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Friday, December 31, 2010
New Blog Post: Share Your DREAM Friday - With Special Guest Dreamer Gary Young! http://bit.ly/hPGnsz
Cool Technology of the Week
Aydogan Ozcan at UCLA has worked for many years to bring high tech tools to low tech places. A cell phone microscope that costs about $14 to produce, can provide laboratory services in isolated locations without the financial resources to purchase diagnostic equipment.
You can imagine clinicians in malaria endemic areas using cell phone microscopes to send blood smear photomicrographs to consultants. Given the ubiquity of cell phone networks throughout the developing world, such technology has real promise.
Last year, I worked with the government of New Zealand on their Focus on Health Competition. One of the competitors was Pictor Ltd, which created diagnostic products using micro arrays of color changing reaction wells requiring microliter quantities of blood or other fluids to be tested. The microarray can be photographed and read with a smart phone.
Making a smart phone into a microscope, hematology lab, and a chemistry lab. That's cool!
Food Allergy News in 2010
Much has happened over the past year and individuals and families with food allergy have a lot to celebrate:
We found out that we should carry 2 doses of epinephrine.
We discovered how to turn off a food reaction in mice.
We educated the public about bullying experienced by our food allergic kids.
More allergists are trying densensitization programs with food allergic patients.
We read about the creation of a low-allergy peanut.
We're able to determine through a blood test which infants are at increased risk for developing allergies.
Researchers are on the way to discovering the gene that could be responsible for eosinophilic esophagitis (EoE).
Conferences, like one run by AAAAI, were a great source of exciting studies and new information.
The discovery of a specific molecule that directs immune cells to develop the capability to produce an allergic response helps researchers with another piece of the allergy puzzle.
So, like with many other things, we have much to be grateful for and much more to do.
Thank you readers for checking in throughout 2010. I look forward to a new year filled with many more advances in food allergy, but I can't wait for the day when I can say, "We have a cure!".
Happy New Year!
We found out that we should carry 2 doses of epinephrine.
We discovered how to turn off a food reaction in mice.
We educated the public about bullying experienced by our food allergic kids.
More allergists are trying densensitization programs with food allergic patients.
We read about the creation of a low-allergy peanut.
We're able to determine through a blood test which infants are at increased risk for developing allergies.
Researchers are on the way to discovering the gene that could be responsible for eosinophilic esophagitis (EoE).
Conferences, like one run by AAAAI, were a great source of exciting studies and new information.
The discovery of a specific molecule that directs immune cells to develop the capability to produce an allergic response helps researchers with another piece of the allergy puzzle.
So, like with many other things, we have much to be grateful for and much more to do.
Thank you readers for checking in throughout 2010. I look forward to a new year filled with many more advances in food allergy, but I can't wait for the day when I can say, "We have a cure!".
Happy New Year!
Thursday, December 30, 2010
Medical transcription outsourcing: Providing perceptive services
The process of healthcare is complemented by inputs from various sources to provide effective and efficient healthcare services. As the healthcare sector deals with services that help improve quality of life and life saving services, it is important that the quality of inputs that contribute to the healthcare process meet the highest quality standards. Healthcare is supported by information from patient records in both the process of providing quality care and dealing with administrative & commercial aspects. It is important that the process of healthcare is documented accurately and in a timely manner to enable streamlined operations.
Medical transcription is the process of creating patient medical records by converting the audio inputs of the patient- healthcare professional encounter into text format. Healthcare facilities have various options available to them to avail medical transcription services including having an in-house department, outsourcing to independent contractors or availing the services of a outsourced medical transcription service provider or even a combination of two or more of these sources. However in the interest of quality output, curbing costs and having a proper system for transcription, outsourcing to a professional medical transcription service provider has been found to be the most viable option.
Outsourced medical transcription service providers provide perceptive medical transcription solutions for the needs of healthcare professionals and healthcare facilities. Outsourced service providers provide services that combine:
- An insight into the workings of healthcare facilities: Medical transcription services have evolved into sophisticated services that extend beyond mere typing services. Medical transcription service providers have an insight into the workings of healthcare facilities and have tailored medical transcription services and technology to support the smooth running of healthcare facilities with regard to patient medical record creation.
- Acumen to provide solutions to the perceived requirements: Medical transcription service providers have anticipated the specific requirements of healthcare professionals and healthcare facilities and provided solutions to meet these requirements. The service providers have used their experience and background to create solutions that provide for:
- Allowing for using preferred methods of capturing dictation
- Systems that automatically check for dictation files and upload the same for transcription at specified intervals
- Specialty-specific trained medical transcriptionists to enhance quality of service in terms of turnaround time and accuracy.
- Archiving of transcripts allowing for easy search options
- Secure and speedy document delivery modes as specified by the healthcare professional/ healthcare facility.
- Constantly work at updating and improving security measures to mitigate concerns regarding HIPAA and HITECH violation
- Discernment that provide services according to changing needs: It is a known fact that the documentation specifications of the healthcare sector is governed by statutory norms. Taking the latest meaningful use requirements mandating EMR/ EHR adoption, medical transcription service providers have discerning included the following in the scope of their services:
- Speech recognition transcription
- HL7 interface enabling transmission of information to the EMR/ EHR
It can be seen that choosing the right medical transcription service provider ensures healthcare facilities and healthcare professionals with not only accurate, timely, secure and cost effective creation of patient medical records but also provides perceptive services that help healthcare facilities cope with the changing healthcare documentation scenario.
TransDyne, a leader in the outsourced medical transcription industry has used their extensive background in information technology and their experience in serving the needs of the healthcare sector to provide total medical transcription solutions.
TransDyne offers quality medical transcription at reasonable prices, executed by experienced and qualified medical transcriptionists with a very quick turnaround time executed through secure HIPAA and HITECH compliant channels, with very high levels of accuracy and all this with technology that is advanced but easy to use!
To avail complete outsourced medical transcription services from TransDyne, click here
APTDC Dy. MANAGERS RECRUITMENT
ANDHRA PRADESH TOURISM DEVELOPMENT CORPORATION LIMITED
(Government of Andhra Pradesh, India)
3-5-891, Tourism House, Himayatnagar, Hyderabad - 500 029.
Ph.040- 23262151,52,53,54 & 57; Fax:040 � 23261801
NOTIFICATION OF VACANCIES ON CONTRACT BASIS
Applications with full bio-data are invited on or before 17.01.2011 to work on contract basis as Dy. Manager (Hotels) (13 posts) in Hotels Department of APTDC Ltd initially for a period of 3 years from the date of joining after selection and renewable for a further period of 2 years depending on satisfactory performance, requirement and rules in force.
All the details are available in the official website of APTDC: www.aptdc.in.
NOTE: This Notification is in continuation of earlier notification dated 24.09.2009 and 31.03.2010 issued in Sakshi and Hindu (Hyderabad Edition) Daily Newspaper and the candidates who have applied earlier are also requested to apply again as per their eligibility.
EASTERN POWER DISTRIBUTION COMPANY OF AP LIMITED JAO NOTIFICATION
EASTERN POWER DISTRIBUTION COMPANY OF AP LIMITED NOTIFICATION
RECRUITMENT FOR THE POST OF JUNIOR ACCOUNTS OFFICER
Applications are invited On-line through APEPDCL WEBSITE
www.apeasternpower.com and http:// apeasternpower.cgg.gov.in from
31-12-2010 to 17-01-2011 (Payment of Fee upto 17-01-2011/
01.00PM only) from eligible candidates for filling up of the following
vacancies by direct recruitment on regular basis in APEPDCL - Accounts Service.
The break-up of vacancies for the post of Junior Accounts Officer shall be as follows :
These vacancies are subject to variation at the time of recruitment based on the necessity.
The spirit of Presidential orders is applicable for the above posts.
Percentage of reservation: BC-25% + 4% Muslim reservation (BC-E)
subject to the orders / instructions of Government from time to time.
SC- 15%, ST-6%, PH-3%
33 1/3 % reservation for women is applicable as per rules.
Detailed notification with break-up of vacancies, Job specification,
Scale of Pay, Age, Community, Educational Qualifications and other
instructions along with syllabus for the written examination may be viewed at
APEPDCL website www.apeasternpower.com and http:// apeasternpower.cgg.gov.in from 31-12-2010.
NOTE:
1. The applicants are required to go through the detailed
notification carefully and decide themselves as to their eligibility
for this recruitment before applying and enter the particulars
completely Online.
2. Candidates are required to retain a photocopy of application
form with Reference ID for future reference.
3. Candidates shall submit the application only through online
mode well in advance of the last date, to avoid last day rush.
4. Applications sent other than On-line mode will not be entertained.
FEE:
Each applicant must pay Rs. 150/- (Rupees One hundred and Fifty Only)
towards Application Processing Fee (including SC/ST/BC/PH/Exservicemen).
i) Applicants under General category must also pay RS.350/-
(Three Hundred and Fifty ONLY) towards Examination Fee in addition to the Application Processing Fee.
ii) Applicants belonging to SC/ST/BC Communities and PH need not pay Examination fee.
iii) Candidates belonging to States other than Andhra Pradesh will
be considered as Non-Local in General category only, and are
required to pay the above-prescribed fee (Rs. 150/- + Rs.350/-)
Mode of Payment of Fee: The Applicant should pay the prescribed Fee as
per the notification in any one of the A.P. Online centers and obtain Fee
paid receipt with Journal Number( 12 digit) in the first instance. Applicants
can also pay the fee through AP Online portal.
(Details of APONLINE CENTERS are available at
http://www.aponline.gov.in/frptool/DistrictWiseFranchiseeDetails.aspx )
Submission of Application: After payment of Fee, the Candidate has to
logon to the website http:// www.apeasternpower.com and click on APPLY
ONLINE link or directly visit http:// apeasternpower.cgg.gov.in to view the
detailed notification, User Guide and Application Form. The applicants shall
invariably fill all the relevant fields in the Application. Immediately on
submission of application the Applicant will get an acknowledgement in the
form of a downloadable pdf document.
Note: Application cannot be accessed unless payment details are entered by the candidate.
Starting date for Payment of Fee and Application submission is 31-12-2010.
Last date for payment of Fee at AP Online is 17-01-2011 upto 01.00 P.M. ONLY
Last date for submission of Application is 17-01-2011 up to 09.00 P.M. ONLY
RECRUITMENT FOR THE POST OF JUNIOR ACCOUNTS OFFICER
Applications are invited On-line through APEPDCL WEBSITE
www.apeasternpower.com and http:// apeasternpower.cgg.gov.in from
31-12-2010 to 17-01-2011 (Payment of Fee upto 17-01-2011/
01.00PM only) from eligible candidates for filling up of the following
vacancies by direct recruitment on regular basis in APEPDCL - Accounts Service.
The break-up of vacancies for the post of Junior Accounts Officer shall be as follows :
These vacancies are subject to variation at the time of recruitment based on the necessity.
The spirit of Presidential orders is applicable for the above posts.
Percentage of reservation: BC-25% + 4% Muslim reservation (BC-E)
subject to the orders / instructions of Government from time to time.
SC- 15%, ST-6%, PH-3%
33 1/3 % reservation for women is applicable as per rules.
Detailed notification with break-up of vacancies, Job specification,
Scale of Pay, Age, Community, Educational Qualifications and other
instructions along with syllabus for the written examination may be viewed at
APEPDCL website www.apeasternpower.com and http:// apeasternpower.cgg.gov.in from 31-12-2010.
NOTE:
1. The applicants are required to go through the detailed
notification carefully and decide themselves as to their eligibility
for this recruitment before applying and enter the particulars
completely Online.
2. Candidates are required to retain a photocopy of application
form with Reference ID for future reference.
3. Candidates shall submit the application only through online
mode well in advance of the last date, to avoid last day rush.
4. Applications sent other than On-line mode will not be entertained.
FEE:
Each applicant must pay Rs. 150/- (Rupees One hundred and Fifty Only)
towards Application Processing Fee (including SC/ST/BC/PH/Exservicemen).
i) Applicants under General category must also pay RS.350/-
(Three Hundred and Fifty ONLY) towards Examination Fee in addition to the Application Processing Fee.
ii) Applicants belonging to SC/ST/BC Communities and PH need not pay Examination fee.
iii) Candidates belonging to States other than Andhra Pradesh will
be considered as Non-Local in General category only, and are
required to pay the above-prescribed fee (Rs. 150/- + Rs.350/-)
Mode of Payment of Fee: The Applicant should pay the prescribed Fee as
per the notification in any one of the A.P. Online centers and obtain Fee
paid receipt with Journal Number( 12 digit) in the first instance. Applicants
can also pay the fee through AP Online portal.
(Details of APONLINE CENTERS are available at
http://www.aponline.gov.in/frptool/DistrictWiseFranchiseeDetails.aspx )
Submission of Application: After payment of Fee, the Candidate has to
logon to the website http:// www.apeasternpower.com and click on APPLY
ONLINE link or directly visit http:// apeasternpower.cgg.gov.in to view the
detailed notification, User Guide and Application Form. The applicants shall
invariably fill all the relevant fields in the Application. Immediately on
submission of application the Applicant will get an acknowledgement in the
form of a downloadable pdf document.
Note: Application cannot be accessed unless payment details are entered by the candidate.
Starting date for Payment of Fee and Application submission is 31-12-2010.
Last date for payment of Fee at AP Online is 17-01-2011 upto 01.00 P.M. ONLY
Last date for submission of Application is 17-01-2011 up to 09.00 P.M. ONLY
Former NIH Director Spins Through Revolving Door, Ends Up at Sanofi-Aventis
A bit of news that got little attention this month was a new job for the former head of the US National Institutes of Health (NIH). Dr Elias Zerhouni had left the NIH in October, 2008. Here is the Reuters version of the story of his hew career:
Zerhouni's Embrace of Corporate Health Care
Although Zerhouni ostensibly left the NIH to return to academia at Johns Hopkins University, note that by February, 2009, four months after his resignation was announced, Zerhouni was already advising the Sanofi CEO.
Soon after he joined the corporate health care world in earnest. In April, 2009, he was proposed for membership on the board of directors of Actelion Ltd, a Swiss biotechnology company. On December 8, 2009, he was elected to the board of Danaher Corp, a diversified technology corporation which makes medical devices. At some time he had become President of the Zerhouni Group, which advertised itself as a resource to "pharmaceutical and biotechnology companies, trade organizations, sovereign wealth funds, government agencies, and research entities around the globe."
Zerhouni at the NIH: His Response to the Conflict of Interest Scandal
There is more than a little irony inspired by Zerhouni's quick circuit through the revolving door.
Zerhouni became director of the NIH in 2002, and announced his departure in October, 2008. In December, 2003, David Willman published his landmark article in the Los Angeles Times on severe conflicts of interest affecting NIH scientists and leaders. It revealed that formerly stringent conflict of interest policies at the Institutes were rescinded by then director Dr Harold Varmus in 1995, during the Clinton administration, and increasingly since 1998, disclosure of NIH personnel's conflicts of interest had been reduced. Thus, in 2002, Zerhouni had taken charge of an agency already deeply affected by conflicts of interest affecting many of its leaders, even though that was not yet public. He initially did nothing about the situation.
Willman published another series of articles revealing even more breathtaking conflicts of interest in December, 2004. (See our post here.) By then, a Los Angeles Times editorial said there was the "appearance of corruption" at the NIH, and called for Dr Zerhouni's resignation.
Only after the second series of articles did Dr Zerhouni swing into action (see post here). In February, 2005, he announced that he would now hold the NIH to a "higher standard." Yet new conflict of interest stories kept surfacing and their handling kept provoking concern (e.g., see this post from 2007, and this post from 2008), and concerns about how NIH deals with conflicts of interest affecting the extramural researchers it funds persist to this day (e.g., see this post).
By the late 1990s, the NIH, like many other government agencies, seemed to have become extremely cozy with the world of big corporations. Dr Zerhouni did nothing to obvious to reduce the local version of this coziness until it had become a public scandal. His actions let questions about the relationships of the NIH, once a pristine example of a government run biomedical research agency, with big health care business persist to this day.
So it should perhaps be no surprise that he so quickly transitioned from the government that is supposed to be"of the people, by the people, for the people" to top leadership positions in corporate health care.
Other US Government Health Care Agency Leaders Transit the Revolving Door
Meanwhile, the previous commissioner of the US Food and Drug Administration, Dr Andrew von Eschenbach, is Senior Director for Strategic Initiatives at the Center for Health Transformation, a group whose membership includes some of the biggest health care organizations, many of which have had their own moments in the sun on Health Care Renewal. For example, see Charter Members, AstraZeneca, Sutter Health, and Wellpoint; and Platinum Members, GlaxoSmithKline and Merck. Dr Eschenbach is also on the board of directors of Histosonics Inc.
Also, the previous director of the Centers for Disease Control, Dr Julie Geberding, became President of Merck Vaccines in late 2009.
Conclusions
So the revolving door just keeps spinning, its revolutions suggesting how closely tied together big government and big corporations have become in what is now the health care business. Whatever the motivations of Doctors Zerhouni, von Eschenbach, and Geberding were, the message to every person in a leadership position in health care in the US government has to still be: you too can earn big corporate compensation soon after you leave here. Who knows how much that siren song will lead current government leaders to avoid antagonizing the leaders of big health care corporations during their government "service." That is, of course, not what we want them to be thinking about if government agencies ae to serve the people, not the CEOs of big corporations.
I am sure that the career transitions of Doctors Zerhouni, von Eschenbach, and Geberding were perfectly legal. If we want government health care agencies to put the peoples' interests ahead of those of the CEOs of big health care corporations, should not, however, the law be changed to at least slow down the revolving door?
French drugmaker Sanofi-Aventis (SASY.PA) replaced its head of research and development with a leading academic and former top U.S. health official on Tuesday to raise its game in medical innovations.
The company said Elias Zerhouni would lead R&D of drugs and bring R&D for vaccines under his control too as Sanofi reshapes its portfolio and looks to vaccines as one area for growth to offset sales losses from mounting generic competition.
The appointment of Zerhouni, a professor of radiology and biomedical engineering, comes as Sanofi battles to buy U.S. rare disease specialist Genzyme.
Chief executive Chris Viehbacher brought in Zerhouni in February 2009 as his scientific adviser, shortly after taking charge of the group which he has been transforming to include the development of drugs based on biotechnology.
Zerhouni's Embrace of Corporate Health Care
Although Zerhouni ostensibly left the NIH to return to academia at Johns Hopkins University, note that by February, 2009, four months after his resignation was announced, Zerhouni was already advising the Sanofi CEO.
Soon after he joined the corporate health care world in earnest. In April, 2009, he was proposed for membership on the board of directors of Actelion Ltd, a Swiss biotechnology company. On December 8, 2009, he was elected to the board of Danaher Corp, a diversified technology corporation which makes medical devices. At some time he had become President of the Zerhouni Group, which advertised itself as a resource to "pharmaceutical and biotechnology companies, trade organizations, sovereign wealth funds, government agencies, and research entities around the globe."
Zerhouni at the NIH: His Response to the Conflict of Interest Scandal
There is more than a little irony inspired by Zerhouni's quick circuit through the revolving door.
Zerhouni became director of the NIH in 2002, and announced his departure in October, 2008. In December, 2003, David Willman published his landmark article in the Los Angeles Times on severe conflicts of interest affecting NIH scientists and leaders. It revealed that formerly stringent conflict of interest policies at the Institutes were rescinded by then director Dr Harold Varmus in 1995, during the Clinton administration, and increasingly since 1998, disclosure of NIH personnel's conflicts of interest had been reduced. Thus, in 2002, Zerhouni had taken charge of an agency already deeply affected by conflicts of interest affecting many of its leaders, even though that was not yet public. He initially did nothing about the situation.
Willman published another series of articles revealing even more breathtaking conflicts of interest in December, 2004. (See our post here.) By then, a Los Angeles Times editorial said there was the "appearance of corruption" at the NIH, and called for Dr Zerhouni's resignation.
Only after the second series of articles did Dr Zerhouni swing into action (see post here). In February, 2005, he announced that he would now hold the NIH to a "higher standard." Yet new conflict of interest stories kept surfacing and their handling kept provoking concern (e.g., see this post from 2007, and this post from 2008), and concerns about how NIH deals with conflicts of interest affecting the extramural researchers it funds persist to this day (e.g., see this post).
By the late 1990s, the NIH, like many other government agencies, seemed to have become extremely cozy with the world of big corporations. Dr Zerhouni did nothing to obvious to reduce the local version of this coziness until it had become a public scandal. His actions let questions about the relationships of the NIH, once a pristine example of a government run biomedical research agency, with big health care business persist to this day.
So it should perhaps be no surprise that he so quickly transitioned from the government that is supposed to be"of the people, by the people, for the people" to top leadership positions in corporate health care.
Other US Government Health Care Agency Leaders Transit the Revolving Door
Meanwhile, the previous commissioner of the US Food and Drug Administration, Dr Andrew von Eschenbach, is Senior Director for Strategic Initiatives at the Center for Health Transformation, a group whose membership includes some of the biggest health care organizations, many of which have had their own moments in the sun on Health Care Renewal. For example, see Charter Members, AstraZeneca, Sutter Health, and Wellpoint; and Platinum Members, GlaxoSmithKline and Merck. Dr Eschenbach is also on the board of directors of Histosonics Inc.
Also, the previous director of the Centers for Disease Control, Dr Julie Geberding, became President of Merck Vaccines in late 2009.
Conclusions
So the revolving door just keeps spinning, its revolutions suggesting how closely tied together big government and big corporations have become in what is now the health care business. Whatever the motivations of Doctors Zerhouni, von Eschenbach, and Geberding were, the message to every person in a leadership position in health care in the US government has to still be: you too can earn big corporate compensation soon after you leave here. Who knows how much that siren song will lead current government leaders to avoid antagonizing the leaders of big health care corporations during their government "service." That is, of course, not what we want them to be thinking about if government agencies ae to serve the people, not the CEOs of big corporations.
I am sure that the career transitions of Doctors Zerhouni, von Eschenbach, and Geberding were perfectly legal. If we want government health care agencies to put the peoples' interests ahead of those of the CEOs of big health care corporations, should not, however, the law be changed to at least slow down the revolving door?
Cleaning Outdoor Clothes
Now that it's winter, I'm wearing base layers, soft-shells, and hard-shells to keep warm while hiking, skiing, and winter mountaineering.
Recently, while hiking in a wintry mix of snow, sleet, and rain, I noticed that my 5 year old Gore-tex jacket was wetting out - the water was not beading off the surface.
Admittedly, the manufacturer of my shells recommends washing them after every 10 to 12 days of hard use or every 20 to 30 days of light use. They also recommend applying durable water repellent (DWR) treatment when water stops beading off the fabric. Since I've climbed every peak in New England in winter conditions over the past 5 years, it was definitely time to wash them for the first time (I know, that sounds disgusting). I'd never washed Gore-tex hard-shells or Power Shield soft-shells, so I had to do some research.
Here's what I found.
To prepare the garment for washing, close the main zippers and pit zips, open pocket zippers, and release tension on all elastic draw cords. You should follow the washing instructions on the garment label, which are likely to be cryptic international symbols. Here's a "Laundry Rosetta Stone" that tells you everything you need to know.
In my case, my Arcteryx Alpha SV Jacket instructions told me to wash the garment on a medium heat setting (40�C). Arcteryx recommended a free-rinsing soap or non-detergent cleaning agent to wash Gore-tex. The washing product should be free of surfactants and detergents, fabric softeners, enzymes, perfumes, or whiteners since these chemicals tend to be hydrophilic (attract water) and can reduce the effectiveness of the durable water repellent (DWR) treatment on your garment. Specifically they recommended Granger's Performance Wash. If you only have access to normal laundry soaps simply rinse the garment with a second rinse cycle in order to completely remove any residual cleaning chemicals.
Once the jacket was clean, I needed to reapply the durable water repellent treatment. DWR is a polymer substance applied to the face-fabric of a Gore-tex garment. Arcteryx recommended Granger's XT Proofer spray because the technologies complement the garment's original DWR treatment. They do not recommend using a wash-in DWR treatment.
After washing, I closed all zippers, hung the wet garment on a hanger and sprayed Granger's XT Proofer evenly onto the wet face fabric of the garment. Next, I placed the garment in a tumble drier on a medium heat setting (40�C) for 40 minutes (Yes you can tumble dry Gore-tex garments safely). The heat maximizes the effectiveness of the DWR treatment.
After washing, DWR treating, and drying, my Gore-tex jacket looked and worked like the day I purchased it. The process was so successful that I repeated it with all my soft-shells and wind shells.
Now that I'm a Gore-tex cleaning expert, I'll wash my outdoor gear a bit more often. Once in five years is definitely not recommended!
Recently, while hiking in a wintry mix of snow, sleet, and rain, I noticed that my 5 year old Gore-tex jacket was wetting out - the water was not beading off the surface.
Admittedly, the manufacturer of my shells recommends washing them after every 10 to 12 days of hard use or every 20 to 30 days of light use. They also recommend applying durable water repellent (DWR) treatment when water stops beading off the fabric. Since I've climbed every peak in New England in winter conditions over the past 5 years, it was definitely time to wash them for the first time (I know, that sounds disgusting). I'd never washed Gore-tex hard-shells or Power Shield soft-shells, so I had to do some research.
Here's what I found.
To prepare the garment for washing, close the main zippers and pit zips, open pocket zippers, and release tension on all elastic draw cords. You should follow the washing instructions on the garment label, which are likely to be cryptic international symbols. Here's a "Laundry Rosetta Stone" that tells you everything you need to know.
In my case, my Arcteryx Alpha SV Jacket instructions told me to wash the garment on a medium heat setting (40�C). Arcteryx recommended a free-rinsing soap or non-detergent cleaning agent to wash Gore-tex. The washing product should be free of surfactants and detergents, fabric softeners, enzymes, perfumes, or whiteners since these chemicals tend to be hydrophilic (attract water) and can reduce the effectiveness of the durable water repellent (DWR) treatment on your garment. Specifically they recommended Granger's Performance Wash. If you only have access to normal laundry soaps simply rinse the garment with a second rinse cycle in order to completely remove any residual cleaning chemicals.
Once the jacket was clean, I needed to reapply the durable water repellent treatment. DWR is a polymer substance applied to the face-fabric of a Gore-tex garment. Arcteryx recommended Granger's XT Proofer spray because the technologies complement the garment's original DWR treatment. They do not recommend using a wash-in DWR treatment.
After washing, I closed all zippers, hung the wet garment on a hanger and sprayed Granger's XT Proofer evenly onto the wet face fabric of the garment. Next, I placed the garment in a tumble drier on a medium heat setting (40�C) for 40 minutes (Yes you can tumble dry Gore-tex garments safely). The heat maximizes the effectiveness of the DWR treatment.
After washing, DWR treating, and drying, my Gore-tex jacket looked and worked like the day I purchased it. The process was so successful that I repeated it with all my soft-shells and wind shells.
Now that I'm a Gore-tex cleaning expert, I'll wash my outdoor gear a bit more often. Once in five years is definitely not recommended!
Wednesday, December 29, 2010
Medical transcription outsourcing: Changing with the times
Healthcare sector by its very nature is a dynamic sector having to change with the changing demands placed on it from various sources. As the healthcare sector is part of essential services the demands placed on it are numerous, encompassing patients, healthcare professionals, pharmaceuticals, insurance providers and the regulatory authorities. To meet the varied often contradictory demands placed on them, the healthcare sector draws support and inputs from various sources.
One such source that aids the healthcare sector in meeting demands placed on it is information from patient medical records. Medical transcription is the process of creating patient medical records from the dictation of the healthcare professional, detailing the patient- healthcare professional encounter. In the initial stages of the process of creating patient medical records was part of the operations of the healthcare facility. But it was soon realized that the medical transcription process is not only a specialized process requiring the right combination of people, processes and technology, but having medical transcription in-house also dilutes the focus of healthcare facility on the core business.
It was acknowledged that outsourcing medical transcription to a professional medical transcription service provider would ensure services that meet all the quality standards and would also help the healthcare facilities save on costs substantially. Today, medical transcription services have evolved into services beyond that of converting audio files into text files. The services provided by medical transcription service providers have the following advantages:
Service with utility based standards: Outsourced medical transcription service providers provide services that are based on solutions that are utility based and ease the working life of healthcare professionals and support staff by providing medical transcription services that have features like:
- Retaining familiar modes of dictation and facilitating automatic upload of audio files
- Enabling healthcare professionals and support staff of the healthcare facility to keep track of work in progress
- Providing options for secure and quick document delivery
- Enabling healthcare professionals to retain familiar methods of dictation- transcription while still allowing for adoption of EMR
Expertise of the service provider: The expertise of the outsourced medical transcription service provider has added to the ease of use of medical transcription services by providing all the benefits while still retaining easy to use utility features. The expertise of the service provider also helps them provide more refined services with regard to accuracy by refining the training methods. The technical expertise of the service provider helps in improving turnaround time and security.
Focus on content: Outsourced medical transcription service providers have refined their services to focus on the quality of content in the transcripts ensuring accurate and quality capture of details. This enables provision of better care and quicker and more comprehensive coding and billing.
Working with the healthcare professional and healthcare facility to anticipate problems and create solutions: Instead of presenting healthcare facilities and healthcare professionals with standardized services, outsourced medical transcription service providers have started working with them to anticipate requirements and create solutions.
TransDyne, a leader in the outsourced medical transcription industry has used their extensive background in information technology and their experience in serving the needs of the healthcare sector to provide affordable and integrated medical transcription solutions.
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Spine Surgeons Reticent About Disclosing Huge Medtronic Payments
Starting in 2007, we posted (here, here, here, here and here) about the payments, often huge, that five manufacturers of prosthetic joints (Biomet, DePuy Orthopaedics (a unit of Johnson & Johnson), Stryker Orthopedics,a unit of Stryker Inc, Zimmer Holdings, and Smith & Nephew) revealed they made to orthopedic surgeons and various academic and other organizations. We also noted that some of the leadership of the major orthopedic societies have received substantial amounts from these companies, as have the societies themselves.
In 2008, our post on this subject noted the minimal disclosure some of the surgeons receiving these huge payments made when writing scholarly articles on related topics. In 2009, an article in the New England Journal of Medicine showed that almost 30% of surgeons who got such payments in 2007 failed to disclose them when they presented at the 2008 American Academy of Orthopedic Surgeons meeting.(1)
Medtronic's Payments to Spine Surgeons
This month, the media reported that Medtronic also made payments, sometimes huge, to orthopedic and spine surgeons (see this post by Dr Howard Brody on the Hooked: Ethics, Medicine and Pharma blog, and our summary post here.)
Now further investigation by John Fauber of the Milwaukee Journal-Sentinel suggests that surgeons receiving often huge payments from Medtronic may not have been good at disclosing them either.
The article examined payments made to surgeons who authored two major studies about bone morphogenetic protein-2, a biologic drug manufactured by Medtronic used to promote bone growth at surgical sites:
No Disclosure in a 2002 Article
The Journal-Sentinel article referred to two scholarly articles written about BMP-2. Regarding the first,
Regarding the lack of disclosures made in the first article,
Little Disclosure in the 2004 Article
Regarding the second article,(2)
Regarding the disclosures made in the second article,
So here we go again. Once again we see an example of a single medical device company paying heroic amounts, hundreds of thousands to over a million dollars a year, to surgeons ostensibly as royalties for their intellectual property. The company and the surgeons were all rather cagey about the nature of the intellectual property for which the money was paid, and about the justification for the size of the payments.
While it is likely that the payments have been going on for a while, previous influential articles written by some of the surgeons receiving the payments contained at best minimal disclosure of their financial relationships with Medtronic, and gave no hint about the magnitude of these relationships. These previous influential articles seemed more enthusiastic about a Medtronic product than was justified by their results. Of course, maybe getting hundreds of thousands or millions of dollars a year from a commercial health care firm could lead to some excess enthusiasm about its products.
It seems that every drug, biotechnology, and device company has its stable of highly paid physicians and surgeons who can be counted on for their enthusiasm about the companies' products, and their reticence about their financial relationships with the companies. We have often discussed the pervasiveness of the web of conflicts of interest that seems to link most commercial health care firms with most influential medical academics and practitioners. The web seems even more pervasive than we once imagined, and the conflicts seem even more intense.
Those who laud ties between academic medicine and industry may perseverate about how collaboration leads to innovation, while denying that mere money can influence professional judgement. However, it is difficult to imagine how even the most well-intentioned professional would not be influenced by hundreds of thousands or millions of dollars a year. When professionals hide the magnitude of such relationships, it only raises more suspicions that they know they have something to hide because they realize they have been bought.
The ever increasing revelations about conflicts of interest pervading academic medicine should inspire extreme skepticism about clinical research or clinical teaching supported in any way by commercial interests. At the very least, these revelations justify the need for detailed and complete disclosure of all financial relationships among commercial health care firms and academic and practicing physicians, and others who make or influence health care decisions.
I suspect that if such full disclosure took place, physicians, other health care professionals and the public, at least those who had not been paid themselves, would be so aghast that such relationships would not remain legal for long.
References
1. Okike K, Kocher MS, Wei EX, Mehlman CT, Bhandari M. Accuracy of conflict-of-interest disclosures reported by physicians. N Engl J Med 2009; 361:1466-1474.
2. Haid RW, Branch CL, Alexander JT, Burkus JK. Posterior lumbar interbody fusion using recombinant human bone morphogenetic protein type 2 with cylindrical interbody cates. The Spine Journal 2004; 4: 527-539.
In 2008, our post on this subject noted the minimal disclosure some of the surgeons receiving these huge payments made when writing scholarly articles on related topics. In 2009, an article in the New England Journal of Medicine showed that almost 30% of surgeons who got such payments in 2007 failed to disclose them when they presented at the 2008 American Academy of Orthopedic Surgeons meeting.(1)
Medtronic's Payments to Spine Surgeons
This month, the media reported that Medtronic also made payments, sometimes huge, to orthopedic and spine surgeons (see this post by Dr Howard Brody on the Hooked: Ethics, Medicine and Pharma blog, and our summary post here.)
Now further investigation by John Fauber of the Milwaukee Journal-Sentinel suggests that surgeons receiving often huge payments from Medtronic may not have been good at disclosing them either.
The article examined payments made to surgeons who authored two major studies about bone morphogenetic protein-2, a biologic drug manufactured by Medtronic used to promote bone growth at surgical sites:
Over the last decade, a small group of prominent surgeons from around the country has been enlisted by medical device-maker Medtronic to do clinical research or write articles about the company's new spine surgery product.
This year alone, many of those doctors received payments of hundreds of thousands to millions of dollars each in royalties for a variety of other Medtronic spinal devices, according to a Journal Sentinel analysis of newly released company payments. Medtronic began disclosing the payments this year, in advance of a federal requirement set to take effect in 2013.
Since it won approval for narrow uses in 2002, the product - bone morphogenetic protein-2, known as BMP-2 - has been an increasingly dominant force in spinal fusion surgery, with sales of about $800 million a year, often for use in other procedures.
Independent doctors say the product's success is due largely to positive findings made by the surgeons affiliated with the company.
Doctors involved with two of the many research articles on BMP-2 published since it was approved - one in 2002, the other in 2004 - received a combined $6 million in royalties this year for other Medtronic spinal products, the newspaper found. The payments went directly to the doctors or business entities they are associated with.
No Disclosure in a 2002 Article
The Journal-Sentinel article referred to two scholarly articles written about BMP-2. Regarding the first,
At the time BMP-2 was approved in 2002, little was known about the financial connections between Medtronic and doctors associated with the clinical trial. Likewise, little was known that year when the Journal of Spinal Disorders & Techniques published the article on the trial.[Note: I am unable to find this article using standard search techniques, so I cannot give a citation for it.]
The paper made no mention of doctors getting royalties or having any financial connection to the company.
Regarding the lack of disclosures made in the first article,
The four co-authors of a 2002 paper about that trial received a total of $2.8 million this year from Medtronic in royalties for products not including BMP-2.
The paper made no mention of any financial relationship between the authors and Medtronic.
Burkus, who also was involved in the 2004 study, again declined to say if he was receiving royalties from Medtronic or if had some other financial connection with the company at the time the 2002 paper was published. He got $573,000 through September.
Curtis Dickman, a Phoenix surgeon, did not respond to phone calls and e-mails. He and Vantage Investments LLC received $306,000 in royalties.
Matthew Gornet, a St. Louis surgeon, and Gornet Enterprises got $591,000 in royalty payments.
Gornet said he did not have a financial connection with the company at the time of the study, though he developed a relationship as a consultant right after the trial, an arrangement that ended after about a year.
He said his patent rights with Medtronic did not begin until 2003 and none of his royalties involves BMP-2.
The last author listed was Thomas Zdeblick, an orthopedic surgeon at the University of Wisconsin School of Medicine and Public Health. Through September, he and Taz Consulting received $1.4 million in royalties for a variety of products.
Other records show Zdeblick has received more than $23 million in royalties from Medtronic since 2002.
In an e-mail, Zdeblick said he had no financial interest in BMP-2. He does receive royalties for the invention of the LT-Cage, which was used in the BMP-2 clinical trial, but the two products are sold separately.
Little Disclosure in the 2004 Article
Regarding the second article,(2)
Three of the four authors of a 2004 article on the study of the productare listed as receiving nearly $4 million this year in royalties from Medtronic for a variety of spinal products, not BMP-2.
That paper was important because it involved a clinical trial that had to be stopped because the product was causing troubling bone formation in the spinal canal of patients. In the paper, that finding was downplayed, with the authors describing the results as 'encouraging.'
[Professor Dan] Spengler, the Vanderbilt orthopedic surgeon and former medical journal editor, said he doubted the paper would have been written in such positive terms by authors without financial ties to Medtronic.
He described the article as egregious, saying it 'just blew off the complications. It's a horrible article.'
Orthopedic surgeon [University of California - Irvine Clinical Professor Charles] Rosen said the paper was biased, calling it 'more of a marketing paper than an objective scientific study.'
Regarding the disclosures made in the second article,
The article described three of the authors as consultants to Medtronic, though it did not disclose that any of them were receiving royalties at the time.Summary
Regis Haid, lead author of the article and an Atlanta neurosurgeon, told the Journal Sentinel he was getting royalties for other Medtronic products. Haid noted disclosure rules for medical journals have become more stringent in recent years.
He said BMP-2 provides excellent benefit to patients, adding he had it implanted in his own neck in an off-label procedure. ;I have BMP in me, and I would put it in you . . . ,' he told a reporter.
Through September, Haid and Spinal Engineering LLC received about $2 million in royalties this year from Medtronic.
Meanwhile, co-author Ken Burkus, a Columbus, Ga., surgeon, and RBCK Research & Consulting, received $573,000.
'Very importantly, you cannot assume that such royalty payments were made prior to 2010,' he said in an e-mail, declining to say whether he got royalties at the time the paper was written. 'I follow the rules to my fullest ability as put forward by the specific journal.'
He took issue with criticism that the paper put a positive spin on a troubling clinical trial.
'I believe the words used were appropriate . . . ,' he said. 'I believe the words used were neither 'positive nor negative' but rather were representative of the data presented.'
He said if other doctors have problems with the paper, they should take it up with the editor of the journal: 'They can write a letter to the editor.'
Co-author Charles Branch Jr., chairman of neurosurgery at Wake Forest University, and the university itself have received $1.2 million in royalties this year.
A spokeswoman for the university said it owns the intellectual property rights to Branch's patents and that royalties generally are split with 35% to the individual and 65% to the university. None of those royalties involved BMP-2, university media relations manager Bonnie Davis said in an e-mail.
She said Branch and Wake Forest were getting royalties at the time the paper was published, but not when the trial was going on.
In a separate e-mail, Branch said use of the term 'encouraging' in the paper 'was not a strong endorsement,' but, rather, recognition that patients getting BMP-2 had superior results to those receiving a traditional bone graft.
So here we go again. Once again we see an example of a single medical device company paying heroic amounts, hundreds of thousands to over a million dollars a year, to surgeons ostensibly as royalties for their intellectual property. The company and the surgeons were all rather cagey about the nature of the intellectual property for which the money was paid, and about the justification for the size of the payments.
While it is likely that the payments have been going on for a while, previous influential articles written by some of the surgeons receiving the payments contained at best minimal disclosure of their financial relationships with Medtronic, and gave no hint about the magnitude of these relationships. These previous influential articles seemed more enthusiastic about a Medtronic product than was justified by their results. Of course, maybe getting hundreds of thousands or millions of dollars a year from a commercial health care firm could lead to some excess enthusiasm about its products.
It seems that every drug, biotechnology, and device company has its stable of highly paid physicians and surgeons who can be counted on for their enthusiasm about the companies' products, and their reticence about their financial relationships with the companies. We have often discussed the pervasiveness of the web of conflicts of interest that seems to link most commercial health care firms with most influential medical academics and practitioners. The web seems even more pervasive than we once imagined, and the conflicts seem even more intense.
Those who laud ties between academic medicine and industry may perseverate about how collaboration leads to innovation, while denying that mere money can influence professional judgement. However, it is difficult to imagine how even the most well-intentioned professional would not be influenced by hundreds of thousands or millions of dollars a year. When professionals hide the magnitude of such relationships, it only raises more suspicions that they know they have something to hide because they realize they have been bought.
The ever increasing revelations about conflicts of interest pervading academic medicine should inspire extreme skepticism about clinical research or clinical teaching supported in any way by commercial interests. At the very least, these revelations justify the need for detailed and complete disclosure of all financial relationships among commercial health care firms and academic and practicing physicians, and others who make or influence health care decisions.
I suspect that if such full disclosure took place, physicians, other health care professionals and the public, at least those who had not been paid themselves, would be so aghast that such relationships would not remain legal for long.
References
1. Okike K, Kocher MS, Wei EX, Mehlman CT, Bhandari M. Accuracy of conflict-of-interest disclosures reported by physicians. N Engl J Med 2009; 361:1466-1474.
2. Haid RW, Branch CL, Alexander JT, Burkus JK. Posterior lumbar interbody fusion using recombinant human bone morphogenetic protein type 2 with cylindrical interbody cates. The Spine Journal 2004; 4: 527-539.
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Defining Business Requirements
In my recent blog about consultants, I highlighted the work of Robert X. Cringely, who noted that most IT projects fail at the requirements stage. This is topic worth its own blog post.
In my roles at various institutions, I've had the opportunity to work with thousands of highly diverse stakeholders. Some are IT savvy, some are not. Some are project management savvy, some are not. Some understand leading practices for their particular departmental functions, some do not.
Here's what I've learned.
1. Automating a dysfunctional manual process will not yield a successful performance improvement outcome. Before any technology project is launched, the business owners need to understand their own process flows and goals for improving them.
2. If business owners cannot define their future state workflows, software is not going to do it for them. Sometimes, business owners tell me "I need to buy a wonderful niche software package from XYZ vendor." When I ask how they will use it, they answer that the software will define their workflow for them.
3. The IT department can impose governance and project management processes to ensure that future state workflows and requirements are defined prior to any procurement processes. However, the business owners who are least experienced with project management methodology will accuse the IT department of slowing down the purchase. One way around this is to create an institutional project management office outside of the IT department which serves as a bridge between the business owners and the IT organization providing the service. Such an approach adds expert resources to the department requesting automation to lead them through a requirements definition process as a first step. Projects without clear requirements and goals can be stopped before they expend time and money on an implementation that is likely to fail.
4. Some departments will try to circumvent governance prioritization and project management processes by contributing departmental funds, obtaining a grant, or getting a donor to fund their software purchases. Such as approach should not be allowed for many reasons. Software licensing is generally about 20% of total implementation cost which includes hardware, configuration, interfacing, testing, training, and support costs. Every software implementation is a project and needs to be considered a use of scarce IT resources. It is reasonable to initiate an automation request through a project management office to define business requirements and goals, then present it to a governance process for prioritization, then fund the total project costs via departmental/grant/donor dollars if the project is deemed a high priority for implementation.
5. Creating formal documentation of business requirements, goals/success metrics, and forecasted financial impact is important to establish ownership of the project by the sponsoring department. Although infrastructure projects such as provisioning networks, desktops, storage, and servers can be owned by the IT department, application projects should never be owned or sponsored by the IT department. The business owner, working with the institutional project management office, needs to drive the implementation to achieve the desired process improvement and to ensure appropriate change management. If the project is considered an IT effort, then business owners will claim their lack of requirements definition or process redesign is an IT failure based on poorly designed or implemented software.
Thus, however unpopular it makes the CIO, insist on business owner sponsorship with defined requirements, goals, and accountability for process and people change management. Every project I've been involved in that includes this role for the business owner has been successful. With clearly defined responsibilities and accountability, customer satisfaction with these projects has been high, because business owners feel compelled to make the project a success rather than expect IT to deliver a finished project to them.
Food Allergy Ball at Waldorf Raises Millions
The 13th annual Food Allergy Ball was held Monday, December 6, 2010 at The Waldorf-Astoria in New York. The evening raised over $4.5 million, which will benefit the Food Allergy Initiative’s research activities and educational programs.
Gift bags featured items like cupcakes from Izzi B's, cookies from Sweet Loren's cookies, and chocolate bars by Divvies. All food served had clearly displayed labels listing all ingredients.
Check out these beautiful pictures from Black Tie magazine showcasing the 13th annual event. What a great way to raise money and awareness for food allergies.
Gift bags featured items like cupcakes from Izzi B's, cookies from Sweet Loren's cookies, and chocolate bars by Divvies. All food served had clearly displayed labels listing all ingredients.
Check out these beautiful pictures from Black Tie magazine showcasing the 13th annual event. What a great way to raise money and awareness for food allergies.
Tuesday, December 28, 2010
Three tips to save health care firms big bucks
Health care providers don’t anticipate the reimbursement rates they get from insurance companies or the federal government to take a giant leap any time soon.
So they’re looking to collect every dollar they’re entitled to under current contracts.
And Bob Stevens, CEO of Crescent Springs-based Bottom Line Systems, is helping them. His company looks for cases where providers have been underpaid.
Bottom Line Systems collected more than $70 million in additional reimbursement for clients over the last year.
The 14-year-old company has 200 employees and serves clients, including hospitals, physician practices and infusion companies, in 20 states. It’s recently been growing revenue by 10 percent to 20 percent per year.
Stevens, who also is a partner in the Crestview Hills-based law firm Dressman Benzinger LaVelle, offers several tips for providers seeking to maximize their revenue in the new year:
• Review contracts carefully. Nearly every dollar that passes through a hospital is covered by a contract or a regulatory system. Knowing the fine print in every agreement is the only way providers can know whether they’re being reimbursed properly.
• Test every payment. Nowadays, periodic audits and sampling are not enough, Stevens said. “There’s so much complexity and opportunity that when you go ahead and review all the claims, the payoff is more than worth the effort.”
• Don’t be afraid to seek outside help. Stevens’ firm operates almost entirely on a contingency basis. “We’re at risk, so I wouldn’t be doing the review if I didn’t think it was worth it,” he said.
A typical hospital, Stevens said, can increase its net revenue between 1 percent and 3 percent by implementing such a review process.
Medical transcription services: Proactive to the needs of healthcare professionals and healthcare facilities
Healthcare is a sector that is dependent on various sources to be able to provide quality services. Apart from the skill, qualification and experience of healthcare professionals and other staff, the healthcare process draws support from various sources like laboratories, pharmaceuticals, surgical and other healthcare equipment to be able to deliver quality healthcare. The process of healthcare as well as healthcare professionals have to document every step in the process of healthcare. This ensures that they can draw information from these records for various purposes. The information in patient medical records also provide valuable inputs to other entities who are involved in other aspects of successfully running a healthcare facility.
The inputs for the data that form a part of the patient medical record comes from various sources including:
- Critical care
- Emergency department
- Pharmacy
- Laboratory
- Radiology
- Cardiology
- Labor & delivery
The information from patient medical records is utilized by:
- The coding and billing department
- Health information management professionals
- Risk managers
- Reporting to statutory authorities
- People involved in scheduling patient visits
The smooth and profitable running of healthcare facilities depend on not only accurate and timely information but also easy access to the information.
Medical transcription is the process of creating patient medical records of the patient- healthcare professional encounter. As information from patient medical records is vital for smooth running of healthcare facilities and helps them in various aspects of running the healthcare facility, it is important that the medical transcription process meets all the quality criteria. As medical transcription is a specialized skill and the role of medical transcription services has evolved to fulfill a broader role in aiding the healthcare process, the prudent option for healthcare facilities is to outsource medical transcription to a professional medical transcription service provider.
Outsourcing medical transcription to a professional service provider helps the documentation process in various aspects, including creating proactive solutions based on the developing requirements of the healthcare facility, healthcare professionals and fulfilling statutory requirements
How does outsourced medical transcription services provide proactive solutions?
- Providing software and tools for medical transcription: The process of medical transcription requires a foolproof system to ensure collection & transmission of dictation files and a process by which the finished transcripts are made available to the healthcare professional through document delivery modes of their choice. The software and tools provided by the medical transcription service provider needs to not only ensure speed and convenience but also ensure security throughout the medical transcription process
- Archives: The information from patient medical records provide useful inputs for various purposes to different departments in the healthcare facility. It is important that the healthcare professionals and the support staff at the healthcare facility have easy access to older transcripts. Outsourced medical transcription service providers provide archiving systems that enable easy access.
- Retaining the tried and tested way of information assimilation: With the prospect of adopting EMR/ EHR systems looming in the horizon, outsourced medical transcription service providers can provide major support to healthcare facilities and healthcare professionals to retain tried and tested methods of information assimilation by facilitating EMR adoption through HL7 interface.
- Speech recognition transcription: Speech recognition software has been adopted by many healthcare professionals. Though this software meets the turnaround time requirements, it requires extensive editing and proofreading to meet acceptable accuracy standards. Outsourced medical transcription service providers have stepped into the breach and are providing editing and proofreading services for these transcripts.
Outsourced medical transcription service providers have always anticipated the needs of healthcare documentation by studying the way the healthcare system works. They have used the right software and tools to provide services that meet the quality criteria of accuracy, turnaround time and security, while reducing prices and retaining convenience and familiar working modes.
TransDyne, a leader in the outsourced medical transcription industry has used their extensive background in information technology and their experience in serving the needs of the healthcare sector to provide affordable and integrated medical transcription solutions.
TransDyne offers quality medical transcription at reasonable prices, executed by experienced and qualified medical transcriptionists with a very quick turnaround time executed through secure HIPAA and HITECH compliant channels, with very high levels of accuracy and all this with technology that is advanced but easy to use!
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How Marketing Mixes Into Medical School Curricula - an Example from Canada
Misery loves company, so here is an interesting case reported by the Canadian Press, via CTV News, about how students in a pain management course at the University of Toronto complained that marketing seemed to have been mixed into their curriculum:
It turned out that:
Dr Jovey defended handing out the free book produced by his part-time employer:
However, it appeared that the "darn good" book's content was biased in favor of Purdue's product, Oxycontin:
A subsequent inquiry has recommended revising the curriculum and dispensing with the drug company funded book.
This is another example of how marketing has infiltrated medical education. It suggests that market influenced education likely includes not only opinions in favor of the specific product being marketed, but distortions of fact to support the product that are hardly evidence-based.
Furthermore, it shows how conflicts of interest facilitate marketing influenced medical education. Note that the bringer of the biased textbooks in this case was being paid honoraria to speak on behalf of the pharmaceutical company, but presumably not to teach the particular course in question. However, his enthusiasm readily carried over to his work in that course.
We have discussed how pharmaceutical marketers regard the "key opinion leaders" whom they pay to speak as salespeople. One would expect salespeople to be enthusiastic for their product even outside of their normal working hours. In my humble opinion, this is why no medical academic should be allowed to simultaneously be a commercially paid "key opinion leader."
By the way, note that this case also suggests how the issues we discuss on Health Care Renewal are relevant globally, not just to the US. I tend to be wary of blogging about cases in other countries, since there may be subtle difference in context across countries that might make interpretation of cases more difficult when viewing them from abroad. However, I think that the facts and language here are straightforward enough for me to be fairly confident about what was going on. Nonetheless, if any Canadian think I have got this wrong, please let me know.
Meanwhile, if anyone is blogging about similar issues from beyond the US shores, please let me know so I can add their work to our blog roll.
Hat tip to Prof Margaret Soltan on the University Diaries blog.
The complaint centered around students being provided a book on managing chronic pain that was funded and copyrighted by the maker of the prescription pain killer OxyContin. The book had been brought in by a non-faculty lecturer with financial ties to the drug company.
It turned out that:
From 2002 to 2006, the pain course was funded by donations, included $117,000 in unrestricted educational grants from four drug companies -- Merck-Frosst, Purdue Pharma, Pharmacia Canada and Pfizer -- although they had no input into course content. Since 2007, the program has been funded solely from faculty budgets.
[Dean of Dentistry Dr David] Mock said Purdue's copyrighted book on pain management had been brought in by Dr. Roman Jovey, an unpaid guest lecturer and co-author of the book who left copies 'for anyone to take.' Jovey, medical director for a chain of clinics called the Centres for Pain Management, is a member of Purdue's speakers' bureau, paid by the company to conduct workshops and lectures.
Dr Jovey defended handing out the free book produced by his part-time employer:
Jovey confirmed he had left copies of the 371-page book, entitled 'Managing Pain: The Canadian Health Care Professionals Reference,' for students.
'It was a gift from Purdue. I'm not at all embarrassed or ashamed. I think it's a darn good book.
"If we all want to be politically correct and have the appearance of being politically correct, then I guess I get it, that nothing that has any kind of pharma logo or name or ownership should be given out to medical students,' he said Wednesday.
'But the losers are the medical students because I think it's a high-quality book, it's very readable and they're deprived of it this year because of this controversy. And I guess they will be in the future.'
However, it appeared that the "darn good" book's content was biased in favor of Purdue's product, Oxycontin:
Dr. Irfan Dhalla said he has concerns about the content of the book, which a medical student taking the course brought to his attention.
'There are definitely things that are not consistent with the evidence,' said Dhalla, a staff physician at St. Michael's Hospital and a lecturer at the university. 'For example, oxycodone ... is listed as a moderate-potency opioid, when I think everybody agrees it's a very strong opioid, up to twice as strong as morphine.'
While it's appropriate to prescribe oxycodone for severe acute pain or cancer pain, Dhalla said the book suggests that physicians can prescribe the drug for chronic non-cancer pain with relative safety for the patient.
'And I think people with experience know that that is just not the case. When you prescribe to people with chronic non-cancer pain, it's very difficult to do that safely,' he said, noting that the book pays little attention to issues of addiction and deaths from overdose.
'The book in several places makes reference to a claim that the rates of addiction if opioids are used for chronic non-cancer pain are very low. And they're not nearly as low as is claimed in the book.'
In fact, a study by Dhalla and colleagues published last year showed prescription rates for opioids -- including OxyContin, a long-acting form of oxycodone -- soared in Ontario over the last two decades, as did the number of deaths linked to the narcotic.
A subsequent inquiry has recommended revising the curriculum and dispensing with the drug company funded book.
This is another example of how marketing has infiltrated medical education. It suggests that market influenced education likely includes not only opinions in favor of the specific product being marketed, but distortions of fact to support the product that are hardly evidence-based.
Furthermore, it shows how conflicts of interest facilitate marketing influenced medical education. Note that the bringer of the biased textbooks in this case was being paid honoraria to speak on behalf of the pharmaceutical company, but presumably not to teach the particular course in question. However, his enthusiasm readily carried over to his work in that course.
We have discussed how pharmaceutical marketers regard the "key opinion leaders" whom they pay to speak as salespeople. One would expect salespeople to be enthusiastic for their product even outside of their normal working hours. In my humble opinion, this is why no medical academic should be allowed to simultaneously be a commercially paid "key opinion leader."
By the way, note that this case also suggests how the issues we discuss on Health Care Renewal are relevant globally, not just to the US. I tend to be wary of blogging about cases in other countries, since there may be subtle difference in context across countries that might make interpretation of cases more difficult when viewing them from abroad. However, I think that the facts and language here are straightforward enough for me to be fairly confident about what was going on. Nonetheless, if any Canadian think I have got this wrong, please let me know.
Meanwhile, if anyone is blogging about similar issues from beyond the US shores, please let me know so I can add their work to our blog roll.
Hat tip to Prof Margaret Soltan on the University Diaries blog.
A Secure Transport Strawman
Over the past few years, I've posted many blogs about the importance of transport standards. Once a transport standard is widely adopted, content will seamlessly flow per Metcalfe's law. We already have good content standards from X12, HL7, ASTM, and NCPDP. We already have good vocabulary standards from NLM, Regenstrief, IHTSDO and others. We have the beginnings of transport standards from CAQH, IHE, and W3C. We have the work of the NHIN Direct Project (now called the Direct Project).
After working with Dixie Baker/the HIT Standards Committee's Privacy and Security Workgroup on the Direct evaluation and after many email conversations with Arien Malec, I can now offer a strawman plan for transport standards.
Based on the implementation guides currently available, the HIT Standards Committee evaluation found the SMTP/SMIME exchange defined by the Direct Project sufficiently simple, direct, scalable, and secure, but stressed the need to develop implementation guidance that is clear and unambiguous. I've received many emails and blog comments about SMTP/SMIME verses other approaches. I believe I can harmonize everything I've heard into a single path forward.
A "little guy" such as a 2 doctor practice in rural America wants to send content to another 2 doctor practice across town. These small practices should not have to operate servers or have to pay for a complex health information exchange infrastructure. Healthcare Information Services Providers (HISPs) should provide them the means to exchange data as easily as Google provides Gmail or Verizon FIOS provides ISP service. All HISP to HISP communications should be encrypted such that the sending practice and receiving practice can exchange data without any HISP in the middle being able to view the contents of the data exchanged.
In my opinion, for this type of exchange
Small Practice 1 ---> HISP 1 ----> HISP 2 ----> Small Practice 2
SMTP/SMIME at an organizational level is the right transport solution. By organizational level, I mean that one certificate is used for the sending organization and one for the receiving organization. There is no need to issue certificates to individual people involved in the exchange.
SMTP/SMIME at an organizational level encrypts, integrity protects, and digitally signs the payload at the point where the message is created. The payload can be sent through multiple intermediaries to the receiver with assurance that the message will be readable only by the intended receiver.
Given the policy guidance to support the little guy, any practice in the country that wants to send any content securely to any other practice without risk of viewing by any intermediary, SMTP/SMIME is sufficient and appropriate.
For other types of exchanges with different policy constraints, TLS is more flexible and functional. In Massachusetts, NEHEN is a federated HIE, enabled by placing open source software within the networks of each participating institution. Server to Server communication is a SOAP exchange over TLS. In this case, the HISP resides within the firewall of each participating payer or provider organization. TLS enables simple, secure transmission from one organization to another. TLS does not require a certificate store. TLS enables REST, SOAP, or SMTP transactions to flow securely because the connection between organizations is encrypted.
Where TLS falls down is in the Direct use case with its policy requirements that no intermediaries between the sender and receiver may have access to unencrypted data. This excludes the case in which the sender uses a HISP as a business associate to package the data as an SMIME message. A sender has no way of knowing what intermediaries the information may flow through, so implementing secured message flows from any sender to any receiver using TLS is untenable.
Thus, our path forward is clear. If we impose a policy constraint that small organizations which use external HISPs should be able to send data securely to other small organizations which use external HISPs such that the HISPs cannot view the data, then SMTP/SMIME with some mechanism to discover the certificates of each organization is the right answer at this time.
If the use case is simpler - secure exchange between HISPs such that the HISPs reside within the trading partner organizations or a relaxation of the policy constraint that HISPs cannot view data, then TLS is the right answer at this time.
The next steps are also clear. Establish SMTP/SMIME as a standard, and secure email using SMTP/SMIME as a certification criteria for EHR technology. Establish standards for X.509 certificates for organization-to-organization exchanges, as suggested by the Privacy and Security Tiger Team.
There you have it - the solution to the transport standards issue for the country - SMTP/SMIME for little guys using external HISPs and TLS for other use cases.
Done! Now it's time to implement and foster adoption.
After working with Dixie Baker/the HIT Standards Committee's Privacy and Security Workgroup on the Direct evaluation and after many email conversations with Arien Malec, I can now offer a strawman plan for transport standards.
Based on the implementation guides currently available, the HIT Standards Committee evaluation found the SMTP/SMIME exchange defined by the Direct Project sufficiently simple, direct, scalable, and secure, but stressed the need to develop implementation guidance that is clear and unambiguous. I've received many emails and blog comments about SMTP/SMIME verses other approaches. I believe I can harmonize everything I've heard into a single path forward.
As with all HIE efforts, policy has to constrain technology. The policy guidance that the Direct Project was given was as follows:
A "little guy" such as a 2 doctor practice in rural America wants to send content to another 2 doctor practice across town. These small practices should not have to operate servers or have to pay for a complex health information exchange infrastructure. Healthcare Information Services Providers (HISPs) should provide them the means to exchange data as easily as Google provides Gmail or Verizon FIOS provides ISP service. All HISP to HISP communications should be encrypted such that the sending practice and receiving practice can exchange data without any HISP in the middle being able to view the contents of the data exchanged.
In my opinion, for this type of exchange
Small Practice 1 ---> HISP 1 ----> HISP 2 ----> Small Practice 2
SMTP/SMIME at an organizational level is the right transport solution. By organizational level, I mean that one certificate is used for the sending organization and one for the receiving organization. There is no need to issue certificates to individual people involved in the exchange.
SMTP/SMIME at an organizational level encrypts, integrity protects, and digitally signs the payload at the point where the message is created. The payload can be sent through multiple intermediaries to the receiver with assurance that the message will be readable only by the intended receiver.
Given the policy guidance to support the little guy, any practice in the country that wants to send any content securely to any other practice without risk of viewing by any intermediary, SMTP/SMIME is sufficient and appropriate.
For other types of exchanges with different policy constraints, TLS is more flexible and functional. In Massachusetts, NEHEN is a federated HIE, enabled by placing open source software within the networks of each participating institution. Server to Server communication is a SOAP exchange over TLS. In this case, the HISP resides within the firewall of each participating payer or provider organization. TLS enables simple, secure transmission from one organization to another. TLS does not require a certificate store. TLS enables REST, SOAP, or SMTP transactions to flow securely because the connection between organizations is encrypted.
Where TLS falls down is in the Direct use case with its policy requirements that no intermediaries between the sender and receiver may have access to unencrypted data. This excludes the case in which the sender uses a HISP as a business associate to package the data as an SMIME message. A sender has no way of knowing what intermediaries the information may flow through, so implementing secured message flows from any sender to any receiver using TLS is untenable.
Thus, our path forward is clear. If we impose a policy constraint that small organizations which use external HISPs should be able to send data securely to other small organizations which use external HISPs such that the HISPs cannot view the data, then SMTP/SMIME with some mechanism to discover the certificates of each organization is the right answer at this time.
If the use case is simpler - secure exchange between HISPs such that the HISPs reside within the trading partner organizations or a relaxation of the policy constraint that HISPs cannot view data, then TLS is the right answer at this time.
The next steps are also clear. Establish SMTP/SMIME as a standard, and secure email using SMTP/SMIME as a certification criteria for EHR technology. Establish standards for X.509 certificates for organization-to-organization exchanges, as suggested by the Privacy and Security Tiger Team.
There you have it - the solution to the transport standards issue for the country - SMTP/SMIME for little guys using external HISPs and TLS for other use cases.
Done! Now it's time to implement and foster adoption.
