that a government and its agents are under no general duty to provide public services, such as police protection, to any individual citizen." [Warren v. District of Columbia,(D.C. Ct. of Ap., 1981)]
If I have to explain it, you wouldn't understand
...ok.....why are we moving to DC.com?


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The parking brake light and the gas door light stay lit - even when the brake is disengaged and gas door closed. This first happened when the temperature dropped below zero and now the lights stay on all the time.
by car question in Helena, MT on December 15, 2008


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Check out the latest news and insight from the ever-evolving world of institutional investing and hedge funds from around the globe.
Read More Industry News >
Asset manager Salient Partners has brought on two new employees.
Rusty Guinn and Todd Centurino have both been appointed to directors of investments, according to an announcement by Salient on Tuesday. They previously worked for the Teacher Retirement System of Texas.
In their new roles, Guinn and Centurino will work with the investment team to oversee and manage Salient's funds and separately manage accounts. Guinn will primarily be responsible for leading the portfolio management team, while Centurino will utilize his TRS experience to lead the management of the firm's public fund mandates.
Guinn was most recently the director of strategic partnership and opportunistic investments at TRS. He previously worked at Credit Suisse in its asset management finance unit.
Centurino was the senior investment manager for external public markets and hedge funds at TRS. Prior to TRS, he worked for seven years at Fidelity Investments.
Houston-based Salient Partners deals in hedge funds and other investment strategies, and has $17.4 billion in assets under management.
Tweets by @eVestment_Hedge
Tweets by @eVestment


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Assistant Professor, UC Department of Pediatrics
Phone 513-636-4785
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Email firstname.lastname@example.com
MD: Case West Reserve University School Medicine, 2001-2005.
Residency: Orthopaedic, University of Chicago Medical Center, 2006-2010.
Fellowship: Pediatric Orthopaedic Surgery, Texas Scottish Rite Hospital, 2010-2011.
3333 Burnet Avenue, Cincinnati, Ohio 45229-3026 | 1-513-636-4200 | 1-800-344-2462 | TTY:1-513-636-4900
New to Cincinnati Children's or live outside of the Tristate area? 1-877-881-8479
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April 30 · 10:00 AMMeet the Recipe Hunters who search for traditional foods and farming practicesAnthony and Leila have traveled to many parts of the worlds working and living on small organic farms and seeking out traditional recipes. They have discovered many of... Learn more
March 31 · 6:00 PM6th Annual CSA ExpoCommunity Supported Agriculture (CSA) is a popular way for consumers to buy local, seasonal food directly from a farmer. Interested consumers purchase a share (aka a "... Learn more
March 5 · 11:00 AMBaking Workshop, Sourdough Bread and MoreThis workshop will feature Sheila Donohue and Petra Zinniker, two experienced bakers and busy moms who will take you through the steps of making sourdough bread. A... Learn more
February 13 · 9:00 AMMonthly Meeting & Potluck: Traditional Food BasicsMegan Bell will offer a presentation and discussion about the basic fundamentals of traditional foods: fermentation, grains, kraut & broth The meeting will be followed... Learn more
January 9 · 9:00 AMMonthly Meeting & Potluck: Processed "foods"Presentation and discussion about the history of processed foods and more..... Steve Trisko and Dan. The meeting will be followed by a potluck. http://... Learn more
- More Meetups


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8 Accredible learners have added this to their to-learn list
4 Accredible learners are enrolled on this course
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This course is offered through FutureLearn — you can add it to your Accredible profile to organize your learning, find others learning the same thing and to showcase evidence of your learning on your CV with Accredible's export features.
Course Date: 22 September 2014
Price: free
Explore the archaeology of the most heavily fortified frontier in the Roman Empire, its people and their lives.
Estimated Workload:
4 hours
Professor of Archaeology, Newcastle University; Project Director Roman Temples Project, Maryport; Project Director Lateran Project.
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Sports |
PRAGUE Nov 18 Czech Republic beat holders Spain 3-2 to win the Davis Cup when Radek Stepanek overcame Nicolas Almagro 6-4 7-6 3-6 6-3 in the final rubber on Sunday.
The victory handed the Czechs a rare double as the first country in 22 years to win the Davis Cup and Fed Cup team trophies for men and women respectively in the same year. (Reporting by Jason Hovet; Editing by Ken Ferris)
Photos of the week
Our top photos from the past week.


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Published by Arrow/Random House
Passing Places by Amanda Macandrew
Book Description
Back Page Blurb:
'You will be a leader when you grow up,' Ishbel promised her daughter. Her father told her she would be a great beauty. In between, something went wrong, hormones, thick ankles,spots, and with them arrived the realisation that parents are not Gods. In the small world of Scotland in the sixties, it was no easy task growing up and rock and roll was pushed aside for the Gay Gordons.
Book Review
This book was published in 1994 and I'm surprised I haven't read it before. I came across it in a second hand book shop and really enjoyed reading it. It is set in Scotland in the sixties and the story moves between Edinburgh and Glasgow. The differing cultures of the two cities are illustrated well and with a good deal of humor. The story follows a young girl through her most difficult teenage years, as the writer puts it, 'hormones, thick ankles, spots, and a realisation that your parents are not god' how true. This book is chock full of comedy with hilarious descriptions of Scottish country dancing, and granny's eccentricities, a late bemoaned pregnancy, and an illicit affair. The sixties liberation revolution never came toScotland, as the writer makes clear. I know this as I lived through these years as a teenager. The writer makes it very clear that drugs and rock and roll were far beyond the pale, smoking cigarettes was the vice of the day. Reading Oscar Wilde meant that you were probably gay and Cliff Richards was the man of the moment. Parents loved Cliff because of his squeaky clean image. The humiliation of having to have a perm to liven your look was a common occurrence at that time; a Tweeny Twink was the smelly weapon of torture. Andrea, the heroine of the story decides to rebel against her perm in the hairdressers as what she really wanted was to look like Sandy Shaw. Under the surface of the families portrayed in this book there is a hint of lust and deception and blackmail, all told with clever subtle humour. This book is really a gem and a good read for anyone but particularly for anyone Scottish born about 1950 onwards and who remembers spangles, refreshers and learning the Gay Gordons in the school gym.


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Tinie Tempah - Demonstration (His newest album)
His album officially came out in the United States on November 18 and it has not been added to Spotify for listening. Been waiting to hear this album for a while and it's finally out. I see, for some reason, it may be available in other counties. Any idea when it may be available in the US? I am paying for premium and I have no idea why Eminem and M.I.A. would release on Spotify, but not Tinie Tempah.
Having a look at the metadata that album is currently only available in Europe it seems.
Unfortunately, its normally out of Spotify's control when content doesn't get added - annoyingly you will find big named artists do withhold content from streaming services in some markets to push up album sales.
Spotify Community Mentor and Troubleshooter
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Please bear in mind that the Community is not an official Spotify support service. It's a place where we all help each other, whether we work for Spotify or not. So please use your discretion when using the forum.


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Costa Fascinosa Cruise Review by carebear79: Transatlantic to brasil
Overall Member Rating
Transatlantic to brasil
Destination: Transatlantic
Embarkation: Genoa
the destination were very nice, however Costa is not one of my favorite cruise lines. As a previous cruiser I have taken cruises from different cruise line, and Costa is actually the one I like the least. I thought Carnival was bad but it doesn't compared to Costa,
overall the food was not that great, they force you to go to the dinner at the restaurant which the food there weren't many variety. Being Italian I thought the pizza would be tasty, but it was just bread with bad tomato sauce. For Room Service you have to pay for it. also for the basketball court, ping pong, and miniature golf, basically all the facilities you have to pay. The entrainment was ok if you were Brazilian, the team were more tailor for Brazilians they were constantly speaking Portuguese, sometime they tried to speak in English but they were more shy to speak English. They also were not so interested in other guess that didn't speak Portuguese, this was disappointed. the dancing team were nice, More cheerful. The cabin steward was nice, he was very friendly. The style of the cruise wasn't my cup of tea, I thought it was ugly. the Gym was full all the time! I didn't like the many language announcement, I thought it was a bit irritated. I am not sure if is true but I don't think costa leave you if you are not on time. they keep your passport, I didn't dare to try but if this is the case then it will be bad! Less
Published 12/29/13
Read more Costa Fascinosa cruise reviews >>
Read Cruise Critic's Costa Fascinosa Review >>
Cabin review: 2444
The room was very nice and spacious.
Port and Shore Excursions
we walked around the town, the town is nice, there are some taxi's that are willing to drive you around, i am not sure for how much, but is a nice option.
Trip of a Lifetime
Disorganized Transatlantic
RCL customer service fails you...
Musical, humorous Captain set ...
An experience to remember
NEVER NEVER cruise Costa again...
Caveat Emptor; Not a Decent Cr...
Costa Fascinosa Quite a Decept...
An experience to remember
Not your average negative revi...
NEVER NEVER cruise Costa again...
Cheap and Cheap!
Sponsored Links


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Customer Reviews
July 09, 2007Reviewer: Mark in IndianaThe Myoplex protein is a nice meal replacement. The powder mixes nicely with water or skim milk. The ready-to-drink Myoplex are much more convenient and tasty. The only down side to the Myoplex powders is that you need to immediately clean your shaker cup after consuming one otherwise the cleanup is a little more difficult. Good product for the money though.