Part ⅡReading Comprehension (Skimming and Scanning) (15 minutes)

　　Directions: In this part, you will have 15 minutes to go over the passage quickly and answer the questions on Answer Sheet 1. For questions 1-7, choose the best answer from the four choices marked A), B), C) and D). For questions 8-10, complete the sentences with the information given in the passage.

　　Will Electronic Medical Records Improve Health Care?

　　Electronic health records (EHRs) have received a lot of attention since the Obama administration committed $19 billion in stimulus funds earlier this year to encourage hospitals and health care facilities to digitize patient data and make better use of information technology. The healthcare industry as a whole, however, has been slow to adopt information technology and integrate computer systems, raising the question of whether the push to digitize will result in information that empowers doctors to make better-informed decisions or a morass of disconnected data.

　　The University of Pittsburgh Medical Center (UPMC) knows firsthand how difficult it is to achieve the former, and how easily an EHR plan can fall into the latter. UPMC has spent five years and more than $1 billion on information technology systems to get ahead of the EHR issue. While that is more than five times as much as recent estimates say it should cost a hospital system, UPMC is a mammoth network consisting of 20 hospitals as well as 400 doctors' offices, outpatient sites and long-term care facilities employing about 50,000 people.

　　UPMC's early attempts to create a universal EHR system, such as its ambulatory electronic medical records rolled out between 2000 and 2005, were met with resistance as doctors, staff and other users either avoided using the new technology altogether or clung to individual, disconnected software and systems that UPMC's IT department had implemented over the years.

　　On the mend

　　Although UPMC began digitizing some of its records in 1996, the turning point in its efforts came in 2004 with the rollout of its eRecord system across the entire health care network. eRecord now contains more than 3.6 million electronic patient records, including images and CT scans, clinical laboratory information, radiology data, and a picture archival and communication system that digitizes images and makes them available on PCs. The EHR system has 29,000 users, including more than 5,000 physicians employed by or affiliated with UPMC.

　　If UPMC makes EHR systems look easy, don't be fooled, cautions UPMC chief medical information officer Dan Martich, who says the health care network's IT systems require a "huge, ongoing effort" to ensure that those systems can communicate with one another. One of the main reasons is that UPMC, like many other health care organizations, uses a number of different vendors for its medical and IT systems, leaving the integration largely up to the IT staff.

　　Since doctors typically do not want to change the way they work for the sake of a computer system, the success of an EHR program is dictated not only by the presence of the technology but also by how well the doctors are trained on, and use, the technology. Physicians need to see the benefits of using EHR systems both persistently and consistently, says Louis Baverso, chief information officer at UPMC's Magee-Women's Hospital. But these benefits might not be obvious at first, he says, adding, "What doctors see in the beginning is that they're losing their ability to work with paper documents, which has been so valuable to them up until now."

　　Opportunities and costs

　　Given the lack of EHR adoption throughout the health care world, there are a lot of opportunities to get this right (or wrong). Less than 10 percent of U.S. hospitals have adopted electronic medical records even in the most basic way, according to a study authored by Ashish Jha, associate professor of health policy and management at Harvard School of Public Health. Only 1.5 percent have adopted a comprehensive system of electronic records that includes physicians' notes and orders and decision support systems that alert doctors of potential drug interactions or other problems that might result from their intended orders.

　　Cost is the primary factor stalling EHR systems, followed by resistance from physicians unwilling to adopt new technologies and a lack of staff with adequate IT expertise, according to Jha. He indicated that a hospital could spend from $20 million to $200 million to implement an electronic record system over several years, depending on the size of the hospital. A typical doctor's office would cost an estimated $50,000 to outfit with an EHR system.

　　The upside of EHR systems is more difficult to quantify. Although some estimates say that hospitals and doctor's offices could save as much as $100 million annually by moving to EHRs, the mere act of implementing the technology guarantees neither cost savings nor improvements in care, Jha said during a Harvard School of Public Health community forum on September 17. Another Harvard study of hospital computerization likewise determined that cutting costs and improving care through health IT as it exists today is "wishful thinking". This study was led by David Himmelstein, associate professor at Harvard Medical School.

　　The cost of getting it wrong

　　The difference between the projected cost savings and the reality of the situation stems from the fact that the EHR technologies implemented to date have not been designed to save money or improve patient care, says Leonard D'Avolio, associate center director of Biomedical Informatics at the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC). Instead, EHRs are used to document individual patients' conditions, pass this information among clinicians treating those patients, justify financial reimbursement and serve as the legal records of events.

　　This is because, if a health care facility has $1 million to spend, its managers are more likely to spend it on an expensive piece of lab equipment than on information technology, D'Avolio says, adding that the investment on lab equipment can be made up by charging patients access to it as a billable service. This is not the case for IT. Also, computers and networks used throughout hospitals and health care facilities are disconnected and often manufactured by different vendors without a standardized way of communicating. "Medical data is difficult to standardize because caring for patients is a complex process," he says. "We need to find some way of reaching across not just departments but entire hospitals. If you can't measure something, you can't improve it, and without access to this data, you can't measure it."

　　To qualify for a piece of the $19 billion being offered through the American Recovery and Reinvestment Act (ARRA), healthcare facilities will have to justify the significance of their IT investments to ensure they are "meaningful users" of EHRs. The Department of Health and Human Services has yet to define what it considers meaningful use

　　Aggregating info to create knowledge

　　Ideally, in addition to providing doctors with basic information about their patients, databases of vital signs, images, laboratory values, medications, diseases, interventions, and patient demographic information could be mined for new knowledge, D'Avolio says. "With just a few of these databases networked together, the power to improve health care increases exponentially," D'Avolio suggested. "All that is missing is the collective realization that better health care requires access to better information—not automation of the status quo." Down the road, the addition of genomic information, environmental factors and family history to these databases will enable clinicians to begin to realize the potential of personalized medicine, he added.

　　1. In America, it is slow to adopt information technology because —————.

　　A) the funds invested by the government is not enough in the past

　　B) EHRs have received less attention of the public in the past

　　C) whether it will be useful to doctors or not is doubtful

　　D) UPMC knows how difficult it is to digitize the hospital

　　2. The University of Pittsburgh Medical Center (UPMC) —————.

　　A) is the first medical center to adopt information technology

　　B) satisfy the requirement of the government on information technology

　　C) spent less money on information technology than it was estimated

　　D) attempted to created a universal EHR system, but met some difficulties

　　3. The health care network’s IT systems require a lot of effort to ensure it can communicate with one another mainly because —————..

　　A) the integration among different system is largely up to the IT staff

　　B) UPMC is like many other health care organizations in the United States

　　C) UPMC makes EHR systems look easy

　　D) UMPC began digitizing some of its records in 1996

　　4. The success of the EHR program is decided by —————..

　　A) the fact whether the information technology is available or not

　　B) the fact how well the doctors are trained to use the information technology

　　C) not only the presence of the technology but the doctor’s training on technology

　　D) the fact whether physicians can see the benefits of using EHR systems

　　5. The most important reason of most hospitals being reluctant to adopt EHR system is that —————.

　　A) the cost is too high for the hospital to afford

　　B) physicians are unwilling to adopt it

　　C) there is a lack of staff with adequate IT expertise

　　D) doctor worry about its negative influence on patients

　　6. According to the study led by David Himmelstein through health IT —————.

　　A) it is possible to cut the costs of the hospital

　　B) it is possible to improve the health care

　　C) it ensure neither cost saving nor improvement in care

　　D) it could save as much as $100 million annually

　　7. The hospital’s managers prefer to —————.

　　A) spend money on an expensive piece of equipment than on information technology

　　B) charge patients access to the information technology as a billable service

　　C) purchase the information technology to improve the health care of the hospital

　　D) invest more money on the training of the physicians to charge patients more money

　　8. Jha said the mere act of implementing the technology guarantees ______________________.

　　9. D'Avolio says the investment on lab equipment can be made up by_____________________.

　　10. Databases of vital signs, images, laboratory values, medications, diseases, interventions, and patient demographic information could be ____________________.

　　Part II Reading Comprehension (Skimming and Scanning)

　　原文精译

　　【1】给自己的事业买最好的保险

　　消防队无意之中淹没了Mad Gab's的总部，Mad Gab's是Gabrielle Melchionda二十多年前建立的美容公司。尽管Melchionda知道，保险公司会替她换掉损坏的桌椅、电脑以及唇膏架子，但她仍泪流满面。然而，让她吃惊的是，随后几个月，才是真正的痛苦，她一直亏欠工资和租金，销售额慢的像涓涓细流。

　　【2】Melchionda女士说，“没有投保最重要的企业停顿保险”。她已经投保了财产险和责任险，却从没有想到多买一张保单，以承担事故之后的收入损失。

　　企业主们有很多类似Melchionda女士的经历。他们的很多保单要么不足以涵盖所有损失，要么投保了错误的风险。关于保险的怨言，有些可以归咎于吝啬的保险公司或信息有误的代理人，更多却是因为企业家自己的保险决策不够全面。

　　独立的保险代理人Steven Spiro说，“一般来讲，干小生意的人并不太清楚他们拥有或需要的保险范围”。他解释，这些人买保险只是为了遵守办公室租赁条约的要求。

　　选择代理人

　　【3】买保险可能让人胆怯，很难知道哪些人是想利用你，哪些人是给你忠告。所以你应该咨询同行的企业家们，他们购买了何种保险以及是向谁购买的。有三类人可以帮你选择保险：独立代理人，专属代理人，风险咨询师。

　　独立代理人，别称“经纪人”，因为他们代表很多家保险公司，所以可以提供很好的选择。保险公司付他们佣金，一般是一张保单每年保险费的10%到20%。注意：由于某些保险公司付给更多佣金，这些经纪人可能受到诱惑，会有私心和偏爱。

　　专属代理人代表某一家保险公司，从该保险公司领取薪水，并对其绝对忠诚。一些诸如Allstate的公司只和自己的代理人打交道;也就是说，你只能通过该家保险公司的代理人来购买此公司的保险。

　　每年年末，按照卖出去的保险和赔偿损失之间的比率，独立代理人和专属代理人都可拿到奖金。这意味着，卖给你尽可能多的保险，而最小化你的索赔，是符合他们利益的。

　　也要理解，大部分代理人只注意保险。美国保险研究所主要从事小本生意研究的专家Arthur Flitner说，“有时候，没有保险，你的问题反而可能处理的更好。”比如说，建立基金以备不时之需，自己为自己投保来应对某些财产风险;或执行严格的雇佣政策，减少诉讼风险，从经济角度来看，这些更有意义。

　　这时就需要风险咨询师的帮助了。他们收费很高，一个简单的项目就要花费几千美元。【4】如果你的运作有很大风险，如果你的公司一年收入2500万美元，如果你的公司有100多名员工，这时候雇佣风险专家，才有意义。

　　找到了可信的代理人，接下来就要买保险了。你想去找多少个代理人都可以，但是需要记住：同样的保险项目，保险公司不会寻找不同的代理人。

　　选择保单

　　如果公司总值低于300万美元，你很有可能需要被称为B.O.P.的业主保单，它把业务保单集中在一起，还让你增添必要的保单。每个保险公司的B.O.P.都不一样，购买的时候，要确保自己进行了精确的比较。

　　如果公司总值高于300万美元，你可能必须分开购买保险。如果公司有几十名员工，做生意不得不买的保单有四个：

　　【5】员工赔偿保险是州法律要求的，它涵盖员工的医疗费用、残疾人士福利金和死亡赔偿，【6】保险比率因行业和职业不同相差甚远。秘书的保险费可能是，每100美元工资给付22美分，而盖顶工可能是，每100美元给付20多美元。确保你的生意分类正确，不要把玩具厂(制造业被认为是高风险的)误归为设计公司(低风险)。雇员填写索赔表格时，保险公司会认为，你的公司是一个风险系数比较高的设计公司，从而提高保险费。

　　【8】财产保险包括房产和办公室里的设备。所在建筑的年龄大小，距离消防队的远近，建筑材料是钢铁还是木材，都会使保险比率大有不同。

　　要注意共同保险条款，如果保险公司认为投保金额不足，这个条款允许保险公司只赔偿部分损失。让代理人加上“协定保险价额 ”，你和保险公司认同一个合适的保险价值。这可能让保险费提高15%，却减少了随后的争端。

　　一般责任保险涵盖公司对他人健康、财产或名誉带来的伤害损失。一般来说，保险费的比率要考虑以下因素：收入，办公室规模，客户数量。大多数的基本成套保险，是每次危险保100万美元;而伞状保单以相对低的价格涵盖更大范围。

　　【9】如果可能，一定买比较贵的“发生”保单，它在事故发生当时就给你赔偿，哪怕你已停业或保单已过期。“索赔”保单与此相反，它只有在你受保期间索赔才有效。

　　【10】企业停顿保险——Melchionda女士本该买的保险，它不仅赔偿事故之后房子重建期间的销售损失、房租、工资损失;还出钱帮你租赁临时办公室或设备，这样你可以尽快的回到轨道上去。

　　这些保单仅仅是投保的开始。根据你经营的生意种类，还可增加其他几十个保单。像医生、医院的医疗过失保险，这些非常重要;而另一些纯粹是浪费。想要决定你需要哪些保险，可以先问自己两个问题：你承受损失的可能性有多大，你自己可以赔偿所有损失吗?正如专家指出的那样，保险旨在赔偿大灾难，而不是日常维护。

　　【7】公共调解员George Von York说，“这是场赌博”。他帮助业主和保险公司谈判，以期获得更多赔偿。“大部分人一辈子也没有得到实在的赔偿。但是，孩子，在你需要时，最好还是有保险。”

　　1. 答案 A

　　解析：本题考查考生对整篇文章大意的掌握。本篇快速阅读的标题为“为自己的公司买最好的保险”，暗示文章内容围绕着如何买保险而展开的。选项A是标题的同义表述，而B、C、D仅仅涉及了买保险过程中的某一个因素。

　　2. 答案D

　　解析：题干中的人名Gabrielle Melchionda出现在文章一开始。文章开头讲述Melchionda女士的遭遇。因为没有保“企业停顿保险”，Melchionda女士蒙受了损失，感到痛苦。答案D是正确选项。

　　3. 答案B

　　解析：题干中in that相当于连词because，表示原因。考题考查买保险为什么让人感到害怕。考生可定位在文章的第五段，文章提及有些是忠告，有些却是在利用投保人，而这之间很难分辨。选项B是对此句话的总结。

　　4. 答案C

　　解析：考题考查在特定的情况下，投保人应该如何做。考生可根据题干中“如果你的运作有很大风险”，将答案定位在第一个小标题picking an agent的最后两段，文章讲到，此时你需要雇风险咨询师，所以选项C是正确答案。

　　5. 答案A

　　解析：考题问到，州法律要求的保险是什么?第二个小标题picking a policy下面的第三段中讲“员工赔偿保险是州法律要求”，所以选项A是正确答案。

　　6. 答案D

　　解析：根据题干中的“worker's compensation”，考生可继续锁定第二个小标题下的第三段，原文中讲“Rates vary widely by industry and occupation”，其中vary意为“不同，变动”，和选项D中的be different同义。

　　7. 答案B

　　解析：根据题干中的人名George Von York，考生可锁定文章的最后一段，George Von York认为保险就是一场赌博，一辈子可能用不到，可是又不能没有，如果有可能，你还是需要买保险。从中可以看出George Von York的态度，他是建议人们买保险的，而选项C是个干扰项，他并不是向投保人收费很高，而是帮助投保人获得更高的索赔。

　　8. 答案equipment in your office

　　解析：根据题干，考生可找到第二个小标题picking a policy下面的第四段，它讲到财产保险涵盖的方面。

　　9. 答案available

　　解析：根据题干，考生可锁定第二个小标题picking a policy下面的第七段，原文讲到买这种保险的条件。

　　10. 答案a temporary office or equipment

　　解析：根据题干中的business interruption insurance，考生可锁定第二个小标题picking a policy下面的第八段，文中提及“企业停顿保险”的承保内容。

　　Part II Reading Comprehension (Skimming and Scanning)

　　原文精译

　　【1】给自己的事业买最好的保险

　　消防队无意之中淹没了Mad Gab's的总部，Mad Gab's是Gabrielle Melchionda二十多年前建立的美容公司。尽管Melchionda知道，保险公司会替她换掉损坏的桌椅、电脑以及唇膏架子，但她仍泪流满面。然而，让她吃惊的是，随后几个月，才是真正的痛苦，她一直亏欠工资和租金，销售额慢的像涓涓细流。

　　【2】Melchionda女士说，“没有投保最重要的企业停顿保险”。她已经投保了财产险和责任险，却从没有想到多买一张保单，以承担事故之后的收入损失。

　　企业主们有很多类似Melchionda女士的经历。他们的很多保单要么不足以涵盖所有损失，要么投保了错误的风险。关于保险的怨言，有些可以归咎于吝啬的保险公司或信息有误的代理人，更多却是因为企业家自己的保险决策不够全面。

　　独立的保险代理人Steven Spiro说，“一般来讲，干小生意的人并不太清楚他们拥有或需要的保险范围”。他解释，这些人买保险只是为了遵守办公室租赁条约的要求。

　　选择代理人

　　【3】买保险可能让人胆怯，很难知道哪些人是想利用你，哪些人是给你忠告。所以你应该咨询同行的企业家们，他们购买了何种保险以及是向谁购买的。有三类人可以帮你选择保险：独立代理人，专属代理人，风险咨询师。

　　独立代理人，别称“经纪人”，因为他们代表很多家保险公司，所以可以提供很好的选择。保险公司付他们佣金，一般是一张保单每年保险费的10%到20%。注意：由于某些保险公司付给更多佣金，这些经纪人可能受到诱惑，会有私心和偏爱。

　　专属代理人代表某一家保险公司，从该保险公司领取薪水，并对其绝对忠诚。一些诸如Allstate的公司只和自己的代理人打交道;也就是说，你只能通过该家保险公司的代理人来购买此公司的保险。

　　每年年末，按照卖出去的保险和赔偿损失之间的比率，独立代理人和专属代理人都可拿到奖金。这意味着，卖给你尽可能多的保险，而最小化你的索赔，是符合他们利益的。

　　也要理解，大部分代理人只注意保险。美国保险研究所主要从事小本生意研究的专家Arthur Flitner说，“有时候，没有保险，你的问题反而可能处理的更好。”比如说，建立基金以备不时之需，自己为自己投保来应对某些财产风险;或执行严格的雇佣政策，减少诉讼风险，从经济角度来看，这些更有意义。

　　这时就需要风险咨询师的帮助了。他们收费很高，一个简单的项目就要花费几千美元。【4】如果你的运作有很大风险，如果你的公司一年收入2500万美元，如果你的公司有100多名员工，这时候雇佣风险专家，才有意义。

　　找到了可信的代理人，接下来就要买保险了。你想去找多少个代理人都可以，但是需要记住：同样的保险项目，保险公司不会寻找不同的代理人。

　　选择保单

　　如果公司总值低于300万美元，你很有可能需要被称为B.O.P.的业主保单，它把业务保单集中在一起，还让你增添必要的保单。每个保险公司的B.O.P.都不一样，购买的时候，要确保自己进行了精确的比较。

　　如果公司总值高于300万美元，你可能必须分开购买保险。如果公司有几十名员工，做生意不得不买的保单有四个：

　　【5】员工赔偿保险是州法律要求的，它涵盖员工的医疗费用、残疾人士福利金和死亡赔偿，【6】保险比率因行业和职业不同相差甚远。秘书的保险费可能是，每100美元工资给付22美分，而盖顶工可能是，每100美元给付20多美元。确保你的生意分类正确，不要把玩具厂(制造业被认为是高风险的)误归为设计公司(低风险)。雇员填写索赔表格时，保险公司会认为，你的公司是一个风险系数比较高的设计公司，从而提高保险费。

　　【8】财产保险包括房产和办公室里的设备。所在建筑的年龄大小，距离消防队的远近，建筑材料是钢铁还是木材，都会使保险比率大有不同。

　　要注意共同保险条款，如果保险公司认为投保金额不足，这个条款允许保险公司只赔偿部分损失。让代理人加上“协定保险价额 ”，你和保险公司认同一个合适的保险价值。这可能让保险费提高15%，却减少了随后的争端。

　　一般责任保险涵盖公司对他人健康、财产或名誉带来的伤害损失。一般来说，保险费的比率要考虑以下因素：收入，办公室规模，客户数量。大多数的基本成套保险，是每次危险保100万美元;而伞状保单以相对低的价格涵盖更大范围。

　　【9】如果可能，一定买比较贵的“发生”保单，它在事故发生当时就给你赔偿，哪怕你已停业或保单已过期。“索赔”保单与此相反，它只有在你受保期间索赔才有效。

　　【10】企业停顿保险——Melchionda女士本该买的保险，它不仅赔偿事故之后房子重建期间的销售损失、房租、工资损失;还出钱帮你租赁临时办公室或设备，这样你可以尽快的回到轨道上去。

　　这些保单仅仅是投保的开始。根据你经营的生意种类，还可增加其他几十个保单。像医生、医院的医疗过失保险，这些非常重要;而另一些纯粹是浪费。想要决定你需要哪些保险，可以先问自己两个问题：你承受损失的可能性有多大，你自己可以赔偿所有损失吗?正如专家指出的那样，保险旨在赔偿大灾难，而不是日常维护。

　　【7】公共调解员George Von York说，“这是场赌博”。他帮助业主和保险公司谈判，以期获得更多赔偿。“大部分人一辈子也没有得到实在的赔偿。但是，孩子，在你需要时，最好还是有保险。”

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