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Paint Colors For Dining Rooms

Upon getting information about an upcoming school science fair and the need to consider a topic of interest, many students will typically have no idea where to get started. While the science fair is typically a common occurrence in any school at any grade level, there are different types of topics that should be taken a look at depending on the age of the student. After first taking a look at the many different categories of science projects, you will be able to locate a suitable choice of topic to take to the next level.There is a wide variety of categories that fall under the types of science projects that can be chosen for a school science fair. These include biology, chemistry, physics, microbiology, biochemistry, medicine, environmental, mathematics, engineering, and earth science. While you may not have yet learned very much in any of these categories, don’t be afraid to see what each one entails. Taking a good look at your interests will allow you to focus on the right direction to take.Many resources are also available for those who are unsure as to the topic they are wanting to use to create their science projects. If you take a look at the topics that fall under the biology category, you will likely notice that there are topics that deal with plants, animals, and humans. For those who are in 2nd grade or 3rd grade, an interesting topic may be to determine if ants are picky over what type of food they eat. While this topic might not be of interest to an 8th grader, it is certainly something in the biology category that an elementary school student would enjoy.Along with the biology category, a high school student may want to take a look at diffusion and osmosis in animal cells as this would be a more appropriate topic for the grade level. A student in 6th grade would be more advanced than an elementary school student, but not as advanced as a high school student. At this middle school grade level, a topic of how pH levels effect the lifespan of a tadpole may be of interest.Whichever resource is used to locate a topic for science projects, it is always a good idea to consider the grade level of the student prior to making a selection. It is always assumed to be best to have a project at an appropriate level in order to keep the attention of the student and provide a fun and enjoyable learning experience.

Art Paintings From Your Photo

The market for Chinese contemporary art has developed at a feverish pace, becoming the single fastest-growing segment of the international art market. Since 2004, prices for works by Chinese contemporary artists have increased by 2,000 percent or more, with paintings that once sold for under $50,000 now bringing sums above $1 million. Nowhere has this boom been felt more appreciably than in China, where it has spawned massive gallery districts, 1,600 auction houses, and the first generation of Chinese contemporary-art collectors.This craze for Chinese contemporary art has also given rise to a wave of criticism. There are charges that Chinese collectors are using mainland auction houses to boost prices and engage in widespread speculation, just as if they were trading in stocks or real estate. Western collectors are also being accused of speculation, by artists who say they buy works cheap and then sell them for ten times the original prices-and sometimes more.Those who entered this market in the past three years found Chinese contemporary art to be a surefire bet as prices doubled with each sale. Sotheby’s first New York sale of Asian contemporary art, dominated by Chinese artists, brought a total of $13 million in March 2006; the same sale this past March garnered $23 million, and Sotheby’s Hong Kong sale of Chinese contemporary art in April totaled nearly $34 million. Christie’s Hong Kong has had sales of Asian contemporary art since 2004. Its 2005 sales total of $11 million was dwarfed by the $40.7 million total from a single evening sale in May of this year.These figures, impressive as they are, do not begin to convey the astounding success at auction of a handful of Chinese artists: Zhang Xiaogang, Yue Minjun, Cai Guo-Qiang, Liu Xiaodong, and Liu Ye. The leader this year was Zeng Fanzhi, whose Mask Series No. 6 (1996) sold for $9.6 million, a record for Chinese contemporary art, at Christie’s Hong Kong in May.Zhang Xiaogang, who paints large, morose faces reminiscent of family photographs taken during the Cultural Revolution, has seen his record rise from $76,000 in 2003, when his oil paintings first appeared at Christie’s Hong Kong, to $2.3 million in November 2006, to $6.1 million in April of this year.Gunpowder drawings by Cai Guo-Qiang, who was recently given a retrospective at the Guggenheim Museum in New York, sold for well below $500,000 in 2006; a suite of 14 works brought $9.5 million last November.According to the Art Price Index, Chinese artists took 35 of the top 100 prices for living contemporary artists at auction last year, rivaling Jeff Koons, Damien Hirst, and a host of Western artists.”Everybody is looking to the East and to China, and the art market isn’t any different,” says Kevin Ching, CEO of Sotheby’s Asia. “Notwithstanding the subprime crisis in the U.S. or the fact that some of the other financial markets seem jittery, the overall business community still has great faith in China, bolstered by the Olympics and the World Expo in Shanghai in 2010.”There are indications, however, that the international market for Chinese art is beginning to slow. At Sotheby’s Asian contemporary-art sale in March, 20 percent of the lots offered found no buyers, and even works by top record-setters such as Zhang Xiaogang barely made their low estimates. “The market is getting mature, so we can’t sell everything anymore,” says Xiaoming Zhang, Chinese contemporary-art specialist at Sotheby’s New York. “The collectors have become really smart and only concentrate on certain artists, certain periods, certain material.”For their part, Western galleries are eagerly pursuing Chinese artists, many of whom were unknown just a few years ago. Zeng Fanzhi, for example, has been signed by Acquavella Galleries in New York, in a two-year deal that exceeds $20 million, according to a Beijing gallerist close to the negotiations; William Acquavella declined to comment. Zhang Xiaogang and Zhang Huan have joined PaceWildenstein, and Ai Weiwei and Liu Xiaodong showed with Mary Boone last spring. Almost every major New York gallery has recently signed on a Chinese artist: Yan Pei Ming at David Zwirner, Xu Zhen at James Cohan, Huang Yong Ping at Gladstone, Yang Fudong at Marian Goodman, Liu Ye at Sperone Westwater. Their works are entering private and public collections that until now have not shown any particular interest in Asian contemporary art.”The market hasn’t behaved as I anticipated,” says New York dealer Max Protetch, who has been representing artists from China since 1996. “We all anticipated that the Chinese artists would go through the same critical process that happens with art anywhere else in the world. I assumed that some artists would fall by the wayside, which has not been true. They all have become elevated. It seems like an uncritical market.”One of the key artists buoyed by this success is Zeng Fanzhi, who is best known for his “Mask” series. Five years ago his works sold for under $50,000. Today he commands prices on the primary market closer to $1 million, with major collectors Charles Saatchi and Jose Mugrabi among his fans. Now preparing for his first solo show at Acquavella in December, he is considered one of the more serious artists on the Beijing scene because he works alone, without the horde of assistants found in most other artists’ studios in China. Still, his lifestyle is typical of that of his equally successful peers. When asked if he owns a mammoth black Hummer parked outside his studio, he answers, “No, that’s an ugly car. I have a G5 Benz.”This success has blossomed under the watchful eye of the Chinese government. Movies, television, and news organizations are strictly censored, but on the whole, the visual arts are not. Despite sporadic incidents of exhibitions being closed or customs officials seizing artworks, by and large the government has supported the growth of an art market and has not interfered with private activity. In the 798 gallery district in Beijing, a Bauhaus-style former munitions complex that has been transformed into the capital’s hottest art center, with more than 150 galleries, one finds works addressing poverty and other social problems, official corruption, and new sexual mores. The icons of the former China-happy workers and peasants and heroic soldiers raising the red banner-are treated with irony, if at all, by the artists whose works are on view in these galleries, which are private venues generally not under the strict control of the Ministry of Culture.On the eve of the Olympics, however, the government asked one gallery to postpone an exhibition until after the games. Considered unsuitable was “Touch,” a show by Ma Baozhong at the Xin Beijing Gallery of 15 paintings depicting important moments in Chinese history, including one based on a photograph showing Mao Zedong with the Dalai Lama and the Panchen Lama in 1954.The Beijing municipality spent enormous funds to renovate the 798 district before the Olympics, putting in new cobblestone streets and lining its main thoroughfare with cafés. Shanghai, which has benefited less from government support, now boasts at least 100 galleries. Local governments throughout the country are establishing SoHo-style gallery districts to boost tourism.One person who seems confident about the future of the Chinese market is Arne Glimcher, founder and president of PaceWildenstein, who opened a branch of his gallery in Beijing in August. Located in a 22,000-square-foot cement space with soaring ceilings, redesigned at a cost of $20 million by architect Richard Gluckman, the gallery is in the center of the 798 district. “We are committed to the art, and we wanted to open a gallery where our artists are,” says Glimcher. Adding that he normally eschews the “McGallery” trend of setting up satellite spaces around the world, Glimcher insists that it was necessary to establish a branch in Beijing because there is “no local gallery of our caliber” with which Pace could partner. He has, however, recruited Leng Lin, founder of Beijing Commune, another gallery operating in 798, to be his director.Another Western dealer who has taken the China plunge is Arthur Solway, who recently opened a branch of James Cohan in Shanghai. “I started coming to China five years ago, and I was fascinated by the energy,” says Solway, who wanted to introduce gallery artists like Bill Viola, Wim Wenders, and Roxy Paine to Asia but, like Glimcher, could not find a public museum or private gallery that he considered professionally qualified to handle such exhibitions. James Cohan Gallery Shanghai is located on the ground floor of a 1936 Art Deco structure in the French Concession, a particularly picturesque section of the city. The building was once occupied by the military, and red Chinese characters over the front door still exhort, “Let the spirit of Mao Zedong flourish for 10,000 years.”"From 1966 to 1976, during the Cultural Revolution, people had nothing, but now there are spas in Shanghai and people drinking cappuccinos and buying Rolex watches-it’s an amazing phenomenon,” says Solway, who believes it is only a matter of time before these same newly affluent consumers begin to collect contemporary art.Chinese collectors-or the hope that there will be Chinese collectors-are the key draw luring these galleries to Beijing. As recently as two years ago, few could name even a single Chinese collector of contemporary art. It was a truism that the Chinese preferred to spend their money acquiring antiquities and classical works. Since then several well-known mainland collectors have emerged on the scene.Most visible is Guan Yi, the suave, well-dressed heir to a chemical-engineering fortune, who has assembled a museum-quality collection of more than 500 works. A major lender to the Huang Yong Ping retrospective organized by the Walker Art Center in Minneapolis in 2005, he regularly entertains museum trustees from all over the world, who make the pilgrimage to his warehouse on the outskirts of Beijing. Now he is building his own museum.Another noted figure is Zhang Lan, head of the South Beauty chain of Szechuan-style restaurants throughout China; she also has assembled an enviable collection and displays pieces from it in her chic establishments. The film actress Zhang Ziyi is representative of a new class of collectors from the entertainment industry, while Pan Shiyi and Zhang Xin, chairman and CEO of the mammoth SOHO China real estate empire, have commissioned projects for their upscale residential properties.Two collectors who are cheerleaders for the Beijing art scene are Yang Bin, an automobile-franchise mogul, and Zhang Rui, a telecommunications executive who is also the backer of Beijing Art Now Gallery, which took part in Art Basel in June, one of the first Beijing galleries to appear at the fair. These two do more than collect art. They have hosted dinners for potential collectors, organized tours to Art Basel Miami Beach, and brought friends with them to sales in London and New York. Zhang Rui, who owns more than 500 works, has lent art to international exhibitions, most notably the installation Tomorrow, which features four “dead Beatles” mannequins floating facedown, created by artists Sun Yuan and Peng Yu for the 2006 Liverpool Biennial, which rejected it.Zhang is now building an art hotel, featuring specially commissioned works and artist-designed rooms, outside the Workers’ Stadium in the center of Beijing. “I am trying to think of ways of changing my private collection into a public collection,” Zhang explained to ARTnews through a translator. It isn’t financially advantageous to do this in China, as no tax benefits accrue from donations to museums or other nonprofit institutions.Zhang Rui represents the handful of Chinese collectors who are public about their activities and are building noteworthy collections. Far more typical of buying activity in China is the rampant speculation taking place in the mainland auction houses. There are 1,600 registered auctioneers, and their sales attract hundreds of bidders. Chinese buyers are more comfortable with auction houses, which have been in business since 1994, than with galleries, which weren’t licensed to operate by the government until the late 1990s.These auction houses run by their own rules, generating what sometimes seems like a “wild, wild East” atmosphere. It is, for example, fairly common for a house to get consignments directly from artists, who then use the sales to establish prices for their works on the primary market. More often, now that China has hundreds of galleries, dealers come to a sale with buyers in tow, publicly bidding up works to establish “record prices” and advertise their artists. This kind of bidding ring would be considered illegal in the United States, but in China it is viewed as a savvy business practice. There is little regulation of auction houses and few developed legal norms in the field, so that even when buyers have grievances-with fakes and forgeries, for example-they do not feel they can resort to the law. Bidding is a social as well as a business activity, and buyers are happy to flaunt their status by paying record prices or quickly flipping artworks, not only for profit but so they can boast of their short-term gains.As the domestic market for contemporary art matures, however, many of these practices are coming into question. “Two years ago it was more necessary for me to bring my artists to auction,” says Fang Fang, owner of Star Gallery in Beijing, which specializes in young emerging artists such as Chen Ke and Gao Yu. “Now that the gallery market has increased, I find it is better to keep my artists out of the auction rooms, and there is much less reason to sell there.”Two mainland firms, Beijing Poly International Auction Company, and China Guardian Auctions Company, dominate the field of contemporary Chinese art. Their combined 2007 total of more than $200 million in sales represented nearly two-thirds of all auction sales in this category in mainland China for the year. Last spring Guardian achieved $142 million in sales of classical artworks, furniture, ceramics, silver, and coins, and $40 million in sales of contemporary material. The latter figure included the $8.2 million fetched by Liu Xiaodong’s Hotbed No. 1, a record for a painting sold on the mainland. In a similar range of sales last spring, Poly sold $130 million worth of works, including $27 million in a single evening contemporary-art sale. (These figures represent a slight decline for the year because both houses held benefit sales for Szechuan earthquake victims, raising more than $20 million to support relief efforts.)Poly and Guardian reflect two vastly different perspectives on the domestic market in Chinese contemporary art. Guardian is the oldest and most respected auction house in China, founded in 1993 by Wang Yannan, daughter of Zhao Ziyang, the former Communist Party leader who was placed under house arrest after opposing the government’s use of force against demonstrators at Tiananmen Square in 1989. If Poly is known for its vast resources and willingness to make deals to nab consignments, Guardian is known for its respected specialists and long-term client relationships. For example, when the Museum of Fine Arts, Boston, decided to sell 20 pieces of Qing dynasty porcelain in mainland China, it consigned the collection to Guardian.The atmosphere of a sale at Poly or Guardian is surprisingly similar to that in the salerooms of Christie’s or Sotheby’s. The catalogues are identical in design, and the bidding proceeds in an orderly, even sedate, fashion, despite the crowds of spectators in the room.”From our beginning, we studied what the principles of an auction house should be, and we stick to these principles,” says Guardian president Wang. She also serves on the board of the new nationwide auctioneers’ association, which hopes to enforce regulations on the auction market.Poly is an enterprise within the China Poly Group Corporation, a $30 billion conglomerate that is the privatized branch of the People’s Liberation Army. Established initially to repatriate artworks and antiquities, Poly has spent $100 million buying objects such as the bronze animal heads from a water-clock fountain that were looted from Beijing’s Summer Palace by British and French troops in 1860; the pieces later turned up in the West. The repatriated objects are showcased in the Poly Art Museum in the sparkling New Beijing Poly Plaza, a glass-enclosed tower designed by Skidmore, Owings & Merrill.The more freewheeling Poly is known for practices such as putting up for auction works from its own collection or having consignors guarantee that they will bring buyers to the sale to meet low estimates. Still, even here there are signs that the market is maturing and has become too expensive for casual speculators. “These collectors that you are talking about are actually quite small collectors,” explains Zhao Xu, senior consultant at Poly. “They bought for several years at very affordable prices, but now that prices are skyrocketing, the only way they can afford to buy is to sell. The collectors that I know already come from a high social status, and they can afford to buy pieces worth $1 million or $2 million and are looking for the best works, the masterpieces, to add to their collections.”When asked if Poly follows the rules of the Western auction houses, Zhao sharply retorts, “Sometimes even Sotheby’s doesn’t follow the rules.” Or as Gong Jisui, an art-market specialist who is a professor at the Central Academy of Fine Arts in Beijing, says, “The Chinese learned this game of speculation from the Westerners who played it first.”The incident to which both men are referring is the sale of the Estella Collection at Sotheby’s Hong Kong on April 9 of this year. The event reaped $18 million for 108 works. (An additional 80 works will be up for sale this month at Sotheby’s New York.) The collection was put together from 2003 to 2006 by New York dealer Michael Goedhuis for a group of investors that included Sacha Lainovic, a director of Weight Watchers International, and Raymond Debbane, CEO of the Invus Group, a private equity firm.Last year the collection of approximately 200 works was sold to William Acquavella, who consigned it to Sotheby’s. Auction house officials will not discuss financial details, but Sotheby’s had a stake in the collection. After the sale it was widely reported that many of the artists were angered by the auction because, they said, they had sold their works to Goedhuis at discount prices in exchange for promises that the collection would remain together for public display.”The idea was to keep the collection intact and to see it safely into some institution,” says Goedhuis, who denies that any promises were made. “The ideal situation was to see it with an institution in China, because there is no such collection.” The collection was published in a book, China Onward, with an essay by leading China expert Britta Erickson, and it was exhibited at the Louisiana Museum of Modern Art in Denmark and the Israel Museum in Jerusalem shortly before the sale. According to Goedhuis, because of the rapid rise in prices, the investors chose to sell the collection with hopes that it would not be broken up.”Since the museums in China aren’t mature enough nor are they rich enough to do an acquisition like this, my hope was that Steve Wynn would do so for his sophisticated casino complex in Macao,” Goedhuis says. He turned to Acquavella because, he says, he believed the dealer would bring the collection to Wynn; Acquavella paid a reported $25 million. Acquavella director Michael Findlay laughs at the suggestion that there was any indication that the collection would go to Wynn. “I think this whole thing is surrounded by so much rumor and speculation,” he says. “We bought a group of paintings, and we sold a group of paintings, and that’s the whole story.”According to Maarten ten Holder, Sotheby’s managing director for North and South America, the firm received inquiries before the sale from several artists in the collection, wondering why the works were to be auctioned. There is disagreement about whether Goedhuis made firm promises to keep the collection together or merely made a sales pitch to artists that inclusion in the collection would enhance their reputations. Yue Minjun, who had two works in the sale, says no promises were made. And Goedhuis bought Zeng Fanzhi’s Chairman Mao with Us from Hanart T Z Gallery in 2005 for the asking price, $30,000, no discount given. It sold for $1.18 million.”You have to understand that there was no market for this work when I was buying,” says Howard Farber, whose collection brought $20 million at Phillips de Pury & Company in London last October. Farber assembled 100 choice works by assiduously visiting artists’ studios in Beijing in the late 1980s, accompanied by the Beijing-based critic Karen Smith, a leading author and curator in this field. A work for which he paid $25,000 in 1996, Wang Guangyi’s Great Criticism: Coca-Cola, was sold at Phillips de Pury for $1.6 million. The buyer was Farber’s son-in-law, Larry Warsh, who bid on several works at the sale, according to newspaper accounts. “I really didn’t actually know I was going to buy the Wang Guangyi until that moment,” says Warsh. “Howard has his collection, and it’s not my collection, and there were many pieces I wanted from that collection that I would have wanted to buy but couldn’t afford.”Many Beijing artists had agreements with Warsh to produce work for his collection and his art advisory business, which began in 2004, inspired by Farber’s example in the field. “I was enamored by China, and then I was enamored by the art of China as I learned about important artists,” says Warsh. “But what really hit me first was how the pricing did not make sense to me at all-everything was out of whack.”Warsh, who amassed a collection of works by Jean-Michel Basquiat, Keith Haring, and Kenny Scharf in the late 1980s, was the publisher of the now-defunct Museums Magazine, which he sold to LTB Media in 2004. He stated at one point that his collection totaled more than 1,200 works; now, he says, he owns approximately 400 paintings and photographs. Part of his collection is managed by his new business venture, AW Asia, which has a gallery in Chelsea and intends to assemble collections of Chinese contemporary art for museums and major private collectors. The Museum of Modern Art in New York recently acquired 23 photographs from AW Asia.With Farber and Warsh circulating in Beijing for a variety of purposes, it was easy for Chinese artists to become confused about who was buying for whom and for what purpose. In recent interviews, several artists-most notably Zhang Xiaogang, who had an agreement with Warsh-pointed to him as an example of a speculator.Warsh replies, “While some artists are not so pleased with their decision to have sold quantities of artwork at what was then their current values not so long ago, there are many artists who are not resentful and actually pleased that someone has taken an interest in their work.”New York dealer Jack Tilton, who has worked with Chinese artists since 1999, says, “All of these artists are hoping that their work finds good homes rather than getting churned in the commercial market. But they have also played a part in this market, embracing capitalism more than we have, in funny ways. They are not naive about any of this stuff.”When asked about the artists’ reactions to the sale of his collection, Farber was flabbergasted: “So what? Now I am the bad guy. That pisses me off!”A number of major collectors of Chinese contemporary art who have been in the field for some time are holding on to their collections. Uli Sigg, Swiss ambassador to China, Mongolia, and North Korea from 1995 to 1998, has built a collection of key works that he has toured in the exhibition “Mahjong” to museums throughout Europe and, most recently, the University of California’s Berkeley Art Museum (September 10-January 4). Belgian collectors Guy and Myriam Ullens have used their resources to establish the first nonprofit contemporary-art center in Beijing, where they are currently exhibiting their historic collection. So far, collector Charles Saatchi has been hanging on to his purchases in preparation for opening his new gallery in London on the 9th of next month with a show of Chinese contemporary art; he has also launched a Chinese-language Web site on which mainland artists can post their works.In comparison with Western buying, mainland Chinese participation pales. Though there are many rumors about the power of the new Chinese buyers, their presence has not been felt in the major auction houses, where most of the records are being set. “Hong Kong right now covers the global buyers, especially those from across Asia,” says Eric Chang, Christie’s international director of Asian contemporary art. “I am not really seeing mainland Chinese buyers-less than 10 percent-a drop from around 12 percent.” Dealers in China also have seen few mainland collectors among their regular clients. “I don’t know yet about collectors,” says New York dealer Christophe Mao of Chambers Fine Art, which recently opened a branch in Beijing.Despite the current shortage of mainland art collectors, China is emerging as a major art center, having become a hub for buyers from South Korea, Taiwan, Singapore, Indonesia, and Southeast Asia, and for overseas Chinese from all over the world. Reflecting this diversity is the wide range of foreign dealers among the 300 galleries in Beijing, including Continua from Italy, Urs Meile from Switzerland, Arario and PKM from South Korea, Beijing Tokyo Art Projects from Japan, and Tang from Indonesia.”In Beijing it’s getting increasingly difficult to talk about the Chinese market as a separate entity from the broader Asian art market or the international art market,” says Meg Maggio, an American who came to China in 1988 and ran one of the first galleries in the country, CourtYard, in Beijing, from 1998 to 2006. Now she has her own gallery, Pékin Fine Arts, where she represents an international stable of artists. “How do you describe the market for a Korean artist showing in China or a Chinese artist living in New York?” she asks, noting that her business can come from South Korean collectors visiting Beijing or European companies doing business in China.One factor in China’s development as a center for contemporary art is the proliferation of art fairs. Beijing has two, the China International Gallery Exposition and Art Beijing; Shanghai has the newly created ShContemporary, now in its second year; and Hong Kong just launched ART HK. CIGE director Wang Yihan says her fair attracted 40,000 visitors this year, while the more high-toned ShContemporary brought in 25,000 and ART HK 08 had 19,000. These numbers may seem small in comparison with the 60,000 who crowd Art Basel, but dealers believe that the fairs in Asia are worthwhile because they attract new buyers and make Asian collectors feel more comfortable about acquiring art from galleries.”Anywhere else, a fair is just a fair,” says Lorenz Helbling of ShanghART, one of the oldest galleries in China and a participant in Art Basel. “But in Shanghai a fair feels like so much more because only there can it make an impact on several million people.” He is referring not only to attendance but to the intensive publicity and official recognition given to ShContemporary in its inaugural year.Just a few years ago it would have been impossible to try to sell contemporary art to Asian buyers, let alone mainland Chinese collectors, in the public forum of an art fair. Now, with the astounding success of Chinese contemporary art, collectors from across the region-and more than a few from the United States and Europe-are targeting China as a destination. According to Nick Simunovic, who has opened an office and showroom for Gagosian Gallery in Hong Kong, it is only a matter of time before these regional buyers turn their attention to Western contemporary art.”My sense is that wherever you have tremendous wealth creation, the collecting cycle goes through three phases,” he says. “First, people collect their cultural patrimony, and then they collect their own contemporary art. I think the final stage is when they gain a more globalized contemporary-art approach.”Gagosian first considered opening an office in Shanghai but encountered obstacles to doing business on the mainland. The most formidable of these is a 34 percent luxury tax on art, which foreign galleries that participated in ShContemporary found difficult to avoid. Hong Kong, by comparison, is a duty-free zone. And Simunovic found that even Jeff Koons was a tough sell in Shanghai, whereas Hong Kong offers more possibilities for Western contemporary art. Just a year ago Hong Kong billionaire Joseph Lau paid $72 million for Andy Warhol’s Green Car Crash (Green Burning Car I). In May Christie’s brought a Warhol portrait of Mao, valued at $120 million and for sale privately, for viewing in Hong Kong. (At press time it had not yet been sold.)”Sure, China is hot, but that’s just the peak of the iceberg,” says Lorenzo Rudolf, former director of Art Basel and cofounder of ShContemporary. “This is not just about a group of Chinese painters. It’s about a growing market going on in this continent.”With the sheer abundance of galleries, auction houses, and art fairs in China, the larger art world is recognizing the power of the Asian market. Standing in an auction house in New York or London watching paintings by Chinese artists sell for millions, one can grouse about this boom and hint that it will turn out to be a bubble. But strolling in a bustling gallery district in Beijing, with students and tourists crowding the cafés and boutiques and filling the huge art showrooms, few would predict a downturn in the near future.

Rebuilding the Tower of Babel – A CEO’s Perspective on Health Information Exchanges

Defining a Health Information ExchangeThe United States is facing the largest shortage of healthcare practitioners in our country’s history which is compounded by an ever increasing geriatric population. In 2005 there existed one geriatrician for every 5,000 US residents over 65 and only nine of the 145 medical schools trained geriatricians. By 2020 the industry is estimated to be short 200,000 physicians and over a million nurses. Never, in the history of US healthcare, has so much been demanded with so few personnel. Because of this shortage combined with the geriatric population increase, the medical community has to find a way to provide timely, accurate information to those who need it in a uniform fashion. Imagine if flight controllers spoke the native language of their country instead of the current international flight language, English. This example captures the urgency and critical nature of our need for standardized communication in healthcare. A healthy information exchange can help improve safety, reduce length of hospital stays, cut down on medication errors, reduce redundancies in lab testing or procedures and make the health system faster, leaner and more productive. The aging US population along with those impacted by chronic disease like diabetes, cardiovascular disease and asthma will need to see more specialists who will have to find a way to communicate with primary care providers effectively and efficiently.This efficiency can only be attained by standardizing the manner in which the communication takes place. Healthbridge, a Cincinnati based HIE and one of the largest community based networks, was able to reduce their potential disease outbreaks from 5 to 8 days down to 48 hours with a regional health information exchange. Regarding standardization, one author noted, “Interoperability without standards is like language without grammar. In both cases communication can be achieved but the process is cumbersome and often ineffective.”United States retailers transitioned over twenty years ago in order to automate inventory, sales, accounting controls which all improve efficiency and effectiveness. While uncomfortable to think of patients as inventory, perhaps this has been part of the reason for the lack of transition in the primary care setting to automation of patient records and data. Imagine a Mom & Pop hardware store on any square in mid America packed with inventory on shelves, ordering duplicate widgets based on lack of information regarding current inventory. Visualize any Home Depot or Lowes and you get a glimpse of how automation has changed the retail sector in terms of scalability and efficiency. Perhaps the “art of medicine” is a barrier to more productive, efficient and smarter medicine. Standards in information exchange have existed since 1989, but recent interfaces have evolved more rapidly thanks to increases in standardization of regional and state health information exchanges.History of Health Information ExchangesMajor urban centers in Canada and Australia were the first to successfully implement HIE’s. The success of these early networks was linked to an integration with primary care EHR systems already in place. Health Level 7 (HL7) represents the first health language standardization system in the United States, beginning with a meeting at the University of Pennsylvania in 1987. HL7 has been successful in replacing antiquated interactions like faxing, mail and direct provider communication, which often represent duplication and inefficiency. Process interoperability increases human understanding across networks health systems to integrate and communicate. Standardization will ultimately impact how effective that communication functions in the same way that grammar standards foster better communication. The United States National Health Information Network (NHIN) sets the standards that foster this delivery of communication between health networks. HL7 is now on it’s third version which was published in 2004. The goals of HL7 are to increase interoperability, develop coherent standards, educate the industry on standardization and collaborate with other sanctioning bodies like ANSI and ISO who are also concerned with process improvement.In the United States one of the earliest HIE’s started in Portland Maine. HealthInfoNet is a public-private partnership and is believed to be the largest statewide HIE. The goals of the network are to improve patient safety, enhance the quality of clinical care, increase efficiency, reduce service duplication, identify public threats more quickly and expand patient record access. The four founding groups the Maine Health Access Foundation, Maine CDC, The Maine Quality Forum and Maine Health Information Center (Onpoint Health Data) began their efforts in 2004.In Tennessee Regional Health Information Organizations (RHIO’s) initiated in Memphis and the Tri Cities region. Carespark, a 501(3)c, in the Tri Cities region was considered a direct project where clinicians interact directly with each other using Carespark’s HL7 compliant system as an intermediary to translate the data bi-directionally. Veterans Affairs (VA) clinics also played a crucial role in the early stages of building this network. In the delta the midsouth eHealth Alliance is a RHIO connecting Memphis hospitals like Baptist Memorial (5 sites), Methodist Systems, Lebonheur Healthcare, Memphis Children’s Clinic, St. Francis Health System, St Jude, The Regional Medical Center and UT Medical. These regional networks allow practitioners to share medical records, lab values medicines and other reports in a more efficient manner.Seventeen US communities have been designated as Beacon Communities across the United States based on their development of HIE’s. These communities’ health focus varies based on the patient population and prevalence of chronic disease states i.e. cvd, diabetes, asthma. The communities focus on specific and measurable improvements in quality, safety and efficiency due to health information exchange improvements. The closest geographical Beacon community to Tennessee, in Byhalia, Mississippi, just south of Memphis, was granted a $100,000 grant by the department of Health and Human Services in September 2011.A healthcare model for Nashville to emulate is located in Indianapolis, IN based on geographic proximity, city size and population demographics. Four Beacon awards have been granted to communities in and around Indianapolis, Health and Hospital Corporation of Marion County, Indiana Health Centers Inc, Raphael Health Center and Shalom Health Care Center Inc. In addition, Indiana Health Information Technology Inc has received over 23 million dollars in grants through the State HIE Cooperative Agreement and 2011 HIE Challenge Grant Supplement programs through the federal government. These awards were based on the following criteria:1) Achieving health goals through health information exchange 2) Improving long term and post acute care transitions 3) Consumer mediated information exchange 4) Enabling enhanced query for patient care 5) Fostering distributed population-level analytics.Regulatory Aspects of Health Information Exchanges and Healthcare ReformThe department of Health and Human Services (HHS) is the regulatory agency that oversees health concerns for all Americans. The HHS is divided into ten regions and Tennessee is part of Region IV headquartered out of Atlanta. The Regional Director, Anton J. Gunn is the first African American elected to serve as regional director and brings a wealth of experience to his role based on his public service specifically regarding underserved healthcare patients and health information exchanges. This experience will serve him well as he encounters societal and demographic challenges for underserved and chronically ill patients throughout the southeast area.The National Health Information Network (NHIN) is a division of HHS that guides the standards of exchange and governs regulatory aspects of health reform. The NHIN collaboration includes departments like the Center for Disease Control (CDC), social security administration, Beacon communities and state HIE’s (ONC).11 The Office of National Coordinator for Health Information Exchange (ONC) has awarded $16 million in additional grants to encourage innovation at the state level. Innovation at the state level will ultimately lead to better patient care through reductions in replicated tests, bridges to care programs for chronic patients leading to continuity and finally timely public health alerts through agencies like the CDC based on this information.12 The Health Information Technology for Economic and Clinical Health (HITECH) Act is funded by dollars from the American Reinvestment and Recovery Act of 2009. HITECH’s goals are to invest dollars in community, regional and state health information exchanges to build effective networks which are connected nationally. Beacon communities and the Statewide Health Information Exchange Cooperative Agreement were initiated through HITECH and ARRA. To date 56 states have received grant awards through these programs totaling 548 million dollars.History of Health Information Partnership TN (HIPTN)In Tennessee the Health Information Exchange has been slower to progress than places like Maine and Indiana based in part on the diversity of our state. The delta has a vastly different patient population and health network than that of middle Tennessee, which differs from eastern Tennessee’s Appalachian region. In August of 2009 the first steps were taken to build a statewide HIE consisting of a non-profit named HIP TN. A board was established at this time with an operations council formed in December. HIP TN’s first initiatives involved connecting the work through Carespark in northeast Tennessee’s s tri-cities region to the Midsouth ehealth Alliance in Memphis. State officials estimated a cost of over 200 million dollars from 2010-2015. The venture involves stakeholders from medical, technical, legal and business backgrounds. The governor in 2010, Phil Bredesen, provided 15 million to match federal funds in addition to issuing an Executive Order establishing the office of eHealth initiatives with oversight by the Office of Administration and Finance and sixteen board members. By March 2010 four workgroups were established to focus on areas like technology, clinical, privacy and security and sustainability.By May of 2010 data sharing agreements were in place and a production pilot for the statewide HIE was initiated in June 2011 along with a Request for Proposal (RFP) which was sent out to over forty vendors. In July 2010 a fifth workgroup,the consumer advisory group, was added and in September 2010 Tennessee was notified that they were one of the first states to have their plans approved after a release of Program Information Notice (PIN). Over fifty stakeholders came together to evaluate the vendor demonstrations and a contract was signed with the chosen vendor Axolotl on September 30th, 2010. At that time a production goal of July 15th, 2011 was agreed upon and in January 2011 Keith Cox was hired as HIP TN’s CEO. Keith brings twenty six years of tenure in healthcare IT to the collaborative. His previous endeavors include Microsoft, Bellsouth and several entrepreneurial efforts. HIP TN’s mission is to improve access to health information through a statewide collaborative process and provide the infrastructure for security in that exchange. The vision for HIP TN is to be recognized as a state and national leader who support measurable improvements in clinical quality and efficiency to patients, providers and payors with secure HIE. Robert S. Gordon, the board chair for HIPTN states the vision well, “We share the view that while technology is a critical tool, the primary focus is not technology itself, but improving health”. HIP TN is a non profit, 501(c)3, that is solely reliant on state government funding. It is a combination of centralized and decentralized architecture. The key vendors are Axolotl, which acts as the umbrella network, ICA for Memphis and Nashville, with CGI as the vendor in northeast Tennessee.15 Future HIP TN goals include a gateway to the National Health Institute planned for late 2011 and a clinician index in early 2012. Carespark, one of the original regional health exchange networks voted to cease operations on July 11, 2011 based on lack of financial support for it’s new infrastructure. The data sharing agreements included 38 health organizations, nine communities and 250 volunteers.16 Carespark’s closure clarifies the need to build a network that is not solely reliant on public grants to fund it’s efforts, which we will discuss in the final section of this paper.Current Status of Healthcare Information Exchange and HIPTNTen grants were awarded in 2011 by the HIE challenge grant supplement. These included initiatives in eight states and serve as communities we can look to for guidance as HIP TN evolves. As previously mentioned one of the most awarded communities lies less than five hours away in Indianapolis, IN. Based on the similarities in our health communities, patient populations and demographics, Indianapolis would provide an excellent mentor for Nashville and the hospital systems who serve patients in TN. The Indiana Health Information Exchange has been recognized nationally for it’s Docs for Docs program and the manner in which collaboration has taken place since it’s conception in 2004. Kathleen Sebelius, Secretary of HHS commented, “The Central Indiana Beacon Community has a level of collaboration and the ability to organize quality efforts in an effective manner from its history of building long standing relationships. We are thrilled to be working with a community that is far ahead in the use of health information to bring positive change to patient care.” Beacon communities that could act as guides for our community include the Health and Hospital Corporation of Marion County and the Indiana Health Centers based on their recent awards of $100,000 each by HHS.A local model of excellence in practice EMR conversion is Old Harding Pediatric Associates (OHPA) which has two clinics and fourteen physicians who handle a patient population of 23,000 and over 72,000 patient encounters per year. OHPA’s conversion to electronic records in early 2000 occurred as a result of the pursuit of excellence in patient care and the desire to use technology in a way that benefitted their patient population. OHPA established a cross functional work team to improve their practices in the areas of facilities, personnel, communication, technology and external influences. Noteworthy was chosen as the EMR vendor based on user friendliness and the similarity to a standard patient chart with tabs for files. The software was customized to the pediatric environment complete with patient growth charts. Windows was used as the operating system based on provider familiarity. Within four days OHPA had 100% compliance and use of their EMR system.The Future of HIP TN and HIE in TennesseeTennessee has received close to twelve million dollars in grant money from The State Health Information Exchange Cooperative Agreement Program.20 Regional Health Information Organizations (RHIO) need to be full scalable to allow hospitals to grow their systems without compromising integrity as they grow.21and the systems located in Nashville will play an integral role in this nationwide scaling with companies like HCA, CHS, Iasis, Lifepoint and Vanguard. The HIE will act as a data repository for all patients information that can be accessed from anywhere and contains a full history of the patients medical record, lab tests, physician network and medicine list. To entice providers to enroll in the statewide HIE tangible value to their practice has to be shown with better safer care. In a 2011 HIMSS editor’s report Richard Lang states that instead of a top down approach “A more practical idea may be for states to support local community HIE development first. Once established, these local networks can feed regional HIE’s and then connect to a central HIE/data repository backbone. States should use a portion of the stimulus funds to support local HIE development.”22 Mr. Lang also believes the primary care physician has to be the foundation for the entire system since they are the main point of contact for the patient.One piece of the puzzle often overlooked is the patient investment in a functional EHR. In order to bring together all the pieces of the HIE puzzle patients will need to play a more active role in their healthcare. Many patients do not know what medicines they take every day or whether they have a living will. Several versions of patient EHR’s like Memitech’s 911medical id card exist, but very few patients know or carry them.23 One way to combat this lack of awareness is to use the hospital as a catch-all and discharge each patient with a fully loaded USB card via case managers. This strategy also might lead to better compliance with post in patient therapies to reduce readmissions.The implementation of connecting qualified organizations began earlier this year. To fully support organizations to move toward qualification the Office of National Coordinator for HIE (ONC) has designated regional education centers (TN rec) who assist providers with educational initiatives in areas like HIT, ICD9 to ICD10 training and EMR transition. Qsource, a non-profit health consulting firm, has been chosen to oversee TNrec. To ensure sustainability it is critical that Tennessee build a network of private funding so that what happened with Carespark won’t happen to HIP TN. The eHealth Initiatives 2011Survey Report states that of the 196 HIE initiatives, 115 act independently of federal funding and of those independent HIE’s, break even through operational revenue. Some of these exchanges were in existence well before the American Recovery and Reinvestment Act in 2009. Startup funding from grants is only meant to get the car going so to speak, the sustainable fuel, as observed in the case of Carespark, has to come from value that can be monetized. KLAS research reports that 54% of public HIE’s were concerned about future sustainability while only 35% of private HIE’s shared this concern.Hospital Implications of HIP TN (A Call to Action)From a Financial perspective, taking our hospital into the future with EMR and an integrated statewide network has profound implications. In the short term the cost to find a vendor, establish EMR in and outpatient will be an expensive proposition. The transition will not be easy or finite and will involve constant evolution as HIP TN integrates with other state HIE’s. To get a realistic idea of the benefits and costs associated with health information integration. we can look to HealthInfoNet in Portland, ME, a statewide HIE that expects to save 37 million dollars in avoided services and 15 million in productivity reduction. Specific areas of savings include paper or fax costs $5 versus $0.25 electronically, virtual health record savings of $50 per referral, $26 saved per ED visit and $17.41 per patient/year due to redundant lab tests which amounts to $52 million for a population of 3 million patients. In Grand Junction Colorado Quality Health Network lowered their per capita Medicare spending to 24% below the national average, gaining recognition by President Obama in 2009. The Santa Cruz Health Information Exchange (SCHIE) with 600 doctors and two hospitals achieved sustainability in the first year of operation and uses a subscription fee for all the organizations who interact with them. In terms of government dollars available, meaningful use incentives exist to encourage hospitals to meet twenty of twenty five objectives in the first phase (2011-2012) and adopting and implement an approved EHR vendor. ARRA specified three ways for EHR to be utilized to obtain Medicare reimbursement. These include e-prescribing, health information exchange and submission of clinical quality measures. The objectives for phase two in 2013 will expand on this baseline. Implementation of EHR and Hospital HIE costs are usually charged by bed or by the number of physicians. Fees can range from $1500 for a smaller hospital up to $12,000 per month for a larger hospital.Perhaps the most compelling argument to building a functional Health Information Exchange is patient and community safety. The Healthbridge reduction in disease outbreak detection of 3-5 days is a perfect example of this safety benefit. Imagine the implications in the case of a rampant virus like avian or swine flu. The goal is to avoid a repeat of the 1918 influenza outbreak and ultimately save the lives of our most at risk. Rick Krohn of Healthsense makes the case for a socially responsible HIE that serves those who are chronically ill, uninsured and homeless. As the taxpayers ultimately bear the societal burden for our country’s healthcare coverage, the need to reduce redundancies, increase efficiency and provide healthcare worthy of the United States is imperative. Right now our healthcare is in the Critical Care Unit it’s time to stabilize it through operational excellence starting with our hospital. Let’s rebuild the Tower of Babel and enhance communication to provide our patients the healthcare they deserve!