Can Google Track Track Trends in the Outbreaks of Diseases?

Jacob Goldstein of The Wall Street Journal is reporting that Google can track trends in outbreaks of diseases. This is a very interesting notion and one in which you want might to pay attention.
"Last summer, for a month before Canadian officials announced an outbreak of listeriosis that would kill some 20 people, Google searches seeking information on the disease were on the rise.
That finding, published this week in Canadian Medical Association Journal, is the latest sign that public-health types are trying to figure out how to mine Internet search data as a potential early-warning system for disease outbreaks.
Think of it as a wonkier example of Google Flu Trends, the tool Google.org rolled out last fall to mine Americans’ search patterns in an effort to track flu outbreaks.
There is a certain, basic logic to all this. You find out someone in your family has listeriosis, you go home and Google it. Multiply that across an outbreak, and it will add up. Interestingly, researchers found that searches for “listeria” — a less technical term for the disease, which is caused by eating tainted food — rose only after the official announcement, perhaps in response to media stories that used the term.
The authors point out some important unanswered questions about how public-health officials might actually use data from the likes of Google. There would likely be lots of false alarms, as factors other than a true disease outbreak prompted search spikes. And it’s unclear just how much of a spike from baseline levels would warrant further investigation.
What’s more, the potential false alarms might spook the public. Google already offers Google Trends, which lets anybody see how the volume of searches for a given term changes over time.
The paper was written by researchers from Harvard Medical School and the Ottawa Health Research Institute. The Harvard author has received research funding from Google.org as well as the National Institutes of Health."

Will Employer Based Health Care Benefits Decline in the Next Ten Years?

Vanessa Fuhrmans of the Wall Street Journal reports that research indicates that trend in employer paid health care benefits may decline over the next 10 years.

"The 30% plunge in health insurers’ shares in recent weeks is an index of how seriously Wall Street believes President Obama’s health-reform agenda will ultimately upend private-sector insurance. Now comes a pair of surveys that indicate more of Corporate America anticipates the end of health-care benefits as we know them, too.
According to a survey of 489 large U.S. employers out today, 62% said they were confident they would still be offering their workers health coverage 10 years from now, down from 73% last year. The economic crisis one reason for the drop; the prospect of a new and much different health-insurance system was another.
“This is the first time in the 14 years that we have conducted this survey that employer confidence declined, and it is not related to an increase in cost trends,” said Ted Nussbaum, a director at Watson Wyatt, an employee benefits consulting group, which conducted the survey with the National Business Group on Health.
A employer poll released last week by Hewitt Associates, a rival consultancy, echoes the sentiment. Though the majority of the 340 big employers surveyed had no immediate plans to change their health coverage strategy, one-fifth said their aim is to move away from directly providing health benefits in the next three to five years — up from 4% in 2008 and none in 2007."

Can a Bone Marrow Transplant Cure Aids?

The following article, written by Mark Schoofs, appeared in today's Wall Street Journal.

"The startling case of an AIDS patient who underwent a bone marrow transplant to treat leukemia is stirring new hope that gene-therapy strategies on the far edges of AIDS research might someday cure the disease.
The patient, a 42-year-old American living in Berlin, is still recovering from his leukemia therapy, but he appears to have won his battle with AIDS. Doctors have not been able to detect the virus in his blood for more than 600 days, despite his having ceased all conventional AIDS medication. Normally when a patient stops taking AIDS drugs, the virus stampedes through the body within weeks, or days.
Dr. Gero Hütter isn't an AIDS specialist, but he 'functionally cured' a patient, who shows no sign of the disease. "I was very surprised," said the doctor, Gero Hütter. The breakthrough appears to be that Dr. Hütter, a soft-spoken hematologist who isn't an AIDS specialist, deliberately replaced the patient's bone marrow cells with those from a donor who has a naturally occurring genetic mutation that renders his cells immune to almost all strains of HIV, the virus that causes AIDS.
The development suggests a potential new therapeutic avenue and comes as the search for a cure has adopted new urgency. Many fear that current AIDS drugs aren't sustainable. Known as antiretrovirals, the medications prevent the virus from replicating but must be taken every day for life and are expensive for poor countries where the disease runs rampant. Last year, AIDS killed two million people; 2.7 million more contracted the virus, so treatment costs will keep ballooning.

While cautioning that the Berlin case could be a fluke, David Baltimore, who won a Nobel prize for his research on tumor viruses, deemed it "a very good sign" and a virtual "proof of principle" for gene-therapy approaches. Dr. Baltimore and his colleague, University of California at Los Angeles researcher Irvin Chen, have developed a gene therapy strategy against HIV that works in a similar way to the Berlin case. Drs. Baltimore and Chen have formed a private company to develop the therapy.

Back in 1996, when "cocktails" of antiretroviral drugs were proved effective, some researchers proposed that all cells harboring HIV might eventually die off, leading to eradication of HIV from the body -- in short, a cure. Those hopes foundered on the discovery that HIV, which integrates itself into a patient's own DNA, hides in so-called "sanctuary cells," where it lies dormant yet remains capable of reigniting an infection.

But that same year, researchers discovered that some gay men astonishingly remained uninfected despite engaging in very risky sex with as many as hundreds of partners. These men had inherited a mutation from both their parents that made them virtually immune to HIV.
The mutation prevents a molecule called CCR5 from appearing on the surface of cells. CCR5 acts as a kind of door for the virus. Since most HIV strains must bind to CCR5 to enter cells, the mutation bars the virus from entering. A new AIDS drug, Selzentry, made by Pfizer Inc., doesn't attack HIV itself but works by blocking CCR5.

About 1% of Europeans, and even more in northern Europe, inherit the CCR5 mutation from both parents. People of African, Asian and South American descent almost never carry it.
Dr. Hütter, 39, remembered this research when his American leukemia patient failed first-line chemotherapy in 2006. He was treating the patient at Berlin's Charité Medical University, the same institution where German physician Robert Koch performed some of his groundbreaking research on infectious diseases in the 19th century. Dr. Hütter scoured research on CCR5 and consulted with his superiors.

Finally, he recommended standard second-line treatment: a bone marrow transplant -- but from a donor who had inherited the CCR5 mutation from both parents. Bone marrow is where immune-system cells are generated, so transplanting mutant bone-marrow cells would render the patient immune to HIV into perpetuity, at least in theory.

There were a total of 80 compatible blood donors living in Germany. Luckily, on the 61st sample he tested, Dr. Hütter's colleague Daniel Nowak found one with the mutation from both parents.
To prepare for the transplant, Dr. Hütter first administered a standard regimen of powerful drugs and radiation to kill the patient's own bone marrow cells and many immune-system cells. This procedure, lethal to many cells that harbor HIV, may have helped the treatment succeed.
The transplant specialists ordered the patient to stop taking his AIDS drugs when they transfused the donor cells, because they feared the powerful drugs might undermine the cells' ability to survive in their new host. They planned to resume the drugs once HIV re-emerged in the blood.

But it never did. Nearly two years later, standard tests haven't detected virus in his blood, or in the brain and rectal tissues where it often hides.

The case was presented to scientists earlier this year at the Conference on Retroviruses and Opportunistic Infections. In September, the nonprofit Foundation for AIDS Research, or amFAR, convened a small scientific meeting on the case. Most researchers there believed some HIV still lurks in the patient but that it can't ignite a raging infection, most likely because its target cells are invulnerable mutants. The scientists agreed that the patient is "functionally cured."

Caveats are legion. If enough time passes, the extraordinarily protean HIV might evolve to overcome the mutant cells' invulnerability. Blocking CCR5 might have side effects: A study suggests that people with the mutation are more likely to die from West Nile virus. Most worrisome: The transplant treatment itself, given only to late-stage cancer patients, kills up to 30% of patients. While scientists are drawing up research protocols to try this approach on other leukemia and lymphoma patients, they know it will never be widely used to treat AIDS because of the mortality risk.

There is a potentially safer alternative: Re-engineering a patient's own cells through gene therapy. Due to some disastrous failures, gene therapy now "has a bad name," says Dr. Baltimore. In 1999, an 18-year-old patient died in a gene therapy trial. Even one of gene therapy's greatest successes -- curing children of the inherited "bubble boy" disease -- came at the high price of causing some patients to develop leukemia.

Gene therapy also faces daunting technical challenges. For example, the therapeutic genes are carried to cells by re-engineered viruses, and they must be made perfectly safe. Also, most gene therapy currently works by removing cells, genetically modifying them out of the body, then transfusing them back in -- a complicated procedure that would prove too expensive for the developing world. Dr. Baltimore and others are working on therapeutic viruses they could inject into a patient as easily as a flu vaccine. But, he says, "we're a long way from that."
Expecting that gene therapy will eventually play a major role in medicine, several research groups are testing different approaches for AIDS. At City of Hope cancer center in Duarte, Calif., John Rossi and colleagues actually use HIV itself, genetically engineered to be harmless, to deliver to patients' white blood cells three genes: one that inactivates CCR5 and two others that disable HIV. He has already completed the procedure on four patients and may perform it on another.

One big hurdle: doctors can't yet genetically modify all target cells. In theory, HIV would kill off the susceptible ones and, a victim of its own grim success, be left only with the genetically engineered cells that it can't infect. But so far that's just theory. All Dr. Rossi's patients remain on standard AIDS drugs, so it isn't yet known what would happen if they stopped taking them.
In 1989, Dr. Rossi had a case eerily similar to the one in Berlin. A 41-year-old patient with AIDS and lymphoma underwent radiation and drug therapy to ablate his bone marrow and received new cells from a donor. It is not known if those cells had the protective CCR5 mutation, because its relation to HIV hadn't been discovered yet. But after the transplant, HIV disappeared from the patient's blood. The patient died of his cancer 47 days after the procedure. Autopsy tests from eight organs and the tumor revealed no HIV."

How did the Medical Professionals Fare in the Congressional Elections?

On his Wall Street Journal Health Blog, Jacob Goldstein took a look at Tuesday's congressional elections. Check it out:

http://blogs.wsj.com/health/2008/11/06/how-many-doctors-are-in-the-house

"Enough with the Democrats and Republicans. How did doctors do in Tuesday’s Congressional elections?
Pretty well: There will be at least 14 MDs in the 111th Congress, a pickup of two seats from the current session, the AMA told us.
Ten of the docs are Republicans and four are Democrats. Don’t hold your breath for them to band together to overcome party differences and lead the nation toward health-care reform.
“You’d think the physicians’ caucus would provide leadership to the parties, but it hasn’t worked out that way,” Michael Burgess, a Texas ob-gyn first elected to the House in 2002, told the Health Blog. “In my humble opinion, there aren’t enough doctors in Congress. It leaves us with a pretty narrow group of individuals, and it’s a little harder to build consensus on common ground.”
Even issues where McCain and Obama shared common ground may prove thorny. Take, for example, moving Medicare payments away from the current fee-for-service payment model — an idea many doctors, including Burgess, are wary of. “Had Sen. McCain been successful, I was hoping to work on him about that,” Burgess told us.
All nine docs who ran for re-election in the House of Representatives held on to their seats, according to the AMA. Another, Florida Republican and internist David Weldon, retired. (A family doc ran as a Democrat to fill Weldon’s seat, but lost to a Republican Realtor who has served in Florida’s Legislature.)
There are two docs in the Senate: Tom Coburn (R., Okla.) ran for re-election and won; John Barasso (R., Wyo.) wasn’t up for reelection.
Three MDs were newly elected to the House; another 15 ran and lost (not as grim as it might sound, given the long odds against unseating incumbents). And one Maryland race, in which an anesthesiologist is running as a Republican for an open seat, is still too close to call, the Baltimore Sun reported this morning.
Specialty Bonus: Five of the 14 docs in Congress are ob-gyn, making it the most common specialty on the Hill. (Insert joke about a “national re-birth” or “delivering change” here.) Family medicine comes in second

Offshore Medical Services Increasing in the United States

The Wall Street Journal published an article by Amar Gupta about the information technology revolution in the medical field. Not only will your doctor not be in the room with you, but he may be half way around the world. Read on!

Health care has managed to avoid the information-technology revolution. But it won't for much longer.
By AMAR GUPTA

"The health-care industry is about to undergo a global revolution driven by a force it can no longer resist: information technology.
While hospitals and other care providers have long been quick to adopt breakthrough technology in medical devices, procedures and treatments, far less attention has focused on innovations in networking and communications.

This is partly because of concerns about breaches in security and patient privacy, and because health care until recently was a service always performed locally, and in person. Big computer networks and the core benefits they offer -- such as increased group productivity and access to data -- weren't on the health-care sector's radar screen.

But that is about to change. IT security will eventually meet the expectations of the health-care industry, just as has happened in other sectors, like banking. And when it does, powerful IT networks crisscrossing the globe will change the way much of health care is delivered: Outsourcing and offshoring of medical and nonmedical services will increase, providing more efficient health care at the most cost-effective rates; systems integrations will allow more medical records to be transferred swiftly and securely; efforts to monitor the safety of medicines will gain global access to data; and professionals and patients will find authoritative and up-to-date information on every specialty online.

In the future, there will be three often overlapping modes of delivering health-care services: services performed in person by humans, services that can be performed by people at a remote location, and services performed by computers without direct human involvement. Offshore outsourcing in combination with a 24-hour work cycle will be appropriate when certain conditions are met -- mainly, if the information involved in the task can be digitized, and if workers at different sites can do their jobs independently from one another.
These changes won't come quickly. There will be plenty of obstacles as institutions and networks reach across borders and encounter different laws as well as technical standards. Licensing, accreditation and accounting issues will arise as well. But eventually all such issues can be resolved by proper regulatory structures and market forces.

In the meantime, health-care organizations that don't join in the coming changes will incur higher costs and less integration. This will make them less competitive in the global health-care marketplace, just as is happening with companies that have resisted outsourcing and systems integration in other sectors.
What follows is a look at four major ways in which IT will revolutionize health care: more offshore services, integration of health-information systems, drug-safety monitoring on a global scale, and more high-quality information to doctors and patients.

The most noticeable changes will be the offshore outsourcing of diagnostic services -- particularly imaging, such as X-rays and mammograms -- and consultations by specialists.
Doctors in the U.S. and other countries have long practiced variations of telemedicine to provide care to patients in hard-to-reach and underserved locations. But in the future, telemedicine will be practiced more as a way of distributing work loads and lowering costs. Teleradiology in particular, in which X-rays are taken at one location and then transmitted to doctors at another site, appears ripe for expansion.

Forces driving the growth of teleradiology include a significant shortage of radiologists, aging populations and more use of imaging in trauma situations, which in turn has fueled a need for 24-hour radiological services in emergency rooms.
With robust IT networks, a single radiologist can support multiple hospitals, or large hospitals can serve as central image-reading sites, spreading the work among a staff of radiologists. Remote sites can be set up with just imaging equipment and technicians, extending radiology services to underserved regions. Offshore outsourcing, meanwhile, can mean that images taken in the middle of the night are still read right away by a wide-awake radiologist working at the height of his or her powers.

The Past: Health care mostly ignored information technology for years. Goals such as linking groups of workers and improving communication weren't priorities for an industry more concerned with delivering services in person and protecting privacy.
The Present: Now, improvements in network security and the ability to transmit images and data around the world have opened the door to changes that will revolutionize the sector.
The Future: Most noticeably, robust IT networks will allow offshore outsourcing of certain medical and nonmedical services and integration of information systems, making health care more efficient and cost-effective. Groups that don't adopt some form of outsourcing will fail to keep up with competitive cost pressures, as has happened in other industries.
The biggest hurdles to the expansion of teleradiology may be the credentialing and billing processes. While many countries will give a doctor a license to practice anywhere in that nation, the practice in the U.S. is to issue licenses at a state level. This creates more bureaucracy. Most states require medical professionals to be U.S. citizens or legal residents in order to be licensed. Also, it is difficult for doctors abroad to get reimbursement from insurance companies in the U.S. for telemedicine services.

Another reason to outsource more medical services abroad: The World Health Organization and the American Cancer Society have identified working at night as a possible cause of cancer. Such a finding may help fuel efforts to wean medical workers from graveyard shifts. Video cameras and other equipment can monitor sleeping hospital patients in other cities, states or countries. Similarly, sleep studies, in which the patient is observed for a full night at a sleep center, can base patients in one country and technicians in another. If the patient develops unusual symptoms, medical personnel can be summoned on the scene.
Over time, the offshore outsourcing of more medical services will benefit developed countries because it can provide faster diagnosis and lower overall costs. Offshore outsourcing also can benefit developing nations, by giving patients more access to expert health care. However, there is a shortage of medical professionals both in developed and developing countries, and the diversion of such resources to foreign patients can potentially aggravate the shortage. These issues, and others, will be partly resolved by market forces.

Globally integrated health-information systems are evolving, along with standardized formats for patient records -- making the charts easier to translate.
A detailed medical history can be critical if a person suffers an illness or accident far from home. Integrated information systems and records that translate easily would be of enormous help in natural disasters and other mass-casualty situations in which the victims come from many different places.

But current hospital information systems were designed to function as islands with their own rules and formats, making a patient's file at one hospital difficult for another to read. Not only are different languages and measures sometimes used, but conflicts between encryption and other software can make it impossible for systems to exchange data electronically.
Computer programs and Internet technology will play big roles in overcoming such obstacles. But experts in IT and medicine will also be indispensable at every stage, whether for building the tools for integration or assisting in specific records transfers.
Hospitals and other health-care organizations in the U.S. have started to make a dent in this area, using domestic medical and IT personnel to develop systems for the electronic exchange of medical records. But so much remains to be done, the higher cost and relative scarcity of U.S. labor available for this work is most likely to lead the industry to outsourcing abroad.
Meanwhile, a precedent already exists for fast and secure international transmissions of U.S. medical records. U.S. hospitals and doctors increasingly rely on workers abroad to transcribe audio recordings into written notes. Typically, the audio recording will be sent in the evening, U.S. time, to transcriptionists in India, for whom it is morning. A written version of the recording is then available to the doctor over the Web before the next day shift begins in the U.S.

As people become more mobile, an international database on drug safety will be created.
Various programs currently do this kind of work in their home countries, including MedWatch, an initiative of the U.S. Food and Drug Administration that investigates and reports on adverse drug reactions and other safety issues involving medical products. MedWatch gets reports from a wide network of domestic sources, including pharmacy companies, insurers and professional associations in the medical, dentistry and nursing fields. But no agency routinely collects and shares information between countries. So, incidents involving medicines purchased abroad can fall through the cracks. This is a growing concern in the U.S. not only because people are traveling more, but also because U.S. residents increasingly purchase prescription drugs from pharmacies in Canada and other countries because of lower prices.

A possible prototype for a global watchdog already exists, designed by researchers from the University of Arizona for the Critical Path Institute. Co-founded by the FDA, C-Path is a nonprofit based in Tucson, Ariz., and Rockville, Md., that researches areas related to drug development and safety. The prototype envisions a network that would connect and share data among multiple organizations including: companies or groups that tested or helped produce the drug; the FDA and equivalent agencies in other countries; and the doctor or organization that prescribed the medication. Individual pharmacies, too, would participate directly -- a critical contribution, since they have the information about buyers, dates and quantities.
Serious challenges to this vision exist, such as different reporting procedures in various countries, and potential conflicts in software and Web protocols. The technical conflicts can be solved over time by IT experts working toward standardization. As with systems-integration challenges, costs and labor shortages will drive the use of offshore labor.
Meanwhile, with the right infrastructure and incentives, pharmacists and pharmacy technicians could replace the current hodgepodge of reporting methods by becoming designated agents for collecting raw information on patients' medication histories, including adverse reactions.

The latest medical knowledge will appear on Web sites edited by eminent specialists in those fields.
Doctors and scientists from around the world will contribute material, and automated search tools will capture updates from, say, a trusted clinical study. The reliance on IT and editorial workers in less-expensive countries, meanwhile, will help make such endeavors more economically viable.
Such sites are likely to take shape as hybrids of information sources and tools, drawing from online textbooks, medical journals, wiki-style editing and automatic updates from various trusted data sources. While the sites will have human editors, developers are working on tools to help comb through the large number of newly published and potentially relevant articles that need to be considered each week. The goal will be not just to increase the amount of medical information at people's fingertips, but also to make it specific, up-to-date, reliable and easier to find.
The detailed nature of this kind of work, and competitive cost pressures, will mean that a mix of medical and IT professionals will have to be employed both in the U.S. and abroad.
The eventual benefits, meanwhile -- from all of the advances predicted -- will be universal."
—Dr. Gupta is the Thomas R. Brown professor of management and technology at the University of Arizona. He can be reached at reports@wsj.com.

Universal Healthcare is a big issue in Campaign '08

Emily P. Walker, Washington Correspondent, MedPage Today, published the following article from Denver regarding Sen. Hillary Clinton's stance on universal healthcare and its mention in her speech at the Democratic National Convention last night.

" Despite tortuous battles during the presidential primaries over the nuances of healthcare reform, Sen. Hillary Clinton was ringing in her support for Sen. Barack Obama's goals at the Democratic National Convention here.
In a so-called unity speech last night, Clinton said that she ran for president in part to "create a healthcare system that is universal, high quality, and affordable so that parents no longer have to chose between care for themselves or their children or be stuck in dead-end jobs simply to keep their insurance."
She added, "I can't wait to watch Barack Obama sign a healthcare plan into law that covers every single American."
Clinton, who was in charge of the failed healthcare reform initiative during her husband's presidency, was scheduled to headline a forum today called "Winning Healthcare Reform in 2009."
Earlier yesterday, some figures in the entertainment world took advantage of the massive press turnout here to draw attention to the plight of children with type 1 diabetes in developing nations.
Among the famous faces were film stars Susan Sarandon, Anne Hathaway, Zooey Deschanel, and Matthew Modine, and hair-guru Paul Mitchell.
The celebrities are all part of the Creative Coalition, a Hollywood non-partisan political and social advocacy group.
At the luncheon, sponsored by Creative Coalition, a clip of a documentary was shown, called "Life for a Child," produced by the International Diabetes Fund and drug-maker Lilly. It tells the story of kids living with type 1 diabetes in Nepal.
Still earlier, Family USA responded to new Census Bureau figures that showed that more Americans had health insurance coverage in 2007 than in 2006.
Families USA, which advocates universal healthcare access, said the increase in insured Americans stems in part from people trading in their employer-sponsored plans for Medicaid.
In fact, healthcare coverage for workers is getting worse, said Ron Pollack, executive director of Families USA. According to Pollack, in 2000, 64.2% of the public was covered by employer-sponsored insurance. In 2007, it was reduced to 59.3%.
"As employer-sponsored health coverage continues to erode, it is important that meaningful healthcare reform become the top and earliest domestic priority of the next president and Congress," said Pollack. "

Can anyone bail out Grady Memorial Hospital in Atlanta?

Grady Memorial Hospital has been a thorn in the side of Atlanta's healthcare community and city, county and state government for many years. Noone has been able to "fix" Grady's health. Grady does have a new CEO named Michael Young, the former president and CEO of Erie County Medical Center Corporation in upstate New York, and I think that he may be the man to heal Grady. Many have profited from Grady's woes. It appears that PricewaterhouseCoopers had a large bounty at stake in the event they can improve the hospital's profitability. My favorite healthcare blogger, Sarah Rubenstein at the Wall Street Journal takes on the Grady issue. Read on.

"PricewaterhouseCoopers has taken on the job of helping fix Grady Memorial Hospital, the public hospital in Atlanta that has been bleeding money for years. The firm had hoped to save Grady $65.5 million in 2008, but the hospital fell $7.7 million short of a mid-year goal, according to a report obtained by the Atlanta Journal-Constitution. By year end, Grady could miss out on $10 million to $20 million in savings because of the setbacks, the consultant said.
Here are problems the AJC lists from an August presentation on the hospital:
“Cultural and behavioral barriers regarding accurately charging patients for services rendered.”
“Inefficient contracting process; Missing sense of urgency and accountability; Lack of aggressiveness with vendors.”
Resistance from physicians involved in surgery, delays due to time needed to address executives’ concerns and difficulty recruiting and retaining qualified staff.
A “higher degree of uncertainty than typical,” and delays in starting initiatives.
Consulting firms themselves have a cost. As of early August, PWC had won $6.2 million in fees through a two-year contract that pays the firm as much as one-fifth of what it saves Grady, according to the AJC. The consultant could make up to $26 million, but will earn less if it saves less. Still, PWC has saved Grady more than $34 million between October and June 30, the report said."

10 Items Which Undo Proper HR Documentation

Proper documentation is essential in human resources. Failure to properly document any issue may lead to your failure to defend or file a lawsuit. The

HR Manager's Legal Reporter published a list of items that sink HR documentation. Here are the top ten:

"1. Unsigned or undated documents. This is the number one failure in documentation. Sign and date everything! Have the employee do the same.

2. Illegibility. You didn't go to med school, so leave the scrawl to the doctors. In court, neatness counts!

3. Late documentation. Judges and juries look askance at disciplinary or other reports written weeks or months after the incident they describe.

4. Inaccuracy. That document looks perfect, but the facts are wrong. Even one error makes the entire document suspect.

5. Unsupported conclusions. Don't write, "Worker X was drunk" without documenting the reasons you think so, e.g. "liquor on breath, slurred speech." Statements by objective witnesses will buttress your conclusion even more.

6. Waffling. If Mike isn't making 200 widgets per hour, don't just write, "Mike's performance must improve." The judge will ask, "Improve from what to what?" Be specific.

7. Don't make excuses. Statements such as "You failed-but I know we've all been pushing hard lately," may win you a nice guy award, but it won't win your case.

8. Don't lie ... even to be nice! Saying someone was let go due in a layoff rather than for cause, if there was cause, can backfire big time in a wrongful termination suit.

9. Be consistent. If you've written up Sally for an infraction, you'd better have written up everyone who did it. Otherwise you're open to a charge of discrimination.

10. Don't over or under focus. Writing up every tiny infraction makes you seem petty. But writing only the job-ending incident makes you appear emotion-driven."

Ten Important Steps Before Terminating an Employee

One of the most unpleasant experiences as a manager is to terminate someone's employment; especially if you like the employee personally. It is never easy. It is important not to let emotions get in the way and stick to corporate protocol. The following tips from HR Factfinder set forth an excellent foundation for handling the process. Check it out.
"90 percent of discrimination charges are discharge-related. The reasons are obvious: Terminations cause hard feelings, create economic need, and destroy feelings of loyalty, says today's expert. What can HR do?
Expert James W. Bucking, partner and co-head of the Employment Department at Foley Hoag LLP in Boston, blogging on HR FactFinder, offers 10 tips for handling terminations and avoiding lawsuits. Here's some of what he says.

1. Know the Facts. As an employer, you have broad authority to compel employees to talk to you. Take advantage of this right, says Bucking. Talk to supervisors, co-workers and subordinates, and make a record of what they tell you. Speak with the employee involved because it's a lot better to know his or her story at the time of termination than to hear it first at a deposition.

2. Review ALL the documents. Be especially wary of "stellar" performance reviews, says Bucking. Also review the disciplinary records of other employees in the same job or area. "There may be perfectly good reasons for treating employees who seem similarly situated differently, and you need to consider these differences in advance," he says. Also, look everywhere documents concerning the employee may exist, including the files, electronic records, and e-mails of the supervisor and everyone else involved.

3. Create new documents. "Sometimes the problem with a termination is that there are few documents supporting your decision. "There is nothing wrong with creating such documents-in fact, it is a good idea," Bucking writes. But never make things up on or backdate the documents you create.

4. Beware the electronic scourge. Many people and documents are typically involved in discharge decisions, and today's technology preserves every bit of the "untidy, behind-the-scenes process." Litigation discovery can reveal it for the world to see. Have an attorney involved at all stages, Bucking advises, as this brings things under attorney/client privilege. If an attorney is not involved, then avoid creating a permanent electronic record.

5. Don't lie. "The worst thing to do when terminating an employee is to be dishonest as to why. Yet this is a common mistake," Bucking says. Like most people, employers hate confrontation and hard truths, so firing for poor performance is often disguised as a layoff. "But most discrimination allegations turn not on direct evidence (like racial slurs), but on 'pretext,'" he says. "An employer gives a false reason for termination, creating the inference that the real reason was unlawful."

6. Don't be cruel. To you, a termination may be just business, but there's no way to avoid an employee taking it as personal. That's likely to lead to a lawsuit, where "cold-heartedness does not play well before a judge, and especially a jury," Bucking says.

7. Conduct the termination respectfully. Don't fire in public. Instead, be as private, respectful, and decent as possible.

8. Have backup. Two people should be present at the termination, says Bucking, and both should take detailed notes. Record anything material that the employeesays, and also what you say, especially on the reason for your action. Be sure that what you tell the employee agrees with your previous oral and written statements.

9. Pay all compensation. Make sure that all monies due to the employee are paid immediately. In many states, all compensation owed must be paid on the day of discharge.

10. Don't forget about non-compete, non-disclosure, severance, and other agreements. Make sure you live up to any obligations to departing employees, and make sure they understand any obligations they owe you. Bucking also suggests considering new agreements such as a release from legal action based on the termination. "It may be a great investment to pay a few weeks of severance for absolution from litigation," he says.In an article on HR.BLR.com, private investigator George Scharm offered some other helpful termination tips, including:--Never fire someone while you're angry. You want to diffuse emotion, not compound it.--If an employee has a poor relationship with his immediate supervisor, get someone else to conduct the firing.--Plan every step of the meeting in advance: what you will say, how you will respond if the employee reacts with anger or hysteria.--Beyond forestalling litigation, as Bucking suggests, severance pay can also be an investment in company security. Be courteous, but firm. Leave nothing open to negotiation.--Have the exit preplanned. Escort the employee out the door and to his or her car."

Medicare..Can Physicians Save Move and Improve Care?

Anna Wilde Mathews, a blogger for the Wall Street Journal tackles a tough issue which is the subject of constant buzz in the healthcare community..Medicare reform. It seems a group of doctors participated in a pilot program run by the Centers for Medicare and Medicaid Saving which offered efficient practices incentive payments. Check it out.

"Washington is revving up for a big debate next year over health care — which, realistically, is likely to end up centering around some form of Medicare reform. Everybody wants to somehow save money while also improving care. Proof that trick can be performed consistently in the real world is hard to come by, despite the flurry of concepts and buzzwords being shopped to congressional staffers as the hope for tomorrow.

Some encouraging data are just out from a closely watched demonstration project on incentive payments for doctors being run by the Centers for Medicare and Medicaid Services. The project focuses on 10 physician group practices that can earn extra money by improving efficiency and hitting various quality benchmarks.

The groups scored nearly perfectly on quality measures for diabetes, heart failure and coronary artery disease, with half achieving the targets for all 27 bogeys, and all of the groups meeting at least 25. But only four achieved the CMS efficiency targets and won the extra payments tied to saving the government money and achieving quality standards.

The savings were measured in a typically convoluted way-– the doctor groups got the bonus if the growth of the demonstration participants’ Medicare costs was at least 2% slower than the growth for other beneficiaries in their geographic areas.

John Pilotte, the CMS project director for the pilot, told the Health Blog he felt the savings results were still “very positive,” and better than the first year, when just two groups achieved the goal. Still, he added, “it sort of underscores the challenges and the difficulties in managing care for the Medicare population.”

So what worked? Pilotte and officials from a number of the clinics flagged various things, including those policy-wonk favorites: chronic disease management and coordination of complex cases.

Theodore Praxel, a medical director at Wisconsin’s Marshfield Clinic, one of the four savings-bonus winners, said there was “no single answer,” but he gave a lot of credit to yet another wonkish fave, an electronic medical record that helped track and alert personnel to what services patients needed. He also pointed out that savings from better prevention of health problems can take years to show up."

Stanford Study Proves Running Slows the Aging Process

I do not enjoy running but I do enjoy how I feel when my run is completed. In addition to the endorphins running releases, running also slows the aging process. Stanford released the following regarding its long term study. I think I'll go for a run this afternoon.

"The Stanford University School of Medicine has released the results of a long-term study that explores how a lifetime of running affects the aging process. The multitude of benefits derived from running have surprised even the research team.
In 1984, James Fries, MD, and his team of research colleagues enlisted 538 runners, all older than 50, and a similar group of nonrunners. Each year since then, the study participants have completed questionnaires about their personal lives, including their ability to groom, dress, and walk themselves as well as to their ease in getting up from a chair and gripping various objects. Their running patterns have been documented through the years as well.
When the study began, the runners averaged about four hours of run time each week. Twenty-one years into the study, run time has diminished to only 76 minutes per average week but the runners were still reaping the benefits of their active lifestyle nonetheless.
After 19 years of study, only 15% of the runners had died, from any cause, compared to 34% of the group of nonrunners. As was expected, the rate of death due to cardiovascular disease was much lower in the group of runners but the running group also had fewer deaths attributed to cancer, infection, and neurological disease, among others.
By the 21st year of the study, participants in both the running and nonrunning groups had started bearing signs of advanced age. They are now all in their 70s and 80s. What has proven to be quite remarkable is that the age of decline is dramatically later in the runners than in the nonrunners.
The onset of initial disability occurred 16 years later, on average, in the group of runners than in the group not running. Even more surprising is that, as age advances, the gap between the health of the runners versus the health of the nonrunners widens, in effect compressing the ill effects of old age into the shortest amount of time possible.
Indeed, it was Fries’ theory of “compression of morbidity” that led to the study in the 1980s. At that time, critics of the new running craze said the exercise would lead to injuries of the knee and other joints that would cause osteoporosis and other crippling disabilities as age advanced.
Fries’ thoughts were that a lifetime of regular exercise, such as running, would extend the runner’s life while enhancing vitality and improving its quality at the same time. His extensive study has proven his hypothesis correct.
Fries is emeritus professor of medicine at Stanford’s medical school and is the senior author of the paper describing his study of running. The Archives of Internal Medicine carries the full details in its August 11 issue.
The National Institute on Aging and the National Institute of Arthritis and Musculoskeletal and Skin Diseases awarded grants for the Fries study."
Source: Stanford School of Medicine and Medheadlines Posted August 13, 2008

Employee Compensation Issues for Small Business Owners

One of the major issues discussed with our clients is salary. It is particulary an important subject in today's economy. In the Atlanta medical community, most office managers want to pay competitive salaries, especially for hard to fill positions such as RNs. I found the following article, by Michael Alter posted on the Human Resources Blog in Inc. magazine, very informative about setting salary levels.

"Compensation is a hot-button issue for employees, but it's an even bigger deal for small-business owners these days. With shrinking profits in this tight economy and costly benefits hanging over your head, there's no room for error in defining employee salary levels. Here are some tips on how to set your salary levels.
I run a payroll service and as you might expect, I hear a lot of feedback from our small-business customers regarding employee compensation.
My conversations with business owners have made one thing clear -- many business-owners struggle with the right amount to pay new employees.
It's a tricky issue. Overpay your employees and profits may drop. Underpay your employees and you'll get inadequate employees or you'll lose them over time to the competition.
The bottomline? Today's competitive business environment necessitates a solid basis for defining compensation levels. Here are a few things to consider when you define the target salary for a new hire.

National Salary Averages Are Irrelevant
Always think local. National salary averages mean nothing if you are located, say, in a small town in Kansas. In fact, salary levels for any given position are very location dependent.
If you are doing salary research, it's imperative that you look for salaries in your town or in towns that are very similar to yours.
Similarly, salary ranges vary considerably by industry. When looking at salary benchmarks, it's important to only look at those from your industry whenever possible.
In addition, the job description, not the job title, should be on center stage when researching salaries. It's what the person will do and what's at stake that matters, not the title that will go on their business card.

Online Salary Wizards
So where can you go to research salaries and why is salary research important?
Before prospective employees start interviewing, they will often check out online salary calculators such as the Salary Wizard at Salary.com.
To understand the expectations of your prospective hires, it's important that you find out what the online salary wizards are saying.
Unfortunately, some of the salary estimates that come from these online tools are way off the mark. In part, that's because the salary wizards are usually geared toward larger businesses, not small businesses. They also are usually bases on title, rather than job responsibilities.
For example, a customer of ours who owns a small PR firm informed me that the Salary.com salary wizard pegged the average starting salary for a Media Relations Specialist in Chicago to be $45,000. In fact, he explained, a more typical range for that particular position is $25,000 to $32,000.
How's that for a scenario? You are ready to offer $31,000, near the high end of what you believe to be the salary range for a position, and the employee, armed with what they believe to be the right salary, says they'd like to get $45,000.
As you can see, regardless of whether the online salary wizards are right or not, it's well worth your time to find out what they say you should be paying.
If what you'd like to pay and what the online salary wizards say you should pay are way out of whack, you'll do well to check some other sources and be ready to present that data to any misinformed candidates.

Industry and Trade Associations

Industry trade associations and HR organization are an excellent source for salary data. Most have undertaken extensive industry salary surveys and have salary data that you can access and evaluate. A quick call to your industry trade association will help you find out if they have the data you are seeking.
You can also ask for the data from associations you don't belong to. In many cases, the results of comparative salary surveys are available on association websites.
Peer Organizations
Talking to peers about current salary levels is always a good idea. Look for an organization that you don't compete with. Maybe you own an ice cream shop and the guy next door owns an apparel store. Since you are not directly competitive, you should have no problem sharing salary information for positions like a bookkeeper. By finding out what your peers are paying, you can get a good sense for market salary rates.

Competitive Research
Getting data about what your competitors are paying their staff is a much tougher assignment but it's doable. When a competitor advertises a position for hire, you might give their HR manager a call and ask what the salary range is for the position. Borderline unethical? Not really. This is routine competitive intelligence gathering in my opinion.

Think In Terms of Ranges
You should always have a salary range that you are willing to pay for any given position. Locking in on a single number is a mistake.
The reason you need to think in terms of salary ranges is that every job candidate has slightly different experience. You should be willing to pay more for a more experienced candidate because, in theory, their prior work experience will make them more productive in your organization relative to a worker with less experience.

Ask Candidates About Salary Before You Tell Candidates About Salary
It's always best to ask prospective recruits what their salary expectations are. Ask early in the interviewing process to avoid a scenario in which you both invest a lot of time only to find out that your expectations are completely misaligned.
Don't ask what a prospective employee wants in the way of salary. Instead, ask them what they need. Your top recruit might desire to earn $75,000 but maybe they only need to earn $55,000. Knowing what they need can help you to define the right salary.
Don't forget that compensation is much more than just cash. You need to tout the benefits of working at your organization and make sure prospective employees understand that value proposition. This can include typical HR benefits such as good health insurance but it should also touch on opportunities for advancement in the organization, training, mentoring, a friendly and fun work atmosphere, and the work itself.

Revisit Your Salaries Often
Salary ranges change constantly based on supply and demand. In a bullish economy, talented recruits are a scarce commodity and you may have to pay higher salaries. In bearish times, you can pay less. Currently, because of the economy, it's a buyer's market for employees. In other words, you can afford to offer a lower salary this year relative to prior years.
If your salary levels are based on research you did years ago, you'd do well to take a fresh look at current salary levels.
If you are not sure what to pay, my recommendation is that you err on the side of paying more than the market because talented and motivated employees can do amazing things. There a lot of areas in business where you can scrimp but paying your employees shouldn't be one of them."

Thoughts about Social Network Sites for Business

I am a fan/student of technology, the internet and any new and exciting trends for business. I have been researching the use of social networking sites for business purposes and have even joined Linked In and My Space and have linked them to my website. I think the following article by Karen E. Klein in Business Week aptly discusses this subject. Enjoy.

"To get the most out of social networking sites, small companies should look past the hype, set concrete business goals, then start experimenting. Social networking online seems to be exploding: Facebook, LinkedIn, Twitter, Digg, and so on. When I ask how these sites can help my business, the answers can be vague. I am trying to relate it to face-to-face networking, which includes sharing ideas, information, and resources with other businesses. Are these sites useful for those goals? There is only so much time in my day and I need to use it effectively. —B.H., Scarborough, Me.

You are correct that social networking is a rapidly growing, headline-grabbing phenomenon. The question for entrepreneurs is how to tap into this trend as a business opportunity, rather than simply a way to connect—or reconnect—with people, says Peter Delgrosso, strategic vice-president for corporate communications with Web.com (WWWW).
"For the most part, these social networking sites should be viewed as complementary to your online presence. Think of it as a nice-to-have, not a must-have," he says. "When used properly, it is something that can gain your business some attention. However, you need to realize it shouldn't be seen as a replacement to your traditional online presence."
Greg Sterling, of Sterling Market Intelligence, considers social network sites primarily for meeting people, asking for advice or referrals and, carefully, doing online marketing. The uses vary by application or site, he notes: "Sites such as LinkedIn can be helpful in connecting with people you want to meet for one reason or another. Twitter and Facebook can be helpful when you're trying to notify a group of people about something you want to promote or about a happening of some kind."

Find Your Networking Niche

Take a few minutes—it doesn't have to be extensive—to look over the top sites and experiment to see what works for you. Even an hour or two a week can help you figure out which sites you like best and are most effective for your particular business. "The viral nature of social networking is quite extraordinary and something that can garner a lot of attention to your efforts in a hurry," Delgrosso says.
He thinks the best site for both networking and human resources purposes is LinkedIn. "The site requires some résumé creation, then offers the opportunity to link in to other like-minded professionals. When used selectively, it can be a very powerful tool for identifying new business partners, new employees, or simply building your personal or business presence," he says.
For gaining exposure to larger audiences, he recommends Facebook: "Consider establishing or joining a network on Facebook based on your business or industry category to tap into people's affinity for the topic. By doing this, you'll cut through the clutter and clearly establish your niche, keeping the interaction focused on the specific subject matter."
Rick Julian, CEO and chief creative officer of Quo Vadis, a startup brand communications agency, says he's getting a positive return on his investment from using social media sites for the past year. "It puts a human face on your business and allows people to get an impression of what a relationship with you would be like. When all things remain equal, people want to work with people they think they'll have an interesting relationship with," Julian says. His firm is represented on five major social networking sites, including YouTube (GOOG) and his blog, and a couple of smaller ones.

"Geometric Extension" and Search Optimization
It sounds like a full-time job, but Julian points out that you can cut and paste some of your content from site to site. "If I put up a YouTube video to create awareness, I might have some discussion on YouTube with the responders and then also put it on my blog, on my Facebook company page, and promote a link to it on Twitter. Just by generating that single asset, I've populated all those networks with content without having to come up with an original piece of content for each of them. There's a geometric extension of your reach," he says.
Robert Jenson, CEO of the Las Vegas-based realty firm the Jenson Group, takes a strictly corporate approach to social networking. "Rather than blogging stream-of-consciousness opinions or using the venue as a diary of sorts, I educate visitors on important, universal industry matters. I try my utmost to ensure the content I post is not just applicable and of interest to those in Las Vegas, where I operate, but also to any real estate consumer nationwide," he says.

He puts bylined articles he's written on his own blog and on social networking sites and uses them to establish his credibility as a real estate expert. "This serves as a 'risk reliever' for both prospective consumers and business affiliates, while also increasing my chances for media coverage by establishing myself as a reliable expert source," Jenson says.
Last, but definitely not least, is the value of social networking sites to search engine optimization (BusinessWeek, 6/20/08). The more sites that include your name and link back to your Web site or blog, the higher your profile rises in search engines, where more and more of your customers are likely to find you, Jenson says. "

Dermatologists Reportedly Offer Two Tiered Skin Care

I read the Schwitzer Health News Blog and found the following topic discussed on the blog to be quite interesting. According to the blog, The New York Times reported that dermatologists are now serving first class and second class services and "it is fast becoming a two-tier business in which higher-paying customers often receive greater pampering."

Excerpt:
"In some dermatologists’ offices, freer-spending cosmetic patients are given appointments more quickly than medical patients for whom health insurance pays fixed reimbursement fees.
In other offices, cosmetic patients spend more time with a doctor. And in still others, doctors employ a special receptionist, called a cosmetic concierge, for their beauty patients.
Dr. David M. Pariser, a dermatologist in Norfolk, Va., and the president-elect of the American Academy of Dermatology, said some practices did maintain preferential policies for cosmetic patients.
“The message is that the cosmetic patient is more important than the medical patient, and that’s not a good message,” Dr. Pariser said.
At a time when dermatologists are trying to advance the idea of a national skin cancer epidemic, such a two-tier system is raising concerns that the coddling of beauty patients may divert attention from skin diseases."