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Sunday, October 31, 2010

Medical transcription outsourcing: Providing affordable and integrated solutions

Healthcare services play an important role in modern life, helping maintain and improve quality of health and well being. Healthcare services also play an important role in emergency situations. Healthcare depends on various inputs internally and externally to provide quality services. Medical transcription services provide valuable inputs to the healthcare process by creating patient records. Outsourcing medical transcription has been found to be one of the most efficient solutions for healthcare facilities and healthcare professionals seeking accurate, speedy and cost effective services.


Outsourcing medical transcription provides affordable and integrated solutions
How does outsourcing medical transcription provide affordable solutions?

  • Lowering costs: The most obvious and immediate outcome of outsourcing medical transcription is the reduction in costs. Factors like medical transcription being the core business of the service provider, the best practices established by the service provider, economies of scale help the medical transcription service provider in providing quality services with substantial savings.
  • Eliminating indirect costs: Outsourcing medical transcription also helps healthcare facilities save on indirect costs like cost of real estate, utilities, investment of transcription equipment & systems, salaries & benefits paid to transcriptionists.
  • Helping protect existing investments: In case the healthcare facility has already invested in a transcription system or EMR system, a technologically savvy medical transcription service provider can help protect these investments by integrating existing systems to enable outsourced transcription services and by allowing for transmitting information into the EMR system using HL7 interface.
How does outsourcing medical transcription provide integrated solutions?
  • Establishing a process for transcription:The process of medical transcription starts with the patient- healthcare professional encounter. The transcription process can be follows the sequence given below:
  1. Dictation
  2. Uploading files
  3. Transcription process
  4. Delivery of transcripts
    Outsourcing medical transcription provides an integrated process not only for the actual transcription process, but also for dictation, collection of audio files, uploading files for transcription and secure, speedy modes of document delivery as per the preference of healthcare professionals and healthcare facilities.
    • Using software and tools: The software and tools used by the medical transcription service provider provides integrated solutions to the needs of varied departments in the healthcare facility involved in the smooth running of the healthcare facility. Outsourced transcription services provide integrated solutions to :
    1. Managerial staff: Outsourced medical transcription services help the managerial staff in conserving the resources of the healthcare facility.
    2. Records management staff: Outsourced medical transcription services aid the records management staff by providing transcripts within the required turnaround time, reports in required formats/templates and by providing them with an efficient system for tracking the work in progress
    3. Support staff: Outsourced medical transcription services provide integrated solutions to the needs of support staff by enabling multiple modes of document delivery and providing them with archival facilities
    4. IT staff: Outsourced medical transcription provided integrated solutions to information technology by integrating transcription systems with the healthcare facility systems, automatically upgrading software, integrating with EMR and providing HIPAA/HITECH measures for technology during the medical transcription process.
      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!


      To avail affordable and integrated medical transcription solutions from TransDyne, click here.

A.P. STATE SEED CERTIFICATION AGENCY RECRUITMENT

Hoffman and Podgurski: A relatively lawless industry and "meaningful use" of health IT, with safety as an afterthought

In their article "Meaningful Use and Certification of Health Information Technology: What About Safety?" (free PDF here), Sharona Hoffman (Professor of Law and Bioethics and Co-Director of the Law-Medicine Center, Case Western Reserve University School of Law) and Andy Podgurski (Professor of Electrical Engineering and Computer Science, Case Western Reserve) make an important case for what I've previously described as "putting the cart before the horse."

At my Oct. 1, 2010 post "Cart before the horse, again: IOM to study HIT patient safety for ONC" I argued that the IOM was only called in to study HIT safety after plans for national rollout were put into law, and a "stimulus to adoption" (with penalties for refusniks) financed at the cost of tens of billions of dollars.

I found this approach to HIT and the sequencing of events - the development of "meaningful use" criteria before usability and safety criteria - quite cavalier.

Hoffman and Podgurski go a step further.

They begin:

In the summer of 2010, the Department of Health and Human Services (HHS) published three sets of regulations to implement ARRA. This article briefly describes and critiques the regulations, arguing that (1) they fail to appropriately address HIT safety and (2) further steps must be taken to protect patients and serve public health needs in the new digital era.

After a brief review of the Meaningful Use and "Certification" (a.k.a. features qualification) regulations and programs, they go on to critique those regulations and programs as a "step towards comprehensive oversight", but a very deficient step considering the ambitions and timelines of the HITECH act and the federal government.

They aptly note (along with with footnotes):

... While advocates argue that computerization will reduce errors, numerous recent reports have demonstrated that the opposite can be true. Hospitals have experienced incidents in which doctors� orders were posted to the wrong patient charts and electronic drug orders were not delivered to nurses who needed to dispense them to patients. A published 2009 review of almost 56,000 CPOE prescriptions found that approximately 1% of them contained errors. Patients who do not receive needed medication or whose treatment is otherwise mismanaged because of software or usability problems can suffer catastrophic consequences [my own mother is sadly familiar with this latter problem - ed.]

General system safety is a property that is attainable only through rigorous processes for development and evaluation. [Evaluations of the kind the healthcare IT industry seems to have steadfastly circumvented and avoided - ed.]

However, the regulations do not address certification of EHR vendors� software development processes or even require vendors to analyze and mitigate potential safety hazards. [In other words, they are essentially meaningless in terms of HIT safety - ed.]

Furthermore, ATCBs [ONC 'Authorized Testing and Certification Bodies'] will use testing requirements developed by the National Institute of Standards and Technology (NIST) that are apparently intended only to determine whether systems include certain features. Passing such tests is not sufficient to ensure that those features function properly in the long term and under varied operating conditions. [In other words, a preflight checklist will be conducted of aircraft that have rarely or never actually flown, to declare them flight ready for the amateur pilot - ed.]

They note the obvious:

Meticulous testing of EHR products is critical to their safety. Because of the government�s lucrative incentive payments, many new vendors may attempt to enter the market and to quickly produce EHR systems whose quality is unproven and perhaps dubious.

A key passage in this article is this:

Admittedly, clinical evaluation of new products poses challenges for vendors who would need to find facilities willing to accept the administrative burdens of assessing systems that may ultimately fail. [In other words, it will cost them to improve the safety of their products, a core competency they should have developed decades ago - ed.]

Such facilities would also experience delays in receiving incentive payments because they would use uncertified systems during the evaluation period. However, certification of HIT that has not been thoroughly evaluated is no more responsible than approval of medications or devices that have not been carefully scrutinized by the FDA

"No more responsible than approval of medications not scrutinized by FDA" is quite on target. I personally would use a stronger term than deficient responsibility, however: deliberate reckless indifference to health IT safety seems more descriptive.

The authors do note that:

The delegation of EHR approval responsibilities to ATCBs will ease HHS�s regulatory burdens and likely supply an adequate pool of experts for HIT testing. HHS is authorized to monitor ATCBs through on-site visits, reports, and review of documentation. It remains to be seen if these measures will ensure that ATCB members are qualified, competent, and free of conflict of interest. These issues will become more critical if HHS eventually requires rigorous clinical testing of EHR systems as described above.

Considering the track record of the pharma and medical device industries as presented in many case examples at this blog, "qualified, competent, and free of conflict of interest" is a tall order indeed for the health IT industry and its "certifiers."

The authors again state the obvious (albeit an "inconvenient truth"):

... it is naive to assume that any use of HIT is better than no use of HIT. [This warning echoes the "use equals success" fallacy as described by Karsh et al. in their recent JAMIA article described here - ed.]

EHR systems constitute complex technology that can introduce errors as well as prevent them. Medical errors can occur because of computer bugs, computer shut-downs, or user mistakes that may be attributable to a flawed user interface. Through communication tools, electronic ordering, decision support features, and data management, EHR systems will guide many aspects of patient care. Treatment success will often depend on their proper functioning.

They conclude:

HHS� new regulations constitute positive first steps and a laudable reversal of a relatively lawless approach to EHR system design and deployment. Previously, the only certification program was offered by the Certification Commission for Health Information Technology, a private industry group that was not subject to regulation.

I used terms such as "wild west", "out of control" and "pre-Flexnerian" to describe the HIT industry. That an attorney would use the term "lawless" seems quite fitting to describe similar observations.

Finally, they state:

Still, much more work must be done to protect public health in the digital era. We urge that future meaningful use and certification criteria and the post-2011 permanent certification program be more attentive to safety issues.

EHR system approval should be no less rigorous than the FDA�s process for drug and device approval because HIT is as safety-critical for patients. A prime criterion for certification should be a documented history of safe operations in a number of clinical environments.

The federal government would be wise to focus less on the speed of EHR adoption and more on product quality. Only through sufficient safeguards for EHR system safety can this technology fulfill its promise to dramatically improve individual and public health outcomes.

In my opinion, the HITECH timelines are far too ambitious (I sense a similar sentiment "between the lines" in the above passage). Perhaps it's time for those timelines to be revisited.

A new Congress should take that on, or defund HITECH and rewrite it to prevent patient harm and AHLTA and UK NPfIT-like debacles, to save billions of taxpayer dollars we really don't have to spare at the moment.

-- SS

Saturday, October 30, 2010

WARANGAL DISTRICT FOREST RECRUITMENT

FCI SOUTH ZONE PWD RECRUITMENT

FCI SOUTH ZONE RECRUITMENT

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APSRTC TRAFFIC / MECHANICAL SUPERVISORS TRAINEE RECRUITMENT

APSRTC TRAFFIC / MECHANICAL SUPERVISORS TRAINEE RECRUITMENT

THE A.P. DAIRY DEVELOPMENT CORPORATION FEDERATION LTD. RECRUITMENT

 



SYLLABUS FOR THE POST OF JUNIOR ENGINEER (MECHANICAL / ELECTRICAL /ELECTRONICS)

MECHANICAL:

1. THERMODYNAMICS: Basic concepts, Open and closed systems. Heat and work, Zeroth, First and second law, application to flow and non-flow processes. Entropy: Availability, Irreversibility, T-S relations, Clapery on and real gas Equations. Properties of ideal gases and vapours. Air standard cycles. Two stage air compressor, CI and SI engineers, Valve travel diagram, Pre ignition, Detonation and Diesel knock, Fuel injection, Carburetion, Super charging, Turbo prop and Rocket engineers. Cooling, Emission and Control. Measurement of calorific value of fuels. Conventional and Nuclear fuels.
2. HEAT TRANSFER: Modes of heat transfer. One � dimensional steady and unsteady conduction. Composite slab and equivalent resistance. Heat dissipation from extended surfaces. Heat exchangers, Over all heat transfer coefficient, Empirical correlations for heat transfer in laminar and turbulent flow, Heat transfer in free and forced convection. Thermal boundary layer over a flat plate. Fundamentals of diffusive and convective mass transfer. Black body and fundamental concepts of radiation. Shape factor, Network analysis.
3. REFRIGERATION AND AIR CONDITIONING : Heat pump, Refrigeration cycles and systems, Refrigerants, Condensers, Expansion devices, Psychrometry, Charts and application to air conditioning, Sensible heating and cooling. Effective temperature, Comfort indices, Load calculations. Solar refrigeration, Duct design.
4. STEAM GENERATORS AND TURBINES : Fire tube and water tube boilers. Binary vapour system. Flow of steam through nozzles and Diffusers. Dryness fraction, Condensation. Various types of turbines, Compounding, Velocity triangles, Partial admission, Reheat, Regeneration, Efficiency and Governance. Gas Turbines, Role of Mach number.
5. MACHINE DESIGN : Theories of failure, Design of Cotter joint, Keys, Splines, Welded joints, Threaded fasteners, Bolt of uniform strength, Screw jack. Design of Bearing, Couplings, Clutches, BELT DRIVES and Spur gear system. Hydrodynamic and Antifriction bearings. Design of shafts for combined loads. Helical and Leaf Springs. Thin and Thick walled pressure vessels.
6. INDUSTRIAL ENGINEERING : Production planning and Control : Forecasting, Moving Averages, Exponential Smoothing, Operations, Scheduling, Assembly line balancing. Product Development, Break-even analysis, Capacity Planning, PERT and CPM.
CONTROL OPERATIONS: Inventory Control, ABC analysis, EOQ model, Material
requirement planning. Job Design, Job standards, Work Measurement, Quality
Management, Quality Analysis and Control.
Operations Research: Linear Programming � Graphical and simplex methods.
Transport and Value Engineer: Value analysis for Cost value.
7. ELEMENTS OF COMPUTATION: Computer Organization, Flow charting, Features of common computer languages � FORTRAN, d Base III, Lotus 1-2-3, C and Elementary Programming. 

 
1. ELECTRIC CIRCUITS: Active and passive network elements � dependent and independent sources � response of passive elements to arbitrary excitations � energy stored in inductance and capacitance � Kirchoff�s loss � formation of mesh and nodel intergo differential equations � their solutions by classical and Laplace transformation methods � Transient and steady state response of RL, RC elements to impulse, step, ramp and sinusoidal inputs � single phase AC circuits � methods of solutions � poly phase circuits � analysis of balanced and unbalanced circuits � measurements of three phase power.
2. ELECTRICAL MEASUREMENTS AND INSTRUMENTS : Absolute and secondary instruments types - Principle of operation of different type of instrument � extension of instrument ranges � measurement of voltage, current , power and energy � localization of cable faults � Murray loop and Varley loop tests � Cathode ray Oscilloscope.
3. ILLUMINATION: Solid angle, luminous flux, luminous flux, luminous intensity � Illumination and candle power � laws of Illumination � flood lighting, street lighting � electric lamps.
4. DC GENERATORS AND MOTORS : Types of DC generators � EMP equation � constructional details � characteristics of shunt, series and compound generators � Armature reaction � types of DC motors � Torque developed in a DC motor � speed controls of DC motors and starters.
5. TRANSFORMERS : Constructional details � Principle of operation - Vector diagrams on no load and load � regulation and efficiency � equivalent circuits and tests for the determination of parameters of equivalent circuits � types of three phase transformers and their applications � Scoot connection of transformers.
6. 3-PHASE ALTERNATORS : Principle of operation and constructional details � types of Alternators � synchronous impedance � voltage regulation � short circuit ration and its importance � phasor diagrams of round rotor and salient pole machines � synchronization � behavior of an alternator connected to infinite bus � effect of varying excitation current and mechanical torque � power angle curves � control of active and reactive powers.
7. 3-PHASE INDUCTION MOTORS: PRINCIPLE OF OPERATION � Cage and Slip ring motors � torque slip characteristics � methods of speed control.
8. 3-PHASE SYNCHRONOUS MOTORS : Principle of operation � torque developed and methods of starting � V and Inverted V curves � effects of variations of excitation � synchronous condensers.
9. SINGLE PHASE INDUCTION MOTORS : Types of single phase motors � Types of Single phase induction motors � characteristics and methods of starting � shaded pole induction motor.
10. TRANSMISSION & DISTRIBUTION : Line Constants � Inductance and capacitance calculations � Representation of over head lines � Short, Medium and Long lines � ABCD constants � Mechanical Design � Seg, Tension Calculations, Turned Power Lines.
11. OVER HEAD LINE INSULATORS: Type of Insulators � Potential distributions over a string of suspension insulators � string efficiency � Methods of improving string efficiency.\
12. UNDERGROUND CABLES : Insulation of cables � Grading of cables � capacitance Measurement in cables - Testing of cables � Power frequency withstand tests.
13. FAULT CALCULATIONS: Balanced Fault Calculations on systems � Symmetrical components � Types � of faults � Analysis of unbalanced faults.
14. GENERATING STATIONS: Location and types, types of hydroelectric power stations, layout of a hydro-power plant, types of turbines used � pumped storage installations � Layout of thermal electric Power stations, types of turbines used, condensers, cooling towers, boiler feed pump: energy flow diagram of steam power plant. Nuclear power generation: nuclear fission � types of nuclear power reactors � principle of a fast breeder reactor.
15. PROTECTION: Characteristic of Relays - Over current, directional and distance protection of lines. Protection of Alternators against stator faults, rotor faults . loss of excitation, unbalanced loading, overloading, failure of prime �mover. Over speeding and voltage, protection transformers against winding faults, overloads and external short circuits.
16. CIRCUIT BREAKERS : Air-blast, oil, minimum oil, vacuum � sulphur hexafluoride circuit breakers � Relative merits and demerits.
17. ECONOMIC ASPECTS: Generation costs and their classification, load curve, load utilization and plant capacity factor. Load sharing between base load and peak-load stations. Load forecasting. Economical distribution of load between unit within an plant and between plants. Modeling of fuel costs for thermal generation. Optimal operation of an all thermal generating system and of a hydro-thermal system. Consideration of transmission losses.
18. UTILIZATION OF ELECTRICAL ENERGY: Industrial drives � Motors for various drives � Motors for various drives � Estimating and Rating � Testing of D.C. and A.C. motors � Neutral Earthing.

ELECTRONICS

FUNDAMENTALS: Coulomb�s law � Ohms law � Fardays laws of electromagnetic induction, Kirchoff�s laws, Ampere�s law Resistance, Capacitance and inductance.
ELECTRONIC CIRCUITS: Graph, tree and links � Loop currents, node voltages two port net works, Z, Y and Hybrid parameters, Alternating currents, RMS value, form factor, R.L.C. in AC circuits power, and power factor, netweork theorms � Harmonic analysis.
ELECTRONIC CIRCUITS: Logic circuits - Universal gates Booleans functions and their realisation � Product of sums and sums of product forms � Combinational circuits � Sequential circuits, SR & JK flip flops, Series and parallel Counters Registers. 
Networks
Network graphs: matrices associated with graphs -- incidence, fundamental cut set and fundamental circuit matrices. Solution methods: nodal and mesh analysis. Network theorems: superposition, Thevenin and Norton�s maximum power transfer, Wye-Delta transformation. Steady state sinusoidal analysis using phasors. Linear constant coefficient differential equations time domain analysis simple RLC circuits, Solution of network equations using Laplace transform: frequency domain analysis of RLC circuits. 2-port network parameters: driving point and transfer functions. State equations for networks.
Electronic Devices
Energy bands in silicon, intrinsic and extrinsic silicon. Carrier transport in silicon: diffusion current, drift current, mobility, resistivity. Generation and recombination of carriers. p-n junction diode, Zener diode, tunnel diode, BJT, JFET, MOS capacitor, MOSFET, LED, p-I-n and avalanche photo diode, LASERs. Device technology: integrated circuits fabrication process, oxidation, diffusion, ion implanation, photolithography, n-tub, p-tub and twin-tub CMOS process. 
Signals and Systems
Definitions and properties of Laplace transform, continuous-time and discrete-time Fourier seris, continuous-time and discrete-time Fourier Transform, z-transform. Sampling theorems. Linear Time-Invariant (LTI) Systems: definitions and properties -- casuality, stability, impulse response, convoilution, poles and zeros frequency response, group delay, phase delay. Signal transmission through LTI systems. Random signals and noise: probability, random variables, probability density function, autocorrelation, power spectral density.
Controls Systems
Basic control system components -- block diagrammatic description, reduction of block diagrams. Open loop and closed loop (feedback) systems and stability analysis of these systems. Signal flow graphs and their use in determining transfer functions of systems -- transient and steady state analysis of LTI control systems and frequency response. Tools and techniques for LTI control system analysis: root loci, Routh-Hurwitz criterion, Bode and Nyquist plots. Control system compensators: elements of lead and lag compensation, elements of Proporational-Integral-Derivative(PID) control. State variable representation and solution of state equation of LTI control systems. 
Electromagnetics
Elements of vector calculus: divergence and curl -- Gauss� and Stokes� theorems, Maxwell�s equations: differential and integral forms. Wave equation, Poynting vector. Plane waves: propagation through various media -- reflection and refraction -- phase and group velocity -- skin depth. Transmission lines: characteristic impedance -- impedance transformation -- Smith chart -- impedance matching -- pulse excitation. Waveguides: modes in rectangular waveguides -- boundary conditions -- cut-off frequencies -- dispersion relations. Antennas: Dipole antennas -- antenna arrays -- radiation pattern -- reciprocity theorem, antenna gain.

TRANSDUCERS AND SIGNAL CONDITIONERS:
Introduction to Instrumentation and Measurement system. General concepts and terminology, measurement systems, Transducers classification, general input-output configuration, methods of correction, performance characteristics � static characteristics of measurement systems, accuracy, precision, sensitivity, other characteristics : Linearity, resolution, systematic errors, random errors, dynamic characteristics of measurement systems: zero � order, and second-order measurement systems and response to step, ramp and impulse inputs, Loading effects under dynamic conditions. Resistive, Inductive, Capacitive, Self-Generating Transducers, Thermal and Radiation Transducers, Photo sensors. Signal conditioners for different Transducers. Digital Sensors.

INSTRUMENTATION COMPONENTS:
Mechanical Components, Pneumatic Components, Electrical & Electromechanical Components, Electronic components, Optoelectronic components.
ELECTRICAL AND ELECTRONIC MEASUREMENT AND INSTRUMENTS:
Introduction to measurements, Physical measurements, Forms and methods of measurements. Measurements errors. Statistical analysis of measurement data. Probability of errors. Limiting errors. Standards, Definitions of standard units, Types of standards, Standards for various parameters. Reliability, Testing and calibration, Types of calibration, Calibration of different Equipments. AC and DC Voltage and Current measurements. Bridges and measurements using brides. HF Bridges. Electrical instruments, Electronic Instruments, Oscilloscopes, Signal Generators and Analyzers, Frequency and Time Measurement. Spectrum Analyzers.
INDUSTRIAL INSTRUMENTATION:
Metrology, Velocity and Acceleration Measurement, Force and Troque Measurement, Pressure Measurement, Flow Measurement, Density Measurement, Radiation Measurement, Other Measurements.
PROCESS CONTROL INSTRUMENTATION:
Process Dynamics, process variables, Load variables, Dynamics of simple pressure, flow level and temperature process, interacting and non-interacting systems, continuous and batch process, self-regulation, Servo and Regular operation, problems. Control Actions and controllers, Optimum Controller Settings, Final Control Elements, Multi loop Control System.
ANALYTICAL INSTRUMENTATION:
pH and Conductivity & Dissolved component analyzers, Gas Analyses, Chromatography, Spectrophotometers, Principle of Nuclear Magnetic Resonance and applications.
VIRTUAL INSTRUMENTATION:
Historical perspective, advantages, block diagram and architecture of a virtual instrument, data-flow techniques, graphical programming in data flow, comparison with conventional programming. Development of Virtual instrument using GUI, Real-time systems, Embedded controller, OPC, HMI/SCADA software, Active X programming.
Virtual Instrumentation (VI) programming Techniques � Data Acquisition Basics, VI Chassis Requirements, Bus interfaces, Networking Basics for Office & Industrial Applications, VISA and IVI, VI toolsets, Distributed I/O Modules, Simulation of Systems Using VI.

SYLLABUS FOR THE POST OF JUNIOR ENGINEER (CIVIL)

1) STRENGTH OF MATERIALS:-
Simple stresses and Strains: Types of stresses and strains � Hook�s Law, Stress-strain curve for mild steel working stress and factor of safety Posion ratio � State of simple shear, complementary � Shear Elastic constants and their relations � Compound bars � Thermal stress.
Compound stresses Mohr�s circle of stress � Principal stresses and planes.
Shear force and bending moment diagrams: S.F.D. and B.M.D. for cantilevers, simply supported beams and over hanging beams subjected to point leads and uniformly distributed loads. Relations among load, shear force and bending moment.
Bending and shear stress: Basic equation; M/I = F/Y = E/R � Distribution of bending and shear stresses across various cross sections such as rectangular, circular, I and T sections, Torsion of Circular shafts � power transmission.
Columns and struts: Euler�s theory and Rankine�s Theory � Socant and Perry formulae for eccentrically loaded columns.
Deflections and slopes: Slopes and deflections in cantilevers simply supported beams; propped beams and fixed beams subjected to point leads and uniformly distributed loads.
2 ) FLUID MACHANICS AND HYDRAULIC MACHINERY:
Fluid statics: Hydrostatic force on a plane and curved area Centre of pressure and its applications to lockgates and dams Metacentric height.
Fluid Dynamics: Convective and local acceleration, Euler�s equation of motion and its intergration, Bernoulli�s equation motion and its application, flow in curved path. Free and forced vortex.
Flow measurements: Notches and weirs, venturimeters, pitot tube, nozzle meter, current meter.
3) BUILDING MATERIALS:
Timber: Different types and species of structural timber, density � moisture relationship, strength in different directions, defects, preservations, plywood.
Bricks: Types, Indian standard classification, absorption, saturation factor, strength in masonry, influence of mortar strength on masonry strength.
Cement: Compounds of different types, setting times, strength.
Cement mortar: Ingredients, proportions, water demand, mortars for plastering and masonry.
Concrete: Importance of w/c ratio, strength, ingredients including admixtures, workability, testing for strength, mix design methods, non-destructive testing.
4) STRUCTURAL ANALYSIS:
Analysis of determinate structures � different methods. Analysis of indeterminate skeletal frames � Moment distribution, Slope deflection, Kani�s, Stiffness and force methods, Energy methods, Muller Breslan principle and application. Plastic analysis of indeterminate beams and simple portal frames � Shape factors.
5) DESIGN OF CONCRETE AND MASONRY STRUCTURES:
Limit state design for bending, Shear, Axial compression and combined forces. Codal provision for slabs, Beams, Columns and footings. Working stress method of design of R.C. members. Principles of pre-stressed concrete design, Materials, Methods of pre-stressing, losses. Design of simple members and determinate structures. Design of brick masonry as per IS codes.
6) ENVIRONMENTAL ENGINEERING:
A) Waste Water engineering: Urban rain water disposal, Systems of sewage collection and disposal. Design of sewers and sewerage systems, Pumping. Characteristics of sewage and its treatment. Disposal of products of sewage treatment. Plumbing systems. Rural and semi-urban sanitation.
B) Solid Waste96 Management: Sources and effects of air pollution, Monitoring of air pollution, Noise pollution, Standards, Ecological chain and balance. Environmental assessment.
7). SOIL MECHANICS AND FOUNDATION ENGINEERING:
Properties and classification of soil, Compaction, Permeability and Seepage, Flow nets, Inverted filters, Compressibility and consolidation. Shearing resistance, Stresses and failure. Soil testing in laboratories and in-situ, Earth pressure theories, Stress distribution in soils, Soil exploration, Samplers, Load tests, Penetration tests. Types of foundations, Selection criteria, Bearing capacity, Settlement, Laboratory and field tests, Types of piles and their design and layout. Foundations on expansive soils, Swelling and its prevention, Foundation on swelling soils.
8) SURVEYING AND TRANSPORT ENGINEERING:
Classification of surveys, Scales, Accuracy, Measurement of distances, Direct and indirect methods, Optical and electronic devices, Measurement of directions, Prismatic compass, Local attraction, The odlytes, Types, Measurement of elevations, Spirit and trigonometric leveling, Contours, Digital elevation modeling concept.
9) GENERAL MENTAL ABILITY: (Reasoning and analytical abilities)


1. ACCOUNTS:
Level of Knowledge: Working knowledge

Objectives:
a. To lay a theoretical foundation for the preparation and presentation of financial statements,
b. To gain working knowledge of the professional standards, principles and procedures of accounting and their application to different practical situations,
c. To gain the ability to solve simple problems and cases relating to company accounts including special type of corporate entities, partnershiop accounts and
d. To familiarize students with the fundamentals of computerized system of accounting, contests
Contents
1. Conceptual Framework for Preparation and Presentation of Financial Statements.
2. Accounting Standards. An overview; standards setting process Working knowledge of all applicable Accounting Standards
3. Company Accounts
a. Preparation of financial statements � Profit and Loss Account, Balance Sheet and Cash Flow Statement
b. Profit (Loss) prior to incorporation
c. Alteration of share capital, Conversion of fully paid shares into stock and stock into shares, Accounting for bonus issue, Accounting for employee stock option plan, Buy back of securities, Equity shares with differential rights, Underwriting of shares and debentures, Redemption of debentures
d. Accounting for business acquisition, Amalgamation and reconstruction (excluding problems of amalgamation on inter-company holding)
e. Accounting involved in liquidation of companies, Statement of Affairs (including deficiency/ surplus accounts) and liquidator�s statement of account of the winding up.
4. Accounts from Incomplete Records
5. Accounting for Special Transactions
(a) Hire Purchase and installment sale transactions
(b) Investment accounts
(c) Departmental and branch accounts including foreign branches
(d) Insurance claims for loss of stock and loss of profit.
6. Accounting in Computerized Environment
(ii) An overview of computerized accounting system- Salient features and significance, Concept of grouping of accounts, Codification of accounts, Maintaining the hierarchy of ledger, Accounting packages and consideration for their selection, Generating Accounting Reports for absorbing overheads to products or services
(iii) Administration overheads --- Method of allocation to cost centres or products
(iv) Selling and distribution overheads --- Analysis and absorption of the expenses in products / customers, impact of marketing strategies, cost effectiveness of various methods of sales promotion.
3. Cost Book-Keeping
Cost Ledgers � Non-integrated accounts, Integrated accounts, Reconciliation of cost and financial accounts.
4. Costing Systems
(a) Job Costing. Job cost cards and database, Collecting direct costs of each job, Attributing overhead costs to jobs, Applications of job costing.
(b) Batch Costing
(c) Contract Costing. Progress payments, Retention money, Escalation clause, Contract accounts, Accounting for material, Accounting for plant used in a contract, Contract profit and Balance sheet entries.
(d) Process Costing
Double entry book keeping, Process loss, Abnormal gains and losses, Equivalent units Interprocess profit, Joint products and by products.
(e) Operating Costing System
5. Introduction to Marginal Costing
Marginal costing compared with absorption costing, Contribution, Breakeven
analysis and profit volume graph.
6. Introduction to Standard Costing
Various types of standards, Setting of standards, Basic concepts of material and
Labour standards and variance analysis.
7. Budgets and Budgetary Control.
The budget manual, preparation and monitoring procedures, budget variances, flexible budget, preparation of functional budget for operating and non-operating functions, cash budget, master budget, principal budget factors.
Financial Management
Objectives:
(a) To develop ability to analyse and interpret various tools of financial analysis and planning,
(b) To gain knowledge of management and financing of working capital,
(c) To understand concepts relating to financing and investments decisions, and
(d) To be able to solve simple cases.
1. Scope and Objectives of Financial Management.
(a) Meaning, Importance and Objectives
(b) Conflicts in profit versus value maximization principle
(c) Role of Chief Financial Officer
2. Time Value of Money
Compounding and Discounting techniques --- Concepts of Annuity and Perpetuity.

2. COST ACCOUNTING
Objectives:
a. To understand the basic concepts and processes used to determine product costs.
b. To be able to interpret cost accounting statements.
c. To be able to analyse and evaluate information for cost ascertainment, planning control and decision making, and
d. To be able to solve simple cases.
Contests:
1. INTRODUCTION TO COST ACCOUNTING.
a. Objectives and scope of Cost Accounting
b. Cost centres and Cost Units
c. Cost Classification for stock valuation, Profit measurement, Decision making and control
d. Coding Systems
e. Elements of Cost
f. Cost behavior pattern, Separating the component of semi-variable costs
g. Installation of a Costing system
h. Relationship of Cost Accounting, Financial Accounting, Management Accounting and Financial Management.
2. COST ASCERTAINMENT
(a) Material Cost
I. Procurement procedures � Store procedures and documentation in respect of receipts and issue of stock, Stock verification.
II. Inventory control � Techniques of fixing of minimum, maximum and recorder levels, Economics Order Quantity, ABC classification, Stocktaking and perpetual inventory.
III. Inventory accounting.
IV. Consumption � Identification with products of cost centres, Basis for consumption entries in financial accounts, monitoring consumption.
(b) Employee cost
I. Attendance and payroll procedures, Overview of statutory requirements, Overtime idle time and Incentives.
II. Labour turnover
III. Utilization of labour, Direct and indirect labour, Charging of labour cost, identifying labour hours with work orders or batches or capital jobs.
IV. Efficiency rating procedures
V. Remuneration systems and incentive schemes.
(c) Direct Expenses sub-contracting �Control on material movements, Identification with the main product or service.
(d) Overheads.

I. Functional analysis � Factory, Administration, Selling, Distribution, Research and Development Behavioral analysis � Fixed, Variable, Semi variables and step cost
II. Factory Overheads � Primary distribution and secondary distribution, Criteria for choosing suitable basis for allotment, Capacity cost adjustments, Fixed absorption rates
3. FINANCIAL ANALYSIS AND PLANNING:
a. Ration Analysis for performance evaluation and financial health
b. Application of Ratio Analysis in decision making
c. Analysis of Cash Flow Statement.
4. FINANCING DECISION
a. Cost of Capital � Weighted average cost of capital and Marginal cost of capital
b. Capital structures decisions � Capital structures patterns, Designing optimum capital structure, Constraints, various capital structure theories.
c. Business Risk and Financial Risk � Operating and financial leverage, Trading on Equity.
5. TYPES OF FINANCING.
a. Different sources of finance
b. Project financing - Intermediate and long term financing.
c. Negotiating term loans with banks and financial institutions and appraisal thereof
d. Introduction to lease financing.
e. Venture capital finance.
6. INVESTMENT DECISIONS
a. Purpose, Objective, Process
b. Understanding different types of projects.
c. Techniques of decision making: Non � discounted and Discounted Cash flow Approaches � Payback Period Method, Accounting Rate of Return, Net Present Value, Internal Rate of Return, Modified Internal Rate of Return, Discounted Payback Period and Profitability Index.
d. Ranking of competing projects, Ranking of projects with unequal lives.
7. MANAGEMENT OF WORKING CAPITAL.
a. Working capital policies
b. Funds flow analysis
c. Inventory Management
d. Receivables Management
e. Payables Management
f. Management of cash and marketable securities
g. Financing of working capital.

SYLLABUS FOR RSM / AM (MKTG) / MARKETING SUPERINTENDENT.
1. Marketing Management: Strategic Marketing Process, Marketing Environment, Marketing Information Systems. Consumer Buyer Behavior, Business Buyer Behavior, Segmentation, Targeting and Positioning.
2. Product Management: Decisions, Development and Lifecycle Strategies, Services and Branding Strategy.
3. Distribution Management: Personal Communication Channels, New Personal Communication Channels, Customer Relationship Management.
4. Financial Management: Financial Planning, Time Value of Money, Cost of Capital, Capital Structure. Capital Budgeting, Risk Analysis in Capital Budgeting. Cash Management, Inventary, Receivables Management.
5. Managerial Economics: Demand Analysis, Demand Forecasting, Production Analysis, Market Analysis, Business Cycles.
6. Management Process and Organization Behavior: Management Process Organizational Behavior, Learning, Personality Emotions, Perception, Motivation Group Behavior, Stress Management, Organisation Development.
7. Business Communication: Types and Channels of Communication
8. Statistics for Management: Statistical Survey, Classification, Tabulation and Presentation of Data, Probabilities, Sampling Distributions, Estimations Business Forecasting, Time Series Analysis, Decision Support Systems.
9. International Marketing: International Marketing Barriers, Political, Legal Environment, Cultural Environment, Product Strategies, Distribution Channels, Promotion Strategies, Pricing.
10. E � Marketing: Strategic E � Marketing, E � Marketing Plan, Online Consumer Behavior, E � Marketing Segmentation & Targeting Four P�s in E � Marketing, E � Consumer, Relationship Management.
11. Retail Marketing: Retail Market Strategy, Store Management Merchandise Management, Merchandise Pricing, Retail Control.
12. Sales Distribution and Supply Chain Management: Personal Selling and Sales Management Organisation Sales Department, Sales Force Management, Logistics of Distribution, Channel Management Planning and Designing Supply Chain Co-ordination in Supply Chain.
13. Adverting and Sales Promotion: Setting Advertising Objectives and Strategies, Advertising Budgets, Media Planning, Sales Promotion.
14. Legal Aspect of Business: Law of Contract, Discharges of Contract, Contract of Indemnity and Guarantee, Negotiable Instruments Act, Companies Act, Consumer Protection Act, 1986, Shops and Establishments Act.
15. Management Information System: MIS Concepts, Strategic MIS Business Processing Methodology, MIS Planning and Development, MIS Organisation Structure Trends in MIS, Decision Marking in MIS, Inter Organizational System � Internet Information Technology and Systems Security and Ethical issues.

Friday, October 29, 2010

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Medical transcription outsourcing: Serving healthcare facilities at all levels

Medical transcription is the process of creating patient medical records of the patient- healthcare professional encounter. It is a known fact that medical transcription services aid healthcare professionals in the provision of quality healthcare. And outsourcing medical transcription helps create patient medical records in an accurate, speedy, secure and cost-effective services.

But a lesser advertised and less known fact about outsourced medical transcription is how it aids the operations of healthcare facilities at every level.

Outsourcing medical transcription has the following benefits:
The managerial staff:

  • Savings on investment: Outsourcing medical transcription helps the managerial staff save on investments substantially, by eliminating the need to invest in transcription equipment and furniture required for transcription.
  • Saving information technology: Expenses for Information technology for executing transcription in-house can be avoided or substantially reduced by outsourcing medical transcription.
  • Staffing benefit: Outsourcing medical transcription enables the staff of the healthcare facility especially the managerial and executive level staff to focus on the core business of providing quality healthcare.
    The records management staff:
    • Recruiting and retaining medical transcriptionist staff: One of the main inputs for quality medical transcription is that of qualified and trained transcriptionists. Outsourcing medical transcription effectively outsources the need to recruit, train and retain the transcription team.
    • Turnaround time: As turnaround time is the guaranteed by the outsourced medical transcription service provider it eliminates the responsibility of the records manager to constantly monitor and follow-up on turnaround time.
    • Process for medical transcription: By outsourcing medical transcription, effectively the responsibility to have an organized process for maintaining services at requisite quality levels is also outsourced.
    • Keeping track: The outsourced medical transcription service provider would have a system in place that would provide a summary of the job status for transcription work, making it easier for the record management staff to keep track of dictations sent, transcripts received and the work-in-progress.
    • HIPAA and HITECH compliance: The onus of securing confidential patient information by securing the team, the technology and processes becomes the responsibility of the outsourced medical transcription service provider.
    The support staff:
    • Multiple modes of document delivery: The support staff at the healthcare facility benefits from the multiple modes of document delivery provided by the outsourced service provider
    • Archives: Archival facilities provided by the outsourced medical transcription service provider enables the support staff to retrieve transcripts easily by using various search criteria.
    The Information technology staff:
    • Redundancy and backup of data: The outsourced service provider would be making provisions for redundancy and backup of systems lessening the burden of the information technology staff.
    • Interfacing of systems: By using advanced technology that is easy to use the outsourced medical transcription service provider would make interfacing the healthcare facility system with that of the outsourced service provider very simple.
    • Install/upgrade software: The responsibility of installing/upgrading software for transcription is undertaken by the service provider when transcription is outsourced.
    • EMR adoption: Outsourcing medical transcription would help in adoption of EMR through HL7 interfacing.
    TransDyne, a leader in the outsourced medical transcription industry has been providing transcription solutions that are customized to suit the specific needs of healthcare facilities. 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 medical transcription services from TransDyne, click here.

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Employee Risk Management: Reduce Your Workers' Compensation Costs

As work environments become safer, the number of workers' compensation claims continues to decline. At the same time, the cost per claim has continued to rise along with the rising cost of health care in general, making the business costs substantial. Along with death and taxes, workers' compensation is something every small business owner with employees must deal with.

As of September 2008, figures from the U.S. Department of Labor's Bureau of Labor Statistics show that businesses spend an average of $28.87 per hour for each employee. This includes salary, as well as benefit expenses such as health insurance, vacation time, and workers' compensation benefits. Overall, 69.7 percent (or $20.13) of the hourly compensation given to employees goes toward salary, and 30.3 percent ($8.74) goes toward benefits, with 1.6 percent ($0.47) of that benefit percentage making its way to workers' compensation. Although 47 cents an hour doesn't sound like much, it adds up over time and can severely impact your business expenses, particularly if this per-hour amount increases.


Job classification is the main factor determining the cost of your premiums. Roofers and construction people, who work around heavy equipment, have the highest risks, whereas office workers have the lowest risk. The basic rates for each job classification are set by each individual state, but there are more guidelines for insurance carriers to follow than there are rules.

By working with your risk management insurance carrier, you can implement both pre- and post-claims programs that will reduce your workers' compensation costs overall. Besides implementing procedures that make your business a more desirable client in terms of insurance rates, you can save even more on your risk management costs by implementing the following practices:

When paying an employee time and a half for overtime, you may only have to report the regular wages, decreasing the amount of payroll that determines your insurance premiums.

Implement programs that bring workers back into the workforce at a faster rate, even if it means bringing them back part time or in a limited capacity. Rising workers' compensation costs are primarily due to increased use of benefits and longer duration of disability. The more time an employee spends on disability, the more wage replacement and medical services increase in cost.

Look for a pattern to claims. Do some locations or areas in your business have fewer claims than others? Determine the reason why. Reducing the number of workers' compensation claims gives your business a better safety record. This makes you a much better risk to an insurance company, making it more likely they will give you better rates in the long run. Overall, this is the best way to reduce your risk management expenses.

GlaxoSmithKline Subsidiary Pleads Guilty to Manufacturing Adulterated Drugs: Three Strikes and ...?

Paxil

First there was Paxil (Seroxat in the UK, or paroxetine), the anti-depressant whose marketing lead GlaxoSmithKline (GSK) to settle allegations of fraud brought by then New York Attorney General Elliott Spitzer in 2004.  That case included allegations of suppression and manipulation of clinical research, and was discussed in great detail in the book Side Effects by Alison Bass.  We posted about various aspects of this case, e.g., more recently here, here, and here

Avandia

Then there was Avandia (rosiglitazone), the anti-diabetic drug whose use was just restricted by the US Food and Drug Administration.  This GlaxoSmithKline product inspired a "spin cycle" which provided us with endless grist for the Health Care Renewal mill.  A good summary of the case appeared in September in the British Medical Journal (Cohen D. Rosiglitazone: what went wrong: Brit Med J 2010; 341: 530-534.  Link here)  Once again, it appears that research was suppressed and manipulated (e.g., see here), Avandia critics were attacked by "experts" whose financial relationships with GSK were not always obvious (e.g., see here), and there were allegations that GSK executives tried to intimidate those who disagreed with them (e.g., see here and here). 

Adulterated Drugs

And now it is adulterated drugs.  Here is the version from Bloomberg:
GlaxoSmithKline Plc, the U.K.�s largest drugmaker, will pay $750 million to settle a U.S. whistleblower lawsuit over the sale of defective drugs.

Glaxo and the U.S. Justice Department announced the agreement yesterday, resolving a false-claims lawsuit first filed in 2004 by Cheryl D. Eckard, a former global quality assurance manager for the London-based company.

'This is not something I wanted to do, but because of patient safety it was necessary,' Eckard, 51, told reporters following a Justice Department press conference in Boston. As a whistleblower, she will receive $96 million from the settlement money.

Glaxo was accused in court papers of selling tainted drugs under false pretenses. The medicines, made at a Glaxo plant in Cidra, Puerto Rico, were misidentified as a result of product mix-ups, according to papers filed in federal court in Boston. The affected drugs included the antidepressant Paxil CR and the diabetes treatment Avandamet. [Note that this is a combination drug that includes Avandia - ed]

The settlement includes a criminal fine and forfeiture totaling $150 million and a $600 million civil settlement under the False Claims Act and related state claims, the Justice Department said in a statement.

'We will not tolerate corporate attempts to profit at the expense of the ill and needy in our society -- or those who cut corners that result in potentially dangerous consequences to consumers,' Carmen M. Ortiz, the U.S. Attorney in Boston, said at yesterday�s news conference.

SB Pharmco Puerto Rico Inc., a Glaxo unit, agreed to plead guilty to charges relating to the manufacture and distribution of adulterated drugs made at the now-shuttered plant, the Justice Department said. Glaxo said in July it had agreed in principle with the U.S. to pay 500 million pounds ($791 million) to resolve the investigation.

'We regret that we operated the Cidra facility in a manner that was inconsistent with current Good Manufacturing Practice requirements and with GSK�s commitment to manufacturing quality,' PD Villarreal, a Glaxo senior vice president, said in an e-mailed statement.

Eckard�s take is the largest ever for a single whistleblower, said Patrick Burns, spokesman for Taxpayers Against Fraud, a nonprofit Washington group that publicizes the use of legal means to combat fraud against the U.S. The federal government will receive $436.4 million from the settlement and participating states will split as much as $163.6 million, the Justice Department said.

Other drugs made at the plant include Kytril, an anti- nausea medication, and Bactroban, an ointment used to treat skin infections, the Justice Department said.

'The false claims arose out of chronic, serious deficiencies in the quality assurance function at the Cidra plant and the defendants� ongoing serious violations of the laws and regulations designed to ensure the fitness of drug products for use,' the government said in court papers.

The U.S. Food and Drug Administration in 2005 seized some Paxil CR lots after it was discovered that the pills sometimes split inappropriately, according to court papers. Some of the pills lacked an active ingredient.
It seems that not only questions about GSK sponsored clinical research about and GSK marketing of Paxil and Avandia, but the company has problems even supplying tablets that contain the pure drugs at the right dose.
Summary and Discussion

First, this is another dreary marcher in the parade of legal settlements that we have now been chronicling for years. This case has some particular features. It included a guilty plea to a crime. Although the allegations included fraud, the fundamental problem seemed to be the selling of adulterated, impure drugs.

So my first comment is that this is the latest instance of a major pharmaceutical company not being able to fulfill its most basic responsibility and reason for being, the manufacture of pure, unadulterated drugs. We previously discussed problems with adulterated drugs made by Baxter International and Johnson and Johnson. We have discussed, seemingly endlessly, how big health care corporations, including but certainly not limited to pharmaceutical companies, have engaged in various sophisticated deceptions involving marketing and clinical research to sell more products at higher prices. Now it seems that while these companies have put so much of their resources into marketing and public relations, not necessarily in honest ways, they have neglected to put the necessary expertise and resources into their most basic manufacturing functions.

So while drug industry sycophants prattle on endless about life-saving innovations, not only have industry marketing and research become less trustworthy, but now we cannot even trust the companies to supply the drug that is on the label in a pure form at the labelled dose.

My next comment is that this is the third big case involving GlaxoSmithKline reported in the last few years. (Although, like the previous cases, the events that lead to recent relevations actually occurred over the last 10+ years.) This would suggest that there is a serious problem with the culture, leadership, and governance at this corporation.

Maybe one reason such problems are allowed to fester is that in the current case, like the last two involving GSK, and as is typical for the legal settlements and crimes we have discussed before, no individuals who authorized, directed, or implemented the problematic behavior seem to have suffered any negative consequences or paid any penalty. In fact, the Guardian just pointed out:
Five of the six senior GlaxoSmithKline executives cited by a whistleblower as part of a cover-up of contamination problems at the group's Puerto Rico factory are understood to still be employed by the pharmaceuticals company.

Cheryl Eckard, who was sacked by the company as a quality control manager in 2003 after repeatedly raising her concerns with a series of GSK executives, received a $96m (�61m) reward this week as part of a $750m criminal and civil settlement between US regulators and the company.

Her evidence stated that she believed company executives refused to acknowledge the gravity of the production violations � which included the wrong strength of pills being shipped � because it would delay the approval of two new drugs by the US Food and Drug Administration.

The court documents allege that Eckard, who had recommended the factory be shut until the issues were resolved, communicated the quality violations at the plant in Cidra to David Pulman, president of global manufacturing and supply; Janice Whitaker, senior vice president of global quality; Peter Savin, vice president of global quality assurance; Diane Sevigny, director of global quality assurance, risk management and compliance; and Jonathan Box, vice president of manufacturing and supply for North America.

All five executives are believed to be still working for the London-listed company, while Pulman is also a member of the company's 18-strong corporate executive team, which includes chief executive Andrew Witty.

As we have said endlessly, penalties that only appear to be (relatively small) costs of doing business are unlikely to deter future bad behavior. Until the people who actually authorized, directed and implemented the bad behavior have to suffer some negative consequences, expect the bad behavior to continue. 

When it comes to health care's leadership, society seems to have acceded to defining deviancy down. Until we start holding health care leaders to high standards, expect their organizations not to uphold high standards.  Further, expect organizations that did not uphold high standards in one instance to fail to uphold them in other instances.

See also comments on the Postscript blog.

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