Toolbar, now with advanced translation

If you saw this text on a webpage, how would you figure out what it means?<br /><br />Если вы читаете этот текст, вы, вероятно, уже говорите по-русски. Однако миллионы людей не знают русского и не могут прочитать миллионы русскоязычных веб-страниц.*<br /><br />You would likely need to translate manually via our <a href="http://www.google.com/language_tools">language tools</a> or in <a href="http://www.google.com/support/toolbar/bin/answer.py?hl=en&answer=20871">Toolbar</a>. Today we're excited to announce that translations will be even easier with the newest release of <a href="http://www.google.com/toolbar/ie/#tbbrand=GZEZ&utm_campaign=en&utm_source=en-et-gblog&utm_medium=et&rd=f">Google Toolbar for Internet Explorer</a>. We have been working with the Translate team to make translations a faster and more integrated part of your browsing experience.<br /><br />The Translate feature automatically detects if the language of a webpage you're on is different from your default language setting and allows you to translate it. With one click, you can now instantly translate the page and all of its text will appear in the new language.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_7ZYqYi4xigk/Skqsoxl37kI/AAAAAAAAD90/RpDHU61tZEI/s1600-h/translate-pip-3-wider.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5353280923590192706" src="http://3.bp.blogspot.com/_7ZYqYi4xigk/Skqsoxl37kI/AAAAAAAAD90/RpDHU61tZEI/s400/translate-pip-3-wider.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 298px;" /></a><br />Language detection happens only on your computer, so no information is sent to Google until you choose to translate a page. You can find more details about how the feature works in our <a href="http://www.google.com/support/toolbar/bin/answer.py?hl=en&answer=146786">help center</a>.<br /><br />If you go to another page in the same language, you will continue to see translations rather than have to translate one page at a time. And if the page has dynamic content, like <a href="http://www.google.com/reader">Google Reader</a>, you will get translations in real-time. Finally, if you frequently translate pages in the same language, Toolbar will let you translate that language automatically without any extra clicks in the future.<br /><br />The new Translate feature is available in all international versions of Toolbar, including English, and the translation service supports 41 different languages: Albanian, Arabic, Bulgarian, Catalan, Chinese, Croatian, Czech, Danish, Dutch, English, Estonian, Filipino, Finnish, French, Galician, German, Greek, Hebrew, Hindi, Hungarian, Indonesian, Italian, Japanese, Korean, Latvian, Lithuanian, Maltese, Norwegian, Polish, Portuguese, Romanian, Russian, Serbian, Slovak, Slovenian, Spanish, Swedish, Thai, Turkish, Ukrainian and Vietnamese.<br /><br /><a href="http://www.google.com/toolbar/ie/#tbbrand=GZEZ&utm_campaign=en&utm_source=en-et-gblog&utm_medium=et&rd=f">Download</a> Google Toolbar for Internet Explorer to try it out for yourself. We'll add this feature to Toolbar for Firefox soon, too.<br /><span style="font-size:85%;"><br />* In case you don't speak Russian, we translated the paragraph above for you using our translation engine:<br /><br /><span style="font-style: italic;">If you are reading this text, you probably already speak in Russian. However, millions of people do not know Russian and cannot read the millions of Russian-language webpages.</span><br /></span><br /><span class="byline-author">Posted by Jerry Tang and Dick Sites, Software Engineers </span>

Toolbar, now with advanced translation

If you saw this text on a webpage, how would you figure out what it means? Если вы читаете этот текст, вы, вероятно, уже говорите по-русски....

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Celebrating Gay Pride 2009

All around Google, we're proud of our work, our culture and, most importantly, our people. In the spirit of celebration, this spring and summer Googlers have participated in Pride celebrations in Tel Aviv, New York, Zürich, San Francisco and many other cities around the world. Pride is a time for the LGBT* community along with families, friends and supporters to stand up for equality, and to honor those who paved the way for us to express sexual orientation and gender identity openly.<br /><br />In the U.S., this year's celebration is historically important: it's the 40th anniversary of the <a href="http://en.wikipedia.org/wiki/Stonewall_riots">Stonewall riots</a> in New York City, a response to what was then routine police harassment of LGBT people. Some 75 Googlers, family members and friends marched with several hundred members of New York's <a href="http://www.gaycenter.org/">Lesbian, Gay, Bisexual and Transgender Community Center</a>. Hundreds of Googlers also joined other U.S. celebrations in Pittsburgh, Chicago, and San Francisco.<br /><br />Earlier this month, around 50 Googlers and friends gathered to celebrate at Europride, Europe's best-known Gay Pride celebration. This year it was in Zürich, Switzerland. After weeks of sunshine, on the morning of the parade it began to storm, but that didn't deter our intrepid Googlers from being out at 6:30am turning a 28-ton truck into a rainbow-colored nightclub on wheels. Hundreds of nuts, bolts and gallons of helium later, the truck was transformed, the sun came out and we were ready to march through the city streets, cheered on by a crowd of 50,000.<br /><br />Google is a company that supports its LGBT employees, taking a <a href="http://googleblog.blogspot.com/2008/09/our-position-on-californias-no-on-8.html">public stand</a> on <a href="http://googleblog.blogspot.com/2008/11/transgender-remembrance-day.html">issues</a> that are important to our community. This is not the first year that Google has supported Pride, and it will certainly not be the last. We hope you enjoy this photo album of our global celebrations.<br /><br /><embed type="application/x-shockwave-flash" src="http://picasaweb.google.com/s/c/bin/slideshow.swf" flashvars="host=picasaweb.google.com&captions=1&hl=en_US&feat=flashalbum&RGB=0x000000&feed=http%3A%2F%2Fpicasaweb.google.com%2Fdata%2Ffeed%2Fapi%2Fuser%2Fgblogphotos%2Falbumid%2F5352881840391025089%3Falt%3Drss%26kind%3Dphoto%26hl%3Den_US" pluginspage="http://www.macromedia.com/go/getflashplayer" width="400" height="267"></embed><br /><br /><br /><span style="font-size:85%;"><span style="font-style: italic;">*LGBT stands for lesbian, gay, bisexual or transgendered people and is also intended to include people who identify as queer, asexual or intersexed, amongst others. </span></span><br /><br /><span class="byline-author">Posted by Cynthia Yeung, Partner Strategy Team</span>

Celebrating Gay Pride 2009

All around Google, we're proud of our work, our culture and, most importantly, our people. In the spirit of celebration, this spring and...

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Google heads to grade school: New resources for K-12 teachers and students

We use the Internet all the time: at home, at work (especially at Google!), on the move, and, increasingly, at school. We believe that the Internet and cloud-based tools are a key part of a 21st century classroom, helping students learn and teachers teach in collaborative and innovative ways. Students use Google Docs to work on group projects; classrooms use Google Sites to show off their work; and teachers use Forms in Google Docs for instant grading and Google Calendar for lesson planning. <a href="http://www.google.com/a/edu/">Google Apps Education Edition</a> is helping schools build online communities for students, teachers and parents, and we now have 4 million students using Google Apps Education around the world.<br /><br />This week the Google Apps Education team is launching a few new ways to make it easier for K-12 schools to use Google Apps, and attending the National Education Computing Conference (<a href="http://center.uoregon.edu/ISTE/NECC2009/">NECC</a>) in Washington D.C. To help address schools' email security needs, <a href="http://www.google.com/postini/email.html">Google Message Security</a> (GMS) will be offered free to current and new eligible primary and secondary schools globally that opt in by July of next year. GMS filters out email messaging threats, and education IT departments can customize the filtering rules and group messaging lists to suit their schools. We're also launching the <a href="http://edu.googleapps.com/">Google Apps Education Community site</a> for educators and students to share tips and ideas for using Google Apps in their classrooms, as well as the <a href="http://www.google.com/educators/p_websearch.html">Search Education Curriculum</a> and a <a href="http://www.google.com/apps/eduresources">Google Apps Education resource center</a> with more than 20 classroom-ready lesson plans for teachers. We'll be adding more to these resources going forward.<br /><br />If you're at NECC this year, come visit the Google team in booth #3148. If not, the teaching and learning continues with some cool <a href="http://edu.googleapps.com/tutorials-and-tips/necc-presentations">presentations and lesson plans</a> on the Google Apps Education Community site, or you can learn more at <a href="http://www.google.com/a/edu">google.com/a/edu</a>.<br /><br /><span class="byline-author">Posted by Dana Nguyen, Google Apps Education team</span>

Google heads to grade school: New resources for K-12 teachers and students

We use the Internet all the time: at home, at work (especially at Google!), on the move, and, increasingly, at school. We believe that the I...

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Media and citizens meet in the YouTube Reporters' Center

<span style="font-size:85%;"><span style="font-style: italic;">This is the first of a series of posts from YouTube's news and politics blog, <a href="http://www.citizentube.com/">Citizentube</a>.</span><span style="font-style: italic;"> -Ed.</span></span><br /><br /><a href="http://www.youtube.com/">YouTube</a> is the biggest video news site on the Internet, and at no time in our site's history was that more apparent than in these last two weeks of the crisis unfolding in Iran. As hundreds of thousands of Iranian citizens took to the streets of Tehran to protest the national elections, the government kicked out foreign journalists, leaving citizens themselves as the only documentarians to the events unfolding there. We've been highlighting many of these videos and keeping track of the latest developments on our YouTube news and politics blog, <a href="http://www.citizentube.com/">Citizentube</a>.<br /><br />Though the circumstances in Iran are unique, this isn't the first time that citizens have played a crucial role in reporting on events around the world. Burmese citizens uploaded exclusive video footage to YouTube during the <a href="http://www.youtube.com/blog?entry=i_r4JhbhmgU">protests in Myanmar</a> back in 2007; people in China's Sichuan province documented the devastating and historic <a href="http://www.youtube.com/blog?entry=pB40GKtrVQY">7.8-magnitude earthquake</a> of 2008 in real-time; and eyewitnesses to the shooting of young <a href="http://www.youtube.com/watch?v=8Tmh9B8LVxM">Oscar Grant</a> by Oakland police forces captured the event on their cell phone cameras and uploaded videos to YouTube for the world to see. Citizens are no longer merely bystanders to world events. Today, anyone can chronicle what they see and participate in the news-gathering process.<br /><br />Though it's the phenomenon of citizen reporting that YouTube is probably best known for, we also have hundreds of news partners who upload thousands of videos straight to YouTube every day. You can see lots of these on our news page at <a href="http://www.youtube.com/news">youtube.com/news</a>. Many of these organizations have used YouTube in unique ways, like asking the community to <a href="http://www.citizentube.com/2009/01/washington-post-asks-your-government.html">submit questions for government officials</a>, providing a <a href="http://www.citizentube.com/2009/04/view-from-press-corp.html">behind-the-scenes look</a> at traveling with the Obama press corps and accepting video applications for a <a href="http://www.citizentube.com/2009/02/last-chance-to-win-trip-with-nick.html">reporting assignment in West Africa</a>. We believe the power of this new media landscape lies in the collaborative possibilities of amateurs and professionals working together.<br /><br />And so today, we're launching a new resource on YouTube to help citizens learn more about how to report the news, straight from the experts. It's called the <a href="http://youtube.com/reporterscenter">YouTube Reporters' Center</a>, and it features some of the nation's top journalists sharing instructional videos with tips and advice for better reporting. Learn how to <a href="http://www.youtube.com/watch?v=4eOynrI2eTM">prepare for an interview</a>; or how to be an <a href="http://www.youtube.com/watch?v=VVKGUctuoXE">investigative reporter</a> from the legendary Washington Post journalist Bob Woodward; or how to <a href="http://www.youtube.com/watch?v=SVVdH8n5470">report on a global humanitarian</a> crisis from Nick Kristof of the New York Times. All of the videos are available on the<a href="http://youtube.com/reporterscenter"> </a>YouTube Reporters' Center channel.<br /><br /><span class="byline-author">Posted by Olivia Ma, YouTube News and Politics</span>

Media and citizens meet in the YouTube Reporters' Center

This is the first of a series of posts from YouTube's news and politics blog, Citizentube . -Ed. YouTube is the biggest video news sit...

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UK's National Programme for IT in the NHS Known Doomed at Outset?

It would seem likely.<br /><br />In May 2009 at "<a href="http://hcrenewal.blogspot.com/2009/05/machinery-behind-healthcare-reform-how.html">The Machinery Behind Healthcare Reform: How the HIT Lobby is Pushing Experimental and Unsafe Technology on Unconsented Patients and Clinicians</a>" I wrote:<div><br /><div><!--StartFragment--> <p class="MsoNormal"></p><blockquote>... I can add that if this initiative <i>[the U.S. multibillion dollar ARRA push towards national healthcare IT by 2014]</i> <b>blows up as it has in the UK</b>, then the only triumph will be the financial triumph of the trade group and its apparatchiks. The losers will be the administration, patients, clinicians, and everyone else in the healthcare system.</blockquote><o:p></o:p><p></p> <!--EndFragment--> <div><div><br /></div><div><span style="font-size:100%;">The UK situation is much worse than I thought. The UK's NPfIT in the NHS was suspected to have been doomed from the start, but proceeded anyway; see "<a href="http://www.computerweekly.com/blogs/tony_collins/2009/06/16-key-points-in-gateway-revie.html">16 key points in Gateway Reviews on NHS IT scheme</a>" and the secretive Gateway Reviews <a href="http://www.connectingforhealth.nhs.uk/about/foi">themselves</a> upon which the preceding article was based, released under UK Freedom Of Information laws. </span>From ComputerWeekly.com author Tony Collins on <a href="http://www.computerweekly.com/Articles/2009/06/22/236526/government-ordered-to-publish-reviews-of-risky-it-projects.htm">Gateway Reviews</a>:<br /><span style="font-size:100%;"><br /></span><p></p><blockquote><p>... Gateway reviews are mini-audits at critical stages in projects. The reports in question gave a red, amber or green status at each stage to help the project’s senior responsible owner decide whether to move to the next phase. </p> <p>The government’s policy on Gateway reviews is to keep them confidential. <a href="http://www.computerweekly.com/blogs/tony_collins/2007/06/shredding-of-gateway-reviews-d.html">All copies of a review are shredded</a>, with the supporting material, to ensure only two reports remain – one for the Treasury’s Office of Government Commerce (OGC) and the other for the project’s senior responsible owner.</p></blockquote><p></p><br /><span style="font-size:100%;">Highlights of the secretive health IT program reviews, now made public:<br /><br /></span><ul><li>the NPfIT was probably doomed from the start, in Spring 2002. As one Gateway Review put it, many dedicated people were working hard on building the components for a car that hadn't been designed. To some extent that's still true today.</li></ul><ul><li>people didn't really know what they were doing in the first critical months in 2002</li></ul><ul><li>the initial plan was for new IT - not for changes to the way people work. So the preoccupation was with IT and not patients. It was hoped that new IT would drive change. But that rarely if ever succeeds.</li></ul><ul><li>that the costs and complexity were initially underestimated - by about £7bn - because nobody had an understanding of what was needed.</li></ul><ul><li>that speed was unduly important. One gateway review suggested that key staff didn't have time to take action on recommendations or learn lessons.</li></ul><ul><li>the programme as a whole, according to one Gateway Review, was not assessed against a list of <a href="http://www.computerweekly.com/Articles/2009/06/22/236526/government-ordered-to-publish-reviews-of-risky-it-projects.htm">Common Causes of Failure</a>, as published by the National Audit Office. Only individual projects were assessed against the list.</li></ul><br />How many of these findings apply in the U.S. Health IT program in 2009?<br /><span style="font-size:100%;"><br /></span>Finally, about the aforementioned May 2009 post, Matthew Holt of the Healthcare Blog wrote that I had "gone loopy", i.e., crazy (see footnote to the above-linked May 2009 post). The Chairman of CCHIT Mark Leavitt wrote that concerns about health IT are expressed by "fearmongers" and should be <a href="http://hcrenewal.blogspot.com/2009/06/mark-leavitt-head-of-cchit-behind-times.html">"laughed off</a>."<br /><br />These cavalier attitudes are a major part of what has gone wrong in HIT, as well as our society more generally.<br /></div><!--StartFragment--> <!--EndFragment--> <div><br /></div><div>Not to draw a specific comparison with these individuals, but our society is crumbling, and it's in no small part due to clowns in leadership roles, rather than as performers in <a href="http://www.ringling.com/">Ringling Bros. and Barnum and Bailey's Greatest Show on Earth</a>.<br /><br /></div><div><br /></div><div><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_8YphtkAHyDU/SkjSnOKcwRI/AAAAAAAAANM/8zOfVxi2Org/s1600-h/bozo.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5352759728388489490" src="http://3.bp.blogspot.com/_8YphtkAHyDU/SkjSnOKcwRI/AAAAAAAAANM/8zOfVxi2Org/s320/bozo.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 90px; height: 114px;" /></a></div><div><div style="text-align: center;"><span style="font-size:85%;">According to Matthew Holt and Mark Leavitt, Health IT concerns are a laughing matter, expressed by crazy people.</span><br /></div><br /></div><div><br />I (and many <a href="http://www.jamia.org/cgi/content/full/16/3/291">like minded colleagues</a>) don't find healthcare information technology issues a laughing matter, however.<br /><br />-- SS</div><div><br />July 1 <span style="font-weight: bold;">Addendum:</span><br /><br />More analysis is at E-Health Insider at <a href="http://www.e-health-insider.com/comment_and_analysis/476/it%27s_history_%28repeating_itself">this link</a>.<br /></div></div></div></div>

UK's National Programme for IT in the NHS Known Doomed at Outset?

It would seem likely. In May 2009 at " The Machinery Behind Healthcare Reform: How the HIT Lobby is Pushing Experimental and Unsafe Tec...

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Extending Google services in Africa

At Google we seek to serve a broad base of people — not only those who can afford to access the Internet from the convenience of their workplace or with a computer at home. It's important to reach users wherever they are, with the information they need, in areas with the greatest information poverty. In many places around the world, people look to their phones, rather than their computers, to find information they need in their daily lives. This is especially true in Africa, which has <a href="http://www.itu.int/ITU-D/ict/publications/idi/2009/index.html">the world’s highest mobile growth rate</a> and where mobile phone penetration is six times Internet penetration. One-third of the population owns a mobile phone and many more have access to one.<br /><br />Most mobile devices in Africa only have voice and SMS capabilities, and so we are focusing our technological efforts in that continent on SMS. Today, we are announcing <a href="http://www.google.co.ug/sms">Google SMS</a>, a suite of mobile applications which will allow people to access information, via SMS, on a diverse number of topics including health and agriculture tips, news, local weather, sports, and more. The suite also includes <a href="http://www.google.co.ug/mobile/sms/#6007">Google Trader</a>, a SMS-based “marketplace” application that helps buyers and sellers find each other. People can find, "sell" or "buy" any type of product or service, from used cars and mobile phones to crops, livestock and jobs.<br /><br />We are particularly excited about <a href="http://www.google.co.ug/mobile/sms/#6001">Google SMS Tips</a>, an SMS-based query-and-answer service that enables a mobile phone user to have a web search-like experience. You enter a free form text query, and Google's algorithms restructure the query to identify keywords, search a database to identify relevant answers, and return the most relevant answer. <br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="http://2.bp.blogspot.com/_7ZYqYi4xigk/SkhZiLE_QpI/AAAAAAAAD9M/x3VockHzabY/s1600-h/Africa_AgScreenShot.gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://2.bp.blogspot.com/_7ZYqYi4xigk/SkhZiLE_QpI/AAAAAAAAD9M/x3VockHzabY/s200/Africa_AgScreenShot.gif" /></a></div><div class="separator" style="clear: both; text-align: center;"><a href="http://1.bp.blogspot.com/_7ZYqYi4xigk/SkhZ3ALKsJI/AAAAAAAAD9U/gH_7UrwdQ2k/s1600-h/Africa_HealthScreenShot2+(2).gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/_7ZYqYi4xigk/SkhZ3ALKsJI/AAAAAAAAD9U/gH_7UrwdQ2k/s200/Africa_HealthScreenShot2+(2).gif" /></a></div><br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br />Both Google SMS Tips and Google Trader represent the fruits of unique partnerships among Google, the <a href="http://www.grameenfoundation.org/">Grameen Foundation</a>, <a href="http://www.mtn.co.ug/" title="MTN Uganda">MTN Uganda</a> and local organizations*. We worked closely together as part of Grameen Foundation's <a href="http://www.applab.org/" title="Applications Laboratory">Application Laboratory</a> to understand information needs and gaps, develop locally relevant and actionable content, <a href="http://www.youtube.com/watch?v=JP7T-o9bGl8">rapidly test prototypes</a>, and conduct multi-month pilots with the people who will eventually use the applications have truly been a global effort, and created with Ugandans, for Ugandans.<br /><br />We're just beginning. We can do a lot more to improve search quality and the breadth — and depth — of content on Google SMS, especially on Tips and Trader. Google SMS is by no means a finished product, but that's what's both exciting and challenging about this endeavor.<br /><br />Meanwhile, if you're curious about what Google is doing in Africa, learn more at the <a href="http://google-africa.blogspot.com/">Google Africa Blog</a>.<br /><br /><b><i>Update:</i></b> Corrected link to YouTube video for "rapidly test prototypes".<br />____<br /><span class="Apple-style-span" style="font-size: small;">*</span><a href="http://brosdi.or.ug/index.php?option=com_frontpage&Itemid=1" title="BROSDI"><span class="Apple-style-span" style="font-size: small;">BROSDI</span></a><span class="Apple-style-span" style="font-size: small;">, (Busoga Rural Open Source and Development Initiative), </span><a href="http://www.straight-talk.or.ug/"><span class="Apple-style-span" style="font-size: small;">Straight Talk Foundation</span></a><span class="Apple-style-span" style="font-size: small;">, </span><a href="http://www.mariestopes.org.uk/ShowContent.aspx?id=40" title="Marie Stopes Uganda"><span class="Apple-style-span" style="font-size: small;">Marie Stopes Uganda</span></a><span class="Apple-style-span" style="font-size: small;">.</span><br /><br />Posted by Joe Mucheru, Head of Google Sub-Saharan Africa, & Fiona Lee, Africa Project Manager

Extending Google services in Africa

At Google we seek to serve a broad base of people — not only those who can afford to access the Internet from the convenience of their workp...

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Outpouring of searches for the late Michael Jackson

At Google, we are moved by the life and untimely passing of Michael Jackson. As word spread of his death, millions and millions of people from all over the world began searching for information about the pop icon. The following chart shows the meteoric rise in related searches around 3:00pm PDT:<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_7ZYqYi4xigk/SkU-oWd43GI/AAAAAAAAD9E/a5-AwfnLbhI/s1600-h/michael-jackson-searches.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5351752595146333282" src="http://1.bp.blogspot.com/_7ZYqYi4xigk/SkU-oWd43GI/AAAAAAAAD9E/a5-AwfnLbhI/s400/michael-jackson-searches.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 240px;" /></a><br />Search volume began to increase around 2:00pm, skyrocketed by 3:00pm, and stabilized by about 8:00pm. As you can see in <a href="http://www.google.com/trends/hottrends?date=2009-6-25&sa=X">Google Hot Trends</a>, many of the <a href="http://www.google.com/trends/hottrends?q=michael+jackson+died&date=2009-6-25&sa=X">fastest rising search queries</a> from yesterday and today have been about Michael Jackson's passing (others pertained to the death of another cultural icon, <a href="http://en.wikipedia.org/wiki/Farrah_Fawcett">Farrah Fawcett</a>). People who weren't near a computer yesterday turned to their mobile phones to check on breaking news. We saw one of the largest mobile search spikes we've ever seen, with 5 of the top 20 searches about the Moonwalker.<br /><br />The spike in searches related to Michael Jackson was so big that <a href="http://news.google.com/">Google News</a> initially mistook it for an automated attack. As a result, for about 25 minutes yesterday, when some people searched Google News they saw a "<a href="http://lh3.ggpht.com/_Ffh95I6Kep4/SkUg5wOKkRI/AAAAAAAACU8/l0ayIfDo-fs/s912/3660499057_f36b4b59a3_o.png">We're sorry</a>" page before finding the articles they were looking for.<br /><br />Michael Jackson led an amazing and controversial life in the public eye. Many of us have a "Michael Jackson story." Mine is that he actually taught me how to moonwalk — thanks to many an hour I spent in front of the television trying to mimic his <a href="http://www.youtube.com/michaeljackson">performances</a>. Regardless of your story or personal opinions about this astounding performer, global interest in the King of Pop is undeniable.<br /><br /><span class="byline-author">Posted by R.J. Pittman, Director, Product Management</span>

Outpouring of searches for the late Michael Jackson

At Google, we are moved by the life and untimely passing of Michael Jackson. As word spread of his death, millions and millions of people fr...

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Why Did US Physicians Give Up Their Ability to Enforce Their Own Professional Standards?

In his recent review of Dr Ezekiel Emanuel's book, (<em>Healthcare, Guaranteed: A Simple, Secure Solution for America</em>,) Dr Arnold Relman, Editor-Emeritus of the New England Journal of Medicine, <a href="http://www.nybooks.com/articles/22798">discussed </a>the history of the deprofessionalization of American physicians.<br /><br /><br /><br /><blockquote><br />The behavior of US physicians has been changed by the commercialization of medical care, and this too has increased costs. US medical practice has traditionally relied on fee-for-service, which has always given it some of the attributes and incentives of a business. However, <em>the American Medical Association (AMA) maintained for many years that medical practice was a profession, not a business. The AMA's ethical guidelines therefore advised physicians to limit their income to reasonable earnings from the care of patients, and to refrain from advertising and from entering financial arrangements with drug and device manufacturers</em>. <em>Those restrictions were lifted after the US Supreme Court decided in 1975 that lawyers, and by extension members of other professions, including physicians, are engaged in interstate commerce and therefore must be subject to antitrust law</em> (from which they had largely been exempt).(1)<br /><br /><em>This decision had an enormous effect on the medical profession, but its consequences have received relatively little public attention</em>. Although the courts did not initiate the commercialization of medicine, they certainly accelerated it and gave it legal justification. <em>In 1980, after medical organizations lost some costly antitrust trials, in which they were accused of such offenses as limiting doctor fees or denying staff privileges, the AMA changed its ethical guidelines, declaring medicine to be both a business and a profession. This lowered the AMA's barriers to the commercialization of medical practice</em>, allowing physicians to participate in any legal profit-making business arrangement that did not harm patients.<br /><br />Nearly a half-century ago, Stanford economics professor Kenneth Arrow, later a Nobel laureate, convincingly argued that medical care cannot conform to market laws because patients are not ordinary consumers and doctors are not ordinary vendors. He said that sick or injured patients must rely on physicians in ways fundamentally different from the price-driven relation between buyers and sellers in an ordinary market. This argument implied that, <em>contrary to the assumptions of antitrust law, market competition among physicians cannot be expected to lower medical prices. And since physicians influence decisions to use medical services far more than patients do, the volume and types of services provided to patients—and hence total health costs—need to be controlled by forces other than the market, such as professional standards and government regulation. But Arrow's argument was largely ignored</em> in the rush to exploit health care for commercial purposes that ensued after the passage of Medicare and Medicaid in 1965.(2)<br /></blockquote><br /><br />Writing about the decline of physicians' professionalism in 2007 [ Relman AS. Medical professionalism in a commercialized health care market. JAMA 2007; 298: 2668-2670. [link <a href="http://jama.ama-assn.org/cgi/content/full/298/22/2668">here</a>) ], Dr Relman had briefly alluded to the effect of the 1975 Supreme Court decision, (see our post <a href="http://hcrenewal.blogspot.com/2007/12/relman-in-jama-on-threats-to-physicians.html">here</a>):<br /><br /><br /><br /><blockquote>The law also has played a major role in the decline of medical professionalism. The 1975 Supreme Court ruling that the professions were not protected from anti-trust law undermined the traditional restraint that medical professional societies had always placed on the commercial behavior of physicians, such as advertising and investing in the products they prescribe or facilities they recommend. Having lost some initial legal battles and fearing the financial costs of losing more, organized medicine now hesitates to require physicians to behave differently from business people. It asks only that physicians' business activities should be legal, disclosed to patients, and not inconsistent with patients' interests. <em>Until forced by anti-trust concerns to change its ethical code in 1980, the American Medical Association had held that <strong>'in the practice of medicine a physician should limit the source of his professional income to medical services actually rendered by him, or under his supervision, to his patients'</strong> and that <strong>'the practice of medicine should not be commercialized, nor treated as a commodity in trade.'</strong> These sentiments reflecting the spirit of professionalism are now gone.<br /></em></blockquote><br /><br />It seems to me that Dr Relman has elucidated one of the "missing links" that help explain the current sorry state of physicians' core values, and the broader continuing health care crisis. I am amazed that this bit of history seems to have been so thoroughly forgotten. Dr Relman did write about it before 2007, but in publications that few physicians and other health care professionals were likely to see. Other than Dr Relman, almost no one writing in the medical and health care literature seems to have interest in this issue. (It has been discussed in the Journal of Health Politics, Policy and Law, and the Stanford Law Review by M. Gregg Bloche, but these unfortunately also could have easily been missed by nearly all physicians and health care professionals.) So we have another example of the anechoic effect.<br /><br />Yet in my humble opinion, every physician and health care professional ought to know that the profession once foreswore the commercialization of medical practice, but gave up on its ability to police its own conflicts of interest after the US Supreme Court decided that professionals are subject to anti-trust law.<br /><br />But knowing this important bit of history raises more questions than it answers:<br /><br /><br /><ul><li>The Supreme Court decision apparently involved interpretation of law, not the constitution. Therefore, why didn't organized medicine pursue a change in the law that would allow physicians to continue to enforce their traditional professional values? </li><li>The Supreme Court decision was primarily directed at lawyers, not physicians. Since the decision, to my knowledge, the law profession has maintained strict rules about conflicts of interest. (For example, no legal CME is sponsored by corporations whose products they seek to have the attendees favor.) Why did the decision wreck physicians' but not lawyers' abilities to regulate their own conflicts of interest? </li><li>The Supreme Court decision only affects US law. Why have physicians in other countries also abandoned their traditional values about commercial entanglements? </li><li>Why did this application of US antitrust law have such significant effects during an era when antitrust enforcement in health care was generally declining? (Insurance companies and hospitals that dominate local markets have not feared antitrust enforcement.)</li><li>Why did only Dr Relman and Prof Bloche seem to care about this up to now?</li></ul><br /><br />Inquiring minds want to know.... And answering these questions might bring us back on the path of true medical professionalism.<br /><br />Hat tip to Merrill Goozner <a href="http://www.gooznews.com/node/2971">in the GoozNews blog</a>.<br /><br /><span style="font-size:85%;">References (from Relman)<br /><br />1. Goldfarb v. Virginia State Bar, 421 U.S. 773 (1975).<br /><br />2. Kenneth J. Arrow, "Uncertainty and the Welfare Economics of Medical Care," The American Economic Review, Vol. 53, No. 5 (December 1963). </span><br /><p></p>

Why Did US Physicians Give Up Their Ability to Enforce Their Own Professional Standards?

In his recent review of Dr Ezekiel Emanuel's book, ( Healthcare, Guaranteed: A Simple, Secure Solution for America ,) Dr Arnold Relman, ...

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We have a winner for the Google Photography Prize

Huge congratulations to <a href="http://www.google.com/intl/en/landing/photographyprize/vote.html#theme15">Daniel Halasz</a> from Hungary, who was awarded the <a href="http://www.google.com/intl/en/landing/photographyprize/">Google Photography Prize</a> this week. This was a global student competition to create themes for <a href="http://www.google.com/ig">iGoogle</a>. More than 3,600 students from across the world entered, and a couple of weeks ago we asked you to <a href="http://googleblog.blogspot.com/2009/06/voting-for-igoogle-photo-themes-now.html">vote on the shortlist</a>. The six finalists who got the most public votes were <a href="http://www.google.com/intl/en/landing/photographyprize/vote.html#theme2">Amelia Ortúzar</a> (Chile), <a href="http://www.google.com/intl/en/landing/photographyprize/vote.html#theme13">Fahad AlDaajani</a> (Saudi Arabia), <a href="http://www.google.com/intl/en/landing/photographyprize/vote.html#theme24">Matjaz Tancic</a> (U.K.), <a href="http://www.google.com/intl/en/landing/photographyprize/vote.html#theme26">Mikhail Simin</a> (U.S.) and <a href="http://www.google.com/intl/en/landing/photographyprize/vote.html#theme33">Vesna Stojakovic</a> (Serbia) — congratulations to all of them! From that group, a jury of respected art critics and artists chose Daniel as the winner. They also gave a special commendation prize to <a href="http://www.google.com/intl/en/landing/photographyprize/vote.html#theme17">Aliyah Hussain</a> from the U.K.<br /><br />You can see the work Daniel and the other finalists submitted at the Saatchi Gallery in London until Sunday, June 28th. Come by if you're in town, or have a look at their photographs on <a href="http://www.google.com/photographyprize">google.com/photographyprize</a>, where you can also add them to your <a href="http://www.google.com/ig">iGoogle homepage</a>.<br /><br /><span class="byline-author">Posted by Posted by Louise Rigby, Consumer Marketing Team</span>

We have a winner for the Google Photography Prize

Huge congratulations to Daniel Halasz from Hungary, who was awarded the Google Photography Prize this week. This was a global student comp...

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Google Voice invites on their way

A couple of months ago we <a href="http://googleblog.blogspot.com/2009/03/here-comes-google-voice.html">announced Google Voice</a>, a service that gives you one phone number to link all your phones and makes voicemail as easy as email. We are happy to share that Google Voice is beginning to open up beyond former GrandCentral users. If you <a href="https://services.google.com/fb/forms/googlevoiceinvite/">requested an invitation</a> on the Google Voice site or previously on GrandCentral, keep your eye out for an invite email.<br /><br />Once you receive your invitation, just click on the link and follow the instructions to setup your new Voice account. To help you find a Google number that is personalized to you, we've added a number picker that lets you search by area code and text. See if you can find a number that contains your name, a specific word or a number combination.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_7ZYqYi4xigk/SkOmFtFfzzI/AAAAAAAAD8M/Yli2L8R0bx8/s1600-h/picker+-+awesome.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5351303399178489650" src="http://3.bp.blogspot.com/_7ZYqYi4xigk/SkOmFtFfzzI/AAAAAAAAD8M/Yli2L8R0bx8/s400/picker+-+awesome.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 288px;" /></a><br />To learn more about Google Voice, check out the video below. If you haven't signed up for a Google Voice invite, make sure to get on the list by leaving us your email address at <a href="http://www.google.com/voiceinvite">www.google.com/voiceinvite</a>.<br /><br /><object height="344" width="425"><param name="movie" value="http://www.youtube.com/v/m4Q9MJdT5Ds&hl=en&fs=1&"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/m4Q9MJdT5Ds&hl=en&fs=1&" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="344" width="425"></embed></object><br /><br /><span class="byline-author">Posted by Craig Walker and Vincent Paquet, Product Managers, Google Voice</span>

Google Voice invites on their way

A couple of months ago we announced Google Voice , a service that gives you one phone number to link all your phones and makes voicemail as ...

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The RUCkus Continues: Former Medicare Administrator Calls the "RUC Process" "Incredibly Flawed," and the AMA Chair Says He's "Inaccurate"

We have posted frequently about the role of the RBRVS Update Committee (RUC) in fixing the rates at which Medicare pays physicians. These payment rates have been much more generous for procedures than for "cognitive" services, (that is, services including interviewing and examining patients, making diagnoses, forecasting prognoses, recommending tests or treatments, and counseling patients.) Several authors have suggested that how the RUC fixes payment rates is a major cause of the decline of primary care. (See our previous posts on this <a href="http://hcrenewal.blogspot.com/2007/03/on-disparities-between-reimbursement-of.html">here</a>, <a href="http://hcrenewal.blogspot.com/2007/12/is-sustainable-growth-rate-main-problem.html">here</a>, <a href="http://hcrenewal.blogspot.com/2008/05/payments-for-patient-centered-medical.html">here</a>, <a href="http://hcrenewal.blogspot.com/2008/07/can-we-fix-medicare-while-pretending.html">here</a>, <a href="http://hcrenewal.blogspot.com/2008/12/no-such-ruc-new-england-journal-takes.html">here</a>, <a href="http://hcrenewal.blogspot.com/2009/02/what-ruc-again-one-of-worlds-most.html">here</a>, and <a href="http://hcrenewal.blogspot.com/2009/06/letter-from-ruc-and-my-reply.html">here</a> and important articles by Bodenheimer et al,[1] and Goodson.[2])<br /><br /><strong>An Interview with a former Medicare administrator</strong><br /><br />Health Affairs just published an interview(3) with Kerry Weems, a recent administrator of the US Center for Medicare and Medicaid Services (CMS) under the Bush administration, who had some remarkable criticism for the RUC.<br /><br /><blockquote><br />Iglehart: The last question I wanted to ask you relates to the Specialty Society Relative Value Scale Update Committee [RUC] of the American Medical Association. The AMA formed the RUC to act as an expert panel in developing relative value recommendations to CMS. The twenty-nine-member committee essentially determines, through the relative values it establishes for the codes that form the basis of Medicare payments, how much doctors will earn from providing services to beneficiaries. <em>In recent years the RUC has come under criticism based on the view that its specialty- dominated composition undervalues primary care services and, in some instances, overvalues specialty services. I have two questions, Kerry, regarding the RUC. You have been in government for twenty-six years; have you ever heard of an administration that has seriously questioned the RUC process, and whether CMS ought to somehow internalize it or delegate it to another body?</em><br /><br />Weems: <em>I think there is a general consensus that the <strong>RUC has contributed to the poor state of primary care in the United States</strong>. In many ways the supposition behind the <strong>RUC process</strong>, behind the whole relative value scale, is incredibly flawed.</em> It's an input measurement system, so it asks, What's the cost of my inputs, and that's how I'm going to price my outputs. It has no relationship to perhaps the market value of what you might buy. <em>So because it's highly procedure based, it's prejudiced against just standard primary care evaluation and management [E&M] visits,</em> because in an E&M visit it's hard to document what happens in the same way that it is when you remove a mole, or perform some other procedure.<br /><br /><em>So the process itself is flawed. <strong>I don't think that we can make a change without a statutory change </strong>giving us the ability to do that. But it's something that is drastically needed. You know, it's funny that we talk about better coordination of care and creating the medical home. Well, the place where this can occur is in <strong>an E&M visit, which has been highly undervalued by the RUC</strong>.</em><br /><br />Iglehart: <em>You say that the RUC process is seriously flawed and needs to be overhauled. Was there ever any discussion during the eight years of the George W. Bush administration about doing that?</em><br /><br />Weems: <em>There were a number of discussions, <strong>but it's a hard nut to crack</strong>. Those discussions never ripened to the point where we could say we've got something better.<br /></em><br />Iglehart: But you'd anticipate under the Obama administration that those discussions will continue?<br /><br />Weems: Sure. And, you know, you can even see the early attempts at trying to crack that. Representative [Pete] Stark [D-CA] introduced last year the so-called CHAMP [Children's Health and Medicare Protection Act] bill, in which he proposed to develop a new payment approach that would have provided more money to primary care physicians. He split it up into several different categories. This probably wasn't the right approach, but again, he was trying to work through the problem, trying to provide more money for primary care. His heart was in the right place.<br /></blockquote><br />There are a number of important points here.<br /><br />First, a former CMS administrator charged that the RUC has a substantial role in the decline of primary care in the US. Such charges have been made by well-reputed academics who have analyzed the role of the RUC from the outside. But as we have said before, aspects of what the RUC does are obscure, especially because the proceedings of RUC meetings are not made public. But now someone more directly involved has made the same charges.<br /><br />Second, a former CMS administrator has called the "RUC process ... incredibly flawed." Even the second Bush administration felt these flaws were sufficient to have "a number of discussions," but found "it's a hard nut to crack." Hence he said that although there is something fundamentally wrong with the "RUC process," the government could not easily fix it.<br /><br />Yet RUC leadership has repeatedly said that the RUC is merely a private advisory committee which gives recommendations to CMS using its rights to free speech and to petition the government. (Note also that above, Inglehart first said that the RUC was formed as "an expert panel" to make "recommendations." But then he said the committee "determines ... how much doctors will earn.") If the RUC is simply an advisory committee, and CMS did not like the advice the RUC was giving, why couldn't CMS leaders simply ignore the RUC?<br /><br />Weems' remarks do not make sense if the RUC is merely an outside private group providing advice. But they do make sense if the RUC is acting like a government agency.<br /><br />So this interview once again raises the question: why does CMS rely exclusively on the RUC to update the RBRVS system, apparently making the RUC de facto a government agency, yet without any accountability to CMS, or the government at large?<br /><br /><strong>A response by the Chair of the Board of the AMA<br /></strong><br />Within days of this interview, Dr Rebecca Patchin, the Chair of the Board of Trustees of the American Medical Association (AMA), wrote a response to the Weems interview. (Amazingly, the response appeared as a <a href="http://healthaffairs.org/blog/2009/06/24/the-rucs-record-defending-primary-care/#more-1469">blog post </a>on the Health Affairs Blog.) <br /><br />First, she implied that a former CMS administrator did not know what he was talking about when it came to the RUC.<br /><br /><blockquote>In the interview, <em><strong>inaccurate statements were made</strong> about the role of the AMA/Specialty Society RVS Update Committee (RUC),</em> which advises CMS regarding the relative levels of reimbursement for different medical procedures performed by physicians.<br /></blockquote><br /><br />Now I feel like I am in good company. The leaders of the RUC have charged that I made inaccurate statements about the RUC as well (see post <a href="http://hcrenewal.blogspot.com/2009/06/letter-from-ruc-and-my-reply.html">here</a>).<br /><br />However, Dr Patchin failed to identify any particular statements by Kerry Weems or his interviewer as inaccurate, much less provide any evidence to that effect. Note that while the RUC leaders also charged me with making inaccurate statements, they did not specify any particular statements as inaccurate, much less produce evidence in support of their contentions.<br /><br />Next, Dr Patchin wrote:<br /><br /><blockquote><em>Every time the RUC has been asked to review payments for E&M</em> (evaluation and management) codes, the RUC has sent CMS recommendations that would lead to higher payments.<br /></blockquote><br />This may be so, but it ignores an important issue. While the RUC may have made some recommendations to increase payments for cognitive services, it has made many more recommendations to increase payments for procedural services. Furthermore, while payments for individual procedures went up, and the volume of procedures also went up, the global budget for physicians' services, called the Sustainable Growth Rate (SGR), resulted in across the board cuts. Since raises for procedures were larger and more frequent than raises for cognitive services, the net effect was that payments for procedures increased relative to cognitive services.<br /><br />Even more important, it begs that question: what has the RUC done at times when no one asked it "to review payments for E&M ... codes?" After all, the RUC leadership has argued again and again that it is only a private advisory committee (and see below for another such argument). As such, it should be able to choose how often it deals with payments for cognitive services. It should not have to wait to be asked to review them. So why wasn't the RUC reviewing these payments more frequently?<br /><br />Then, Dr Patchin reiterated:<br /><br /><blockquote>To clarify: <strong><em>The RUC makes recommendations</em></strong> to CMS, and then CMS makes its payment decisions. </blockquote><br />and again,<br /><br /><blockquote><br />Bottom line: <em><strong>the RUC makes recommendations</strong></em>, CMS makes payment decisions.<br /></blockquote><br /><br />This, once more, begs the questions. Why didn't the RUC make more recommendations to improve payments for cognitive services? Why doesn't CMS get recommendations about payments to physicians from sources other than the RUC? Why doesn't CMS make the process for setting physicians' payments, and updating and revising the RBRVS system more broad-based and transparent? Why did the administrator of CMS feel unable to change or ignore the "RUC process?"<br /><br />I don't have the capacity to find out the answers to these questions. Answering them might take some investigative reporting, or even a Congressional investigation. Given that physicians' payments are key incentives driving the health care system, and that payments favoring procedures are likely to be a major cause for rising volume and costs of procedures, which, in turn, is likely to be a major reason our health care system is so expensive, why do we know so little about how these payment rates are set?<br /><br /><span style="font-size:85%;">References </span><br /><span style="font-size:85%;"></span><br /><span style="font-size:85%;">1. Bodenheimer T, Berenson RA, Rudolf P. The primary care-specialty income gap: why it matters. Ann Intern Med 2007; 146: 301-306. Link </span><a href="http://www.annals.org/cgi/content/full/146/4/301"><span style="font-size:85%;">here</span></a><span style="font-size:85%;">.</span><br /><span style="font-size:85%;">2. Goodson JD. Unintended consequences of Resource-Based Relative Value Scale reimbursement. JAMA 2007; 298(19):2308-2310. Link </span><a href="http://jama.ama-assn.org/cgi/content/short/298/19/2308"><span style="font-size:85%;">here</span></a><span style="font-size:85%;">.<br />3. Iglehart JK. Doing more with less: a conversation with Kerry Weems. Health Aff 2009; </span><a href="http://content.healthaffairs.org/cgi/content/full/hlthaff.28.4.w688/DC1"><span style="font-size:85%;">http://content.healthaffairs.org/cgi/content/full/hlthaff.28.4.w688/DC1</span></a><span style="font-size:85%;"> </span>

The RUCkus Continues: Former Medicare Administrator Calls the "RUC Process" "Incredibly Flawed," and the AMA Chair Says He's "Inaccurate"

We have posted frequently about the role of the RBRVS Update Committee (RUC) in fixing the rates at which Medicare pays physicians. These pa...

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Announcing the AdSense for Mobile Applications beta

You don't have to be a mobile expert to see how smartphones are revolutionizing our daily lives. Lower prices, faster network speeds and unlimited data plans mean that people often reach for their cell phone rather than their computer when they are seeking information. As a result, mobile applications have become more and more popular, helping people find music, make restaurant reservations or check bank balances — all on their phone.<br /><br />We want to contribute to the growth of these mobile applications, which is why we're happy to announce our beta launch of <a href="http://www.google.com/ads/mobileapps">AdSense for Mobile Applications</a>. After all, advertisers are looking for ways to reach potential customers when they are engaged with mobile content, and application developers are looking for ways to show the best ads to their users. We have already had a successful trial of this service with a small number of partners, and are excited that we can now offer this solution to a broader group.<br /><br />AdSense for Mobile Applications allows developers to earn revenue by displaying text and image ads in their iPhone and Android applications. For our beta launch, we've created a <a href="http://www.google.com/ads/mobileapps">site</a> <link: com="" ads="" mobileapps=""> where developers can learn more about the AdSense for Mobile Applications program, see answers to frequently asked questions and sign up to participate in our beta. Advertisers can also learn about the benefits of advertising in mobile applications.<br /><br />We're excited to open up this beta to more developers, and look forward to offering new features for our mobile advertisers and publishers in upcoming releases. We also want to say a big thank you to the partners who worked with us on the trial stages of this project including Backgrounds, Sega, Shazam, Urbanspoon and more.<br /><br />Check out this short video of Howard Steinberg, Director of Business Development at <a href="http://urbanspoon.com/">Urbanspoon</a>, discussing his experience with AdSense for Mobile Applications.<br /><br /><object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/AaMDikYsO_g&hl=en&fs=1&rel=0"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/AaMDikYsO_g&hl=en&fs=1&rel=0" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="340" width="560"></embed></object><br /><br /><span class="byline-author">Posted by Susan Wojcicki, Vice President, Product Management</span></link:>

Announcing the AdSense for Mobile Applications beta

You don't have to be a mobile expert to see how smartphones are revolutionizing our daily lives. Lower prices, faster network speeds and...

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The Day in the Cloud Challenge has begun

Today, we invite you to take part in the <a href="http://www.dayinthecloud.com/?utm_source=google&utm_medium=blog&utm_campaign=ogb">Day in the Cloud Challenge</a>, an online scavenger hunt that's being played simultaneously on the ground and in the air aboard Virgin America flights across the U.S. The Day in the Cloud demonstrates how people can use <a href="http://www.google.com/apps/">Google Apps</a> to stay connected with friends, family and co-workers when they're away from their homes — even at 35,000 feet in the air.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_7ZYqYi4xigk/SkJDLAApaoI/AAAAAAAAD8E/QfDCL183zxg/s1600-h/Game_Play_Screen.png"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5350913163529906818" src="http://2.bp.blogspot.com/_7ZYqYi4xigk/SkJDLAApaoI/AAAAAAAAD8E/QfDCL183zxg/s400/Game_Play_Screen.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 237px;" /></a><br />The <a href="http://www.dayinthecloud.com/?utm_source=google&utm_medium=blog&utm_campaign=ogb">online game</a> will be available until 11:59pm PDT today, so find a quiet spot, do some finger stretches, and take the challenge.<br /><br /><span class="byline-author">Posted by Vivian Leung, Google Apps Team</span>

The Day in the Cloud Challenge has begun

Today, we invite you to take part in the Day in the Cloud Challenge , an online scavenger hunt that's being played simultaneously on the...

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Let's make the web faster

From building data centers in different parts of the world to designing highly efficient user interfaces, we at Google always strive to make our services faster. We focus on speed as a key requirement in product and infrastructure development, because our <a href="http://googleresearch.blogspot.com/2009/06/speed-matters.html">research</a> indicates that people prefer faster, more responsive apps. Over the years, through continuous experimentation, we've identified some performance best practices that we'd like to share with the web community on <a href="http://code.google.com/speed">code.google.com/speed</a>, a new site for web developers, with tutorials, tips and performance tools.<br /><br />We are excited to <a href="http://groups.google.com/group/make-the-web-faster">discuss</a> what we've learned about web performance with the Internet community. However, to optimize the speed of web applications and make browsing the web as fast as turning the pages of a magazine, we need to work together as a community, to tackle some larger challenges that keep the web slow and prevent it from delivering its full potential:<br /><ul><li>Many protocols that power the Internet and the web were developed when broadband and rich interactive web apps were in their infancy. Networks have become much faster in the past 20 years, and by collaborating to update protocols such as HTML and TCP/IP we can create a better web experience for everyone. A great example of the community working together is <a href="http://en.wikipedia.org/wiki/HTML_5">HTML5</a>. With HTML5 features such as AppCache, developers are now able to write JavaScript-heavy web apps that run instantly and work and feel like desktop applications.</li></ul><ul><li>In the last decade, we have seen close to a <a href="http://www.webmonkey.com/print/blog/Google_Throws_Its_Weight_Behind_HTML_5">100x improvement</a> in JavaScript speed. Browser developers and the communities around them need to maintain this recent focus on performance improvement in order for the browser to become the platform of choice for more feature-rich and computationally-complex applications.</li></ul><ul><li>Many websites can become faster with little effort, and collective attention to performance can speed up the entire web. Tools such as Yahoo!'s <a href="http://developer.yahoo.com/yslow/">YSlow</a> and our own recently launched <a href="http://code.google.com/speed/page-speed/">Page Speed</a> help web developers create faster, more responsive web apps. As a community, we need to invest further in developing a new generation of tools for performance measurement, diagnostics, and optimization that work at the click of a button.</li></ul><ul><li>While there are now more than 400 million broadband subscribers worldwide, broadband penetration is still relatively low in many areas of the world. Steps have been taken to bring the benefits of broadband to more people, such as the <a href="http://googlepublicpolicy.blogspot.com/2008/11/vote-for-broadband-in-white-spaces.html">FCC's decision</a> to open up the white spaces spectrum, for which the Internet community, including Google, was a strong champion. Bringing the benefits of cheap reliable broadband access around the world should be one of the primary goals of our industry. </li></ul>To find out what Googlers think about making the web faster, see the video below. If you have ideas on how to speed up the web, please <a href="http://moderator.appspot.com/#15/e=79951&t=79d39">share</a> them with the rest of the community. Let's all work together to make the web faster!<br /><br /><object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/IWWBnJEsUtU&hl=en&fs=1&rel=0"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/IWWBnJEsUtU&hl=en&fs=1&rel=0" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="340" width="560"></embed></object><br /><br /><span class="byline-author">Posted by Urs Hoelzle, SVP, Operations and Bill Coughran, SVP, Engineering</span>

Let's make the web faster

From building data centers in different parts of the world to designing highly efficient user interfaces, we at Google always strive to make...

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Practicing (Clinical Trials) Medicine Without a License

Another story of dubious clinical research, this time <a href="http://www.tampabay.com/news/business/article1012526.ece">reported</a> by the St Petersburg (Florida, US) Times:<br /><br /><blockquote><br />Vladimir Martin called himself 'doctor' and ran 17 clinical trials of new drugs for major pharmaceutical companies before one patient noticed he didn't have a medical license.<br /><br />The patient alerted the St. Petersburg Times, whose resulting story led to a state investigation. On Saturday, <em>Martin, 43, was arrested on charges of practicing medicine without a license.</em> He was later released from the Pinellas County Jail on $10,000 bail. The felony charge carries a maximum sentence of five years in prison and maximum fine of $5,000.<br /><br />The Clearwater man, who changed his last name from Kossatchev after moving to Florida in 2003, went to medical school in the former Soviet Union and practiced in a hospital in his native Ukraine.<br /><br />Ruth Weber, a 74-year-old Clearwater resident, told the Times in April 2008 that <em>the man who called himself Dr. Martin enrolled her in a study for lower-back pain and adjusted the dosage of her medicine</em>. Only licensed physicians are supposed to conduct such activities. Patients in the study were <em>randomly selected to receive a new Johnson & Johnson painkiller called tapentadol, a placebo or the potent narcotic oxycodone.<br /></em><br />Though Dr. Robert Lee Jackson, a Clearwater osteopath, was listed by the FDA as the physician conducting the study, Weber said she never saw Jackson. In weekly visits to <em>Alliance Medical Research Group</em> on Belcher Road, Weber said it was Martin who drew blood, doled out medication and, at one point, doubled her dosage.<br /><br />Martin also conducted electrocardiograms on Weber, although his techniques were so rusty the electrodes kept slipping off, she said. Weber eventually dropped out of the study when she saw no improvement for her back pain.<br /><br />A second woman, Ann Reed, told investigators she also responded to an ad for a drug study trial at Alliance Medical Research. Martin took her blood, listened to her heart and gave her medications, Reed said. Martin sometimes had to stick her four times to draw blood, she said.<br /><br />Like Weber, Reed said she never saw Jackson during her trial, which involved 13 visits between May 2007 and March 2008.<br /><br />Greg Panico, a spokesman for Johnson & Johnson, said the company audited Alliance Medical after the Times' story and submitted its findings to the FDA. He declined to discuss the nature of the report, but said the drug company is no longer working with Alliance Medical.<br /><br />Panico also said data collected in the tapentadol study at that site was not submitted to the FDA.<br /><br />The drugmaker said it reported its findings to the <em><a href="http://www.sterlingirb.com/aboutus.php">Sterling Institutional Review Board</a> in Atlanta</em>, which had been hired by Johnson & Johnson to oversee patient safety during the trial.<br /><br />Despite losing the Johnson & Johnson trial, Martin told investigators in July that he was conducting four other drug studies.<br /></blockquote><br />A little Google searching turned up another example <a href="http://http://clinicaltrials.gov/ct2/show/study/NCT00387010">on ClinicalTrials.gov </a>of a commercially funded clinical study for which the Alliance Medical Research Group enrolled patients. This was a Phase III study sponsored by Cephalon, an "Open-Label Study to Evaluate the Effect of Treatment With Fentanyl Buccal Tablets on Pain Anxiety Symptoms When Used for the Management of Breakthrough Pain." Note also that Sterling Institutional Review Board appears to be another example of a for-profit, commercial institutional review board.<br /><br />Here we have another example of remarkably bad implementation of commercially sponsored and commercially supervised clinical trials. <br /><br />We have posted a number of times about sloppy and mismanagement of commercially sponsored clinical research, often under the auspices of for-profit contract research organizations (CROs) and for-profit institutional review boards (IRBs). See <a href="http://hcrenewal.blogspot.com/2006/05/saga-of-study-3014-and-safety-of.html">this 2006 vintage post </a>on the infamous study 3014 on Ketek, sponsored by Sanofi Aventis. <br /><br />In my humble opinion, in the contemporary business world, many managers are driven mainly by quarterly profits. However, what works best to boost profits in the short run may not be what works to produce valid clinical research that maximizes the safety of and respect afforded human research subjects. When all the organizations involved in the research, the sponsor, the organization implementing the research, and the organization supervising research ethics are for-profit, the incentives to cut corners are multiplied. Cutting corners can jeopardize the validity of the studies, and the safety and respectful treatment of study subjects.<br /><br />I again submit that making human experimental research into a commercial enterprise, mainly serving the marketing of drugs and devices, may not produce good science, and may not be good for patients. It might be a better idea to leave human research to not-for-profit organizations and health care professionals.<br /><br /><br />Hat tip to <a href="http://pharmagossip.blogspot.com/2009/06/alliance-medical-research-group.html">PharmaGossip</a>.

Practicing (Clinical Trials) Medicine Without a License

Another story of dubious clinical research, this time reported by the St Petersburg (Florida, US) Times: Vladimir Martin called himself ...

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Mark Leavitt, Head of CCHIT: Behind the Times and Uninformed on Health IT Realities?

<span style="font-size:100%;">Signs that a leader who alleges himself or herself to be objective and a scientist is, in fact, neither objective nor scientific include:</span><div><span style="font-size:100%;"><br /></span></div><div><ul><li><span style="font-size:100%;">Resorting to <a href="http://www.nizkor.org/features/fallacies/ad-hominem.html">ad hominem</a> attacks when questioned or criticized.</span></li><li><span style="font-size:100%;">Deficient familiarity with the current literature.</span></li><li><span style="font-size:100%;">Opining that others' concerns expressed in that literature could be "laughed off."<br /></span></li><li><span style="font-size:100%;">Years-behind view of the situation on the ground.</span></li></ul></div><div><span style="font-size:100%;"><br /></span></div><div><span style="font-size:100%;">The head of CCHIT, Mark Leavitt, has penned the following at iHealthBeat (emphases and comments in <span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">red italic</span> mine):</span></div><div><span style="font-size:100%;"><br /></span></div><div> <blockquote><span style="font-size:100%;"><a href="http://www.ihealthbeat.org/perspectives/2009/health-it-under-arra-its-not-the-money-its-the-message.aspx">June 19, 2009 - Perspectives</a></span></blockquote><blockquote><p class="MsoNormal"><span style="font-size:100%;"><b>Health IT Under ARRA: It's Not the Money, It's the Message</b></span></p> <p class="MsoNormal"><span style="font-size:100%;">by Mark Leavitt</span></p><p style="text-align: left;" class="MsoNormal"><span style="font-size:100%;">... Estimates by the Congressional Budget Office suggest the total incentive payout could reach $34 billion, although with expected savings the net cost is half that. Add to that another $2 billion that the Office of the National Coordinator for Health IT can use on various initiatives in support of the goal of having <span style="font-weight: bold;">an </span><span style="font-weight: bold;">EHR for every American </span>by 2014.</span><span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);"><br /></span></p><p style="text-align: left;" class="MsoNormal"><span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[Note the catchy marketing slogan, which carries the implicit message "what manner of people would oppose Mother and Apple Pie?" - ed.]</span></p><p class="MsoNormal"><span style="font-size:100%;">But more important than the money itself is the message implicitly conveyed along with it. Will incentives be perceived as an intrusive, carrot-and-stick manipulation of health care providers' business decisions?<span> </span>Or will health care providers interpret ARRA as the correction of a reimbursement anomaly, welcoming the opportunity to modernize their information management and <span style="font-weight: bold;">transform</span> </span><span style="font-size:100%;">the care they </span><span style="font-size:100%;">deliver. </span><br /></p><p style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0); text-align: left;" class="MsoNormal">[Cybernetic Miracle™ Alert - note the grandiose term "transform", as opposed to "facilitate" or "improve" - ed.]</p><p class="MsoNormal"><span style="font-size:100%;">Some of the early signs have been worrisome.<span> </span>Before ARRA, most surveys concluded that cost was the No. 1 barrier to EHR adoption. But as soon as it appeared that the cost barrier might finally be overcome, <b>individuals with a deeper-seated "anti-EHR" bent emerged.</b> Their numbers are small, but <b>their shocking claims -- that EHRs kill people, that massive privacy violations are taking place,<br /></b></span></p> <p class="MsoNormal"><span style="font-size:100%;"><b><span style="font-style: italic;"><span style="color: rgb(255, 0, 0);">[As an information scientist, I'm almost embarrassed to post</span> </span></b><a style="font-weight: bold;" href="http://news.google.com/archivesearch?q=hipaa+violation+complaint&btnG=Search&hl=en&ned=us&um=1&scoring=a"><span style="font-style: italic;">this link</span></a><b><span style="font-style: italic;"><span style="font-weight: bold;"> </span><span style="color: rgb(255, 0, 0);">and</span> </span></b><a style="font-weight: bold;" href="http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=18369111&ordinalpos=1&log$=relatedarticles&logdbfrom=pubmed"><span style="font-style: italic;">this link</span></a><b><span style="font-style: italic;"><span style="color: rgb(255, 0, 0);">, the results of just a few minutes' work with public resources. Thorough, robust searches in </span></span></b></span><a href="http://www.dialog.com/sources/"><span style="font-style: italic; font-weight: bold;">Dialog</span></a><span style="font-size:100%;"><b><span style="font-style: italic;"><span style="color: rgb(255, 0, 0);">'s suite of databases, </span></span></b></span><span style="font-size:100%;"><b><span style="font-style: italic;"><span style="color: rgb(255, 0, 0);">Current Contents, </span></span></b></span><span style="font-size:100%;"><b><span style="font-style: italic;"><span style="color: rgb(255, 0, 0);">Lexis Nexis, SciFinder etc. would show far more -</span> <span style="color: rgb(255, 0, 0);">ed.]</span></span></b></span></p><p></p><p class="MsoNormal"><span style="font-size:100%;"><b>that shady conspiracies </b></span><span style="font-size:100%;"><b>are operating --</b></span><span style="font-size:100%;"><span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);"><br /></span></span></p><p class="MsoNormal"><span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[i.e.,</span><b> </b><a style="font-weight: bold;" href="http://www.ehrstimulustour.com/"><span style="font-style: italic;">HIT industry lobbies</span></a><b> <span style="font-style: italic; color: rgb(255, 0, 0);">- ed.]</span></b></p><p class="MsoNormal"><span style="font-size:100%;">make stimulating copy for the media. Those experienced with EHRs might <b>laugh these stories off</b>, but risk-averse newcomers to health IT</span><span style="font-size:100%;">, both health care providers and policymakers<br /></span></p><p class="MsoNormal"><span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">[i.e., those who take due diligence and </span><span style="font-style: italic;"><a style="font-weight: bold;" href="http://hcrenewal.blogspot.com/2009/03/health-it-hold-harmless-and-defects-gag.html">fiduciary responsibilities</a> </span><span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);">seriously - ed.]</span></p><p class="MsoNormal"><span style="color: rgb(0, 0, 0);">are easily affected by <span style="font-weight: bold;">fear mongering.</span></span><span style="font-weight: bold; font-style: italic; color: rgb(255, 0, 0);"><br /></span></p><p></p></blockquote> <!--EndFragment--> </div><br />That is, <span style="font-weight: bold;">Bah!</span> to the apostates' narratives --<br /><br />-- even though many of these narratives are in the peer-reviewed biomedical science and biomedical informatics literature ...<br /><br /><span style="font-size:100%;"><br /></span><div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://2.bp.blogspot.com/_8YphtkAHyDU/SkB8K2HAZ2I/AAAAAAAAANE/SU6gFdDouew/s1600-h/dogbert.gif"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5350412883081586530" src="http://2.bp.blogspot.com/_8YphtkAHyDU/SkB8K2HAZ2I/AAAAAAAAANE/SU6gFdDouew/s320/dogbert.gif" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 166px; height: 165px;" /></a><span style="font-weight: bold;">Bah!</span><br /></div><span style="font-size:100%;"><br /><br />I'm really tired of amateurish political rhetoric and marketing puffery masquerading as substantive debate on critical issues as above. However, being experienced with EHRs, their design, implementation and lifecycle, and concerned with widespread irrational exuberance over health IT (a facilitative tool that carries risk to patients and medical organizations if not done well) I am not at all "laughing these stories off", and will critique the above in a quite serious manner. </span><span style="font-size:100%;"><br /><br />Indeed, "laughing off" stories from credible sources and personnel (e.g., many AMIA members) about potential harm from an experimental technology affecting patients seems the height of hubris, or blindness of a kind mediated by </span><span class="ResultBody">incomplete knowledge</span><span style="font-size:100%;"> or conflicts of interest.<br /><br />First, binary thinking. It seems those who critique health IT's drawbacks are "</span><span style="font-size:100%;"><b>individuals with a deeper-seated anti-EHR bent</b>." That is, they don't buy into the consensus of the industry "experts" and must therefore be biased and wrong. </span><div><div><br /><div><div><span style="font-size:100%;">I, in fact, am a health IT proponent, but simply abhor poor HIT such as at my series <a href="http://tinyurl.com/b28s74">here</a>, or HIT sold to my organization in an unusable (but "Certified") state as in the Civil Complaint <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/DUCOM_EMR_Complaint.pdf">here</a> (PDF). I believe the rush to <a href="http://www.jamia.org/cgi/content/abstract/13/1/106">national EHR by 2014 is premature</a>, will waste massive amounts of money, and will cause disruption to an already strained healthcare system with resultant adverse effects. I believe far more research remains to be done before our social and technical understanding of "how to do clinical IT well" justifies mass government-mandated cybernetic re-engineering in healthcare. (See literature list below.)</span><div><div><span style="font-size:100%;"><br /></span></div><div><span style="font-size:100%;">On the issue of ad hominem attacks against questions and critique, I documented those at Healthcare Renewal at</span><span class="Apple-style-span" style="font-size:100%;"> </span><span class="Apple-style-span" style="color: rgb(153, 51, 51);font-size:100%;" ><span class="Apple-style-span" style="letter-spacing: -1px; line-height: 19px;"><b><span class="Apple-style-span">"</span><span class="Apple-style-span" style="color: rgb(0, 0, 0); letter-spacing: normal; line-height: normal;"><span class="Apple-style-span">Open letter to Mark Leavitt, Chairman, Certification Commission for Healthcare Information Technology on Penalties For Use of Non-Certified HIT</span></span><span class="Apple-style-span" style="color: rgb(0, 0, 0); font-weight: normal; letter-spacing: normal; line-height: normal;"><span class="Apple-style-span">" </span><a style="font-weight: bold;" href="http://hcrenewal.blogspot.com/2009/06/open-letter-to-mark-leavitt-chairman.html"><span class="Apple-style-span">at this link</span></a><span class="Apple-style-span">. Both I and another physician, David Kibbe, MD, M</span></span></b></span></span><span style="font-size:100%;"><span class="Apple-style-span" style="letter-spacing: -1px; line-height: 19px;"><b><span class="Apple-style-span" style="color: rgb(0, 0, 0); font-weight: normal; letter-spacing: normal; line-height: normal;"><span class="Apple-style-span">BA, <span class="Apple-style-span">Health IT Consultant at American Academy of Family</span><span class="Apple-style-span"> Physicians, were subjected to "nonlinear" commentary.</span></span></span></b></span><br /><br />It also seems Dr. Leavitt is unfamiliar with or deliberately downplaying a growing body of literature on health IT risks and failures. <span style="font-style: italic; color: rgb(255, 0, 0); font-weight: bold;">[Health IT failure never, ever puts patients at risk, as I wrote</span><span style="font-weight: bold;"> </span><a style="font-weight: bold;" href="http://hcrenewal.blogspot.com/2009/05/health-it-failure-never-puts-patients.html"><span style="font-style: italic;">here</span></a>, <span style="font-style: italic; color: rgb(255, 0, 0); font-weight: bold;">of course - ed.]</span><br /><br />Examples of this growing body of "unknown" or "ignored" or "downplayed" literature include:<br /></span></div><!--StartFragment--> <!--EndFragment--> <div><div><span style="font-size:100%;"><br /></span></div><div><span style="font-size:100%;">1. The article "<a href="http://www.jamia.org/cgi/content/full/16/3/291">Health IT Project Success and Failure: Recommendations from Literature and an AMIA Workshop</a>", </span><span class="Apple-style-span" style="font-size:100%;"><span class="Apple-style-span" style="">Bonnie Kaplan and Kimberly D. Harris-Salamone, Journal of the American Medical Informatics Association 2009;16:291-299. DOI 10.1197/jamia.M2997 - and the references cited.</span></span></div><div><span style="font-size:100%;"><br /></span></div><div><span style="font-size:100%;">There are more than<b> 70 references</b> at the end of this article (See fulltext at link above), and my comments on the findings and recommendations of the multi-working group informatics workshop that created it are in the post "</span><span class="Apple-style-span" style=";font-family:Helvetica;font-size:100%;" ><span class="Apple-style-span" style="font-family:georgia;"><b>Health IT Project Success and Failure: Recommendations from Literature and an AMIA Workshop</b>"</span><span class="Apple-style-span" style="font-family:Georgia;"> <a href="http://hcrenewal.blogspot.com/2009/03/health-it-project-success-and-failure.html">at this link</a>.</span></span></div><div><span style="font-size:100%;"><br /></span></div><div><span style="font-size:100%;">2. This corpus of literature below. These are just examples and not a comprehensive listing:</span></div><div><span style="font-size:100%;"><br /></span></div><div><span style="font-size:100%;"><blockquote><span style="font-size:100%;">Joint Commission: <a href="http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_42.htm">Sentinel Events Alert on HIT</a>, Dec. 2008.<br /><br />National Research Council report. <a href="http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572">Current Approaches to U.S. Healthcare Information Technology are Insufficient</a>. Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions, Jan. 2009<br /><a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15302.htm"><br />The National Programme for IT in the NHS: Progress since 2006,</a> Public Accounts Committee, January 2009. Summary points <a href="http://www.publications.parliament.uk/pa/cm200809/cmselect/cmpubacc/153/15304.htm">here</a>.<br /><br /><a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinfo.htm">Common Examples of Healthcare IT Difficulties</a> (my own 10-year-old website). S. Silverstein, MD, Drexel University College of Information Science and Technology.<br /><br /></span><span style=";font-family:times new roman;font-size:100%;" ><a href="http://jama.ama-assn.org/cgi/content/extract/301/12/1276">Health Care Information Technology Vendors' "Hold Harmless" Clause - Implications for Patients and Clinicians</a>, Ross Koppel and David Kreda, Journal of the American Medical Association, 2009; 301(12):1276-1278 </span><br /><span style="font-size:100%;"><br /><a href="http://www.ischool.drexel.edu/faculty/ssilverstein/regulation_and_oversight_hoffman.pdf">Finding a Cure: The Case for Regulation And Oversight of Electronic Health Records Systems</a>, Hoffman and Podgurski, Harvard Journal of Law & Technology 2008 vol. 22, No. 1<br /><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/18213422">Failure to Provide Clinicians Useful IT Systems: Opportunities to Leapfrog Current Technologies</a>, Ball et al., Methods Inf Med 2008; 47: 4–7,<br /><br /><a href="http://jama.ama-assn.org/cgi/content/extract/301/9/919">IT Vulnerabilities Highlighted by Errors, Malfunctions at Veterans’ Medical Centers</a>, JAMA Mar. 4, 2009, p. 919-920.<br /><br /><a href="http://pediatrics.aappublications.org/cgi/content/abstract/116/6/1506">Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System</a>, Han et al., Pediatrics Vol. 116 No. 6 December 2005, pp. 1506-1512<br /><br /><a href="http://jama.ama-assn.org/cgi/content/abstract/293/10/1197">Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors</a>. Ross Koppel, PhD, et al, Journal of the American Medical Association, 2005;293:1197-1203<br /></span><br /><a href="http://www.ctlab.org/documents/Hiding%20in%20plain%20sight.pdf">Hiding in Plain SIght: What Koppel et al. tell us about healthcare IT</a>. Christopher Nemeth, <em></em>Richard Cook. <em></em>Journal of Biomedical Informatics. 38 (4): 262-3.<br /><span style="font-size:100%;"><br /><a href="http://www.jamia.org/cgi/content/short/15/4/408">Workarounds to Barcode Medication Administration Systems: Their Occurrences, Causes and Threats to Patient Safety</a>, Koppel, Wetterneck, Telles & Karsh, JAMIA 2008;15:408-423<br /><br /><a href="http://www.nytimes.com/2009/03/06/opinion/06coben.html">The Computer Will See You Now</a>, New York Times, Armstrong-Coben, March 5, 2009,<br /><br /><a href="http://iig.umit.at/efmi/badinformatics.htm">Bad Health Informatics Can Kill</a>. Working Group for Assessment of Health Information Systems of the European Federation for Medical Informatics (EFMI).<br /><br /><a href="http://archinte.ama-assn.org/cgi/content/short/167/13/1400">Electronic Health Record Use and the Quality of Ambulatory Care in the United States</a>. Arch Intern Med. 2007;167:1400-1405<br /></span><span style="font-weight: bold;"><br /></span><a href="http://www.jamia.org/cgi/content/abstract/13/1/106">Predicting the Adoption of Electronic Health Records by Physicians: When Will Health Care be Paperless?</a> Ford et al., J Am Med Inform Assoc. 2006;13:106-112<br /><br /><a href="http://www.jamia.org/cgi/content/abstract/16/3/274">Resistance Is Futile: But It Is Slowing the Pace of EHR Adoption Nonetheless</a>, Ford et al., J Am Med Inform Assoc. 2009;16:274-281<br /><span style="font-size:100%;"><br /><a href="http://archinte.ama-assn.org/cgi/reprint/165/10/1111.pdf">High Rates of Adverse Drug Events in a Highly Computerized Hospital</a>, Nebeker at al., Arch Intern Med. 2005;165:1111-1116.<br /><br />"<a href="http://articles.icmcc.org/2009/01/23/dutch-ehr-postponed-are-they-in-good-company/">Dutch nationwide EHR postponed: Are they in good company?</a>", ICMCC.org, Jan. 24, 2009<br /><br />“<a href="http://www.ama-assn.org/amednews/2006/12/11/bisa1211.htm">Avoiding EMR meltdown</a>.” About a third of practices that buy electronic medical records systems stop using them within a year, AMA News, Dec. 2006.<br /><br />"The failure rates of EMR implementations are also consistently high at close to 50%", from <a href="http://www.infoclin.ca/assets/emr%20success%20methodologies%20framework%20development%20ishimr%202006%20v2.pdf">Proceedings of the 11th International Symposium on Health Information Management Research</a> – iSHIMR 2006<br /><br />"Industry experts estimate that failure rates of Electronic Medical Record (EMR) implementations range from 50–80%.", from <a href="https://www.advancedmd.com/pressroom/white_papers/commonsense_to_emrs.pdf">A Commonsense Approach to EMRs</a>, July 2006<br /><br /><a href="http://www.taxonomer.com/PublishTxgd001/index.htm">Adverse Effects of Information Technology in Healthcare</a>. This knowledge center presents a collection of information on the adverse effects of information technology in its application to healthcare. It also references sources of information on information security, and related media reports.<br /><br /><a href="http://www.ischool.drexel.edu/faculty/ssilverstein/Goldfinch_pessimism_PAR.pdf">Pessimism, Computer Failure, and Information Systems Development in the Public Sector</a>. Shaun Goldfinch, University of Otago, New Zealand, Public Administration Review 67;5:917-929, Sept/Oct. 2007<br /><br />The literature at my HIT website's "<span style="font-weight: bold;">Other Resources</span>" page (<a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=other">link</a>)<br /><br /></span>The teachings of the field of <span style="font-weight: bold;">Social Informatics</span> about new Information and Communications Technologies (ICT's) and the unanticipated negative consequences they cause. An introductory essay entitled “<span style="font-weight: bold;">Learning from Social Informatics</span>” by R. Kling at the University of Indiana can be found <a href="http://rkcsi.indiana.edu/archive/SI/Arts/SI_report_Aug_14.doc">at this link</a> (MS-Word file). The book “<span style="font-weight: bold;">Understanding And Communicating Social Informatics</span>” by Kling, Rosenbaum & Sawyer, Information Today, 2005 (<a href="http://www.amazon.com/Understanding-Communicating-Social-Informatics-Communication/dp/1573872288/ref=sr_1_1/102-9749119-8288920?ie=UTF8&s=books&qid=1174318804&sr=8-1">Amazon.com link here</a>) was based on this essay.<br /></blockquote></span></div><div><span style="font-size:100%;"><br /><br /></span></div><div><span style="font-size:100%;">3. The warnings of HIT dangers from the U.S. Joint Commission, the EFMI, as linked above, and others; doubts about cost savings from Wharton and Stanford professors (surely no amateurs). </span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51);font-size:100%;" ><span class="Apple-style-span" style="line-height: 19px;"><br /></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51); line-height: 19px;font-size:100%;" ><span class="Apple-style-span">In the June 20, 2009 Wall Street Journal article "</span><a href="http://online.wsj.com/article/SB10001424052970204005504574235751720822322.html" style="color: rgb(102, 153, 204);"><span class="Apple-style-span">The Myth of Prevention</span></a><span class="Apple-style-span">", Abraham Verghese, Professor and Senior Associate Chair for the Theory and Practice of Medicine at Stanford, echoed </span><a href="http://hcrenewal.blogspot.com/2009/06/wharton-on-healthcare-it-can-i-go-home.html" style="color: rgb(102, 153, 204);"><span class="Apple-style-span">several Wharton professor's doubts</span></a><span class="Apple-style-span"> about the cost savings and ultimate value of electronic medical records, touted as the cybernetic savior of healthcare:</span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51);font-size:100%;" ><span class="Apple-style-span" style="line-height: 19px;"><br /></span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51);font-size:100%;" ><span class="Apple-style-span" style="line-height: 19px;"> <!--StartFragment--> <blockquote>... I have similar problems with the way President Obama hopes to pay for the huge and costly health reform package he has in mind that will cover all Americans; he is counting on the “savings” that will come as a result of investing in preventive care and investing in the electronic medical record among other things. It’s a dangerous and probably an incorrect projection.</blockquote></span></span></div><div><span style="font-size:100%;"><br /></span></div><div><span style="font-size:100%;">There are also reports of problems from FDA-like agencies of other countries such as Sweden's, whose </span><span class="Apple-style-span" style="color: rgb(51, 51, 51); line-height: 19px;font-size:100%;" ><span class="Apple-style-span">report entitled "</span><span style="font-weight: bold;"><span class="Apple-style-span">The Medical Products Agency’s Working Group </span></span><span style="font-weight: bold;"><span class="Apple-style-span">on Medical Information Systems: Project summary</span></span><span class="Apple-style-span">" (available in English translation at </span><a href="http://www.lakemedelsverket.se/upload/foretag/medicinteknik/en/Medical-Information-Systems-Report_2009-06-18.pdf" style="color: rgb(102, 153, 204);"><span class="Apple-style-span">this link</span></a><span class="Apple-style-span"> in PDF) stated:</span></span></div><div><span class="Apple-style-span" style="color: rgb(51, 51, 51);font-size:100%;" ><span class="Apple-style-span" style="line-height: 19px;"><br /></span></span></div><div style="font-family:georgia;"><span class="Apple-style-span" style="color: rgb(51, 51, 51);font-size:100%;" ><span class="Apple-style-span" style="line-height: 19px;"> <!--StartFragment--> <blockquote><div><span class="Apple-style-span" style="color: rgb(51, 51, 51);"><span class="Apple-style-span" style="line-height: 19px;"><p class="MsoNormal"><span class="Apple-style-span">It is becoming more common that electronic patient record systems and other systems are interconnected, for instance imaging systems or laboratory systems. It is obvious that such systems should not be regarded as “purely administrative”; instead they have the characteristic features that are typical for medical devices. They sort, compile and present information on patients’ treatments and should therefore be regarded as medical devices in accordance to the definition.</span></p><p class="MsoNormal"><span class="Apple-style-span">Since the electronic patient record system often replaces/constitutes the user interface of “traditional” medical device systems, the call for 100% accuracy of the presented information is increased. </span><b><span class="Apple-style-span">Patient record systems have crucial impact on patient safety, and this has been proven to be the case after a series of incidents <span style="font-style: italic; color: rgb(204, 0, 0);">[including deaths - ed.]</span> that has been reported to the Swedish National Board of Health and Welfare.</span></b></p> <!--EndFragment--> </span></span></div></blockquote></span></span></div><div><span style="font-size:100%;"><br /></span></div><div><span style="font-size:100%;">On wonders if Dr. Leavitt would include the Swedish Medical Products Agency, who incidentally have a <a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108646.htm">cooperation agreement with our own FDA</a>, under the category of "fearmongers."<br /><br />Finally, stories of HIT mayhem of which Dr. Leavitt seems blissfully unaware are making their way to appropriate political circles. The whistleblowers are afraid to speak out publicly due to fear of job loss or retaliation. However, when the case examples do come out, it may be Dr. Leavitt who will be found to be "fear mongering" about those who care more about patients and their rights than about information technology.</span></div><div><span style="font-size:100%;"><br /></span></div><div><span style="font-size:100%;"><b>Health IT Under ARRA: It's Not the Money, It's the Message.</b> Indeed.</span></div><div><span style="font-size:100%;"><br /></span></div><div><span style="font-size:100%;">And Dr. Leavitt's message about those who think critically about health IT seems quite ill informed and mean spirited. </span></div><div><span style="font-size:100%;"><br /></span></div><div><span style="font-size:100%;">Finally, to get past the <a href="http://www.nizkor.org/features/fallacies/ad-hominem.html">ad hominem</a> and other <a href="http://en.wikipedia.org/wiki/List_of_fallacies">logical fallacy</a> nonsense I believe will be coming my way, I'll just admit to any and all of it. I'm an SOB, I'm a disgruntled curmudgeon, I'm an HIT dilettante, my uncle was in the mafia, I kick little cygnet swans in the park to be mean to </span><span style="font-size:100%;">Chucky,</span><span style="font-size:100%;"> the cob (father) , and Princess, the pen (mother). </span><span style="font-size:100%;"> /sarc<br /><br />:-)<br /></span><span style="font-size:100%;"><br /></span></div><div><span style="font-size:100%;"><br /></span></div><div><span style="font-size:100%;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://3.bp.blogspot.com/_8YphtkAHyDU/SkBtdfUDLNI/AAAAAAAAAM8/bdaIWUCgEK8/s1600-h/swan_family_june22_2009.jpg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5350396710705376466" src="http://3.bp.blogspot.com/_8YphtkAHyDU/SkBtdfUDLNI/AAAAAAAAAM8/bdaIWUCgEK8/s320/swan_family_june22_2009.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 316px; height: 215px;" /></a></span></div><div style="text-align: center;"><span style="font-size:100%;"><span style="font-size:85%;">The Mute Swan family of Towamencin Twp., PA. Click to enlarge. The cygnets have really grown this past month (major cuteness warning if you click <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cygnus.jpg">this picture</a> from June 1!)</span><br /></span></div><div><span style="font-size:100%;"><br /><br />Now that we're hopefully past the expected <a href="http://www.nizkor.org/features/fallacies/ad-hominem.html">ad hominem</a>, perhaps the real issues can be addressed.<br /><br />As a final piece of advice to Dr. Leavitt, I can add that dismissing concerns of others, Dogbert-style, is not a way to win friends and influence people.<br /></span><br /></div><div><span style="font-size:100%;">Humor and a little humility work much better.<br /><br />-- SS</span></div></div></div></div></div></div></div>

Mark Leavitt, Head of CCHIT: Behind the Times and Uninformed on Health IT Realities?

Signs that a leader who alleges himself or herself to be objective and a scientist is, in fact, neither objective nor scientific include: Re...

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An Original Excuse

The Associated Press just published <a href="http://www.google.com/hostednews/ap/article/ALeqM5iqRyDDIAJ4RAA-ImdqfMw4q86TcQD98UHT7G0">a story </a>about another company which apparently failed to report adverse events associated with its product:<br /><blockquote><br />Complaints about a contact lens solution linked to a 2007 outbreak of eye infections that blinded several people went unreported by the manufacturer for more than a year, government documents show.<br /><br />The documents show <em>Advanced Medical Optics received complaints about the solution more than a year before it was recalled, and failed to promptly report nine complaints as required by law</em>.<br /><br />The company <em>pulled its Complete MoisturePlus off the market in May 2007 after the Centers for Disease Control and Prevention linked the fluid to dozens of cases of a serious infection called Acanthamoeba keratitis</em>.<br /><br />Lawyers for customers suing AMO obtained the documents, which stem from a previously undisclosed inspection by the Food and Drug Administration, through a Freedom of Information Act request. The papers were obtained by The Associated Press.<br /><br />Of roughly 70 plaintiffs suing AMO and represented by the law firm Schmidt LLP, three had eyes removed, three others suffered blindness and about two dozen had at least one corneal transplant. The others suffered permanent vision damage.<br /><br /><em>Beginning in February 2006 and continuing through November, AMO received a series of complaints about users who were diagnosed with the Acanthamoeba infections. But those reports were not disclosed until June 2007</em>, when FDA inspectors came to investigate the company's headquarters following its product recall.<br /></blockquote><br /><br />What is most striking is the company's rationale for not reporting:<br /><blockquote><br />When questioned by FDA inspectors, company officials said <em><strong>they were not obligated to report the complaints because the product's labeling does not say it protects against Acanthamoeba</strong></em>, according to the FDA documents.<br /><br />Kelly Morrison, a spokeswoman for Abbott Laboratories, which acquired AMO in February, said the company 'believed it was reporting customer complaints in compliance with FDA regulations.' She declined to elaborate. Abbott Laboratories is based in North Chicago.<br /></blockquote><br /><br />That is an original excuse. Did the "company officials" really mean to imply that in the absence of a promise to protect against a specific microbiologic organism, patients and physicians should assume that the product could be contaminated with that organism? This completely ignores the company's basic responsibility to supply a product that is uncontaminated with any harmful organisms, and unadulterated with any harmful substances, and hence to be vigilant for any events that suggest that the product could have been contaminated or adulterated.<br /><br />The "company officials'" bizarre excuse suggest a fundamental lack of comprehension of their responsibilities for the health and safety of the patients using their products. This is a particularly weird example of how little many leaders of health care organizations understand about health care.

An Original Excuse

The Associated Press just published a story about another company which apparently failed to report adverse events associated with its produ...

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All for Good: Bringing search, scale and openness to community service

While many organizations are doing great work to enable community service locally, it's not simple to search across opportunities from a variety of places to find what's right for you. We have some experience finding relevant information from among many scattered sources, and when we learned that President Obama and the First Lady were making community service <a href="http://www.time.com/time/politics/article/0,8599,1872152,00.html?iid=fb_share">a top priority even before taking office</a>, we thought we could help make a difference.<br /><br />With our mission in mind, a group of <a href="http://googleblog.blogspot.com/2006/05/googles-20-percent-time-in-action.html">"20%" engineers, designers, and program managers</a> from Google and other tech companies began work on <a href="http://www.allforgood.org/">All for Good</a>, a new service to help you find volunteer events in your community, and share those events with your friends.<br /><br />All for Good provides a single search interface for volunteer activities across many major volunteering sites and organizations like <a href="http://www.liveunited.org/">United Way</a>, <a href="http://www.volunteermatch.org/">VolunteerMatch</a>, <a href="http://www.handsonnetwork.org/">HandsOn Network</a> and <a href="http://www.reachoutandread.org/about_find.html">Reach Out and Read</a>. By building on top of the amazing efforts of existing volunteer organizations like these, we hope to amplify their efforts.<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://1.bp.blogspot.com/_7ZYqYi4xigk/Sj-jvlYl3sI/AAAAAAAAD70/TvosAtLcq4A/s1600-h/afg"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5350174920223874754" src="http://1.bp.blogspot.com/_7ZYqYi4xigk/Sj-jvlYl3sI/AAAAAAAAD70/TvosAtLcq4A/s400/afg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 228px;" /></a><br />And in the spirit of open data, All for Good has a data API that anyone can use to search the same data displayed on the All for Good site. All for Good was developed entirely using <a href="http://code.google.com/appengine/">App Engine</a> and <a href="http://www.google.com/base/">Google Base</a>, with the full code repository hosted on <a href="http://code.google.com/hosting/">Google Code Hosting</a>. We'll be inviting developers to contribute to the open source application soon, so stay tuned.<br /><br />Just as releasing the Maps API led to an surge of independent and creative uses of geographic information, we've built All for Good as a platform to encourage innovation in volunteerism, as much as an end product in itself. We hope software developers will use the API or code to build their own volunteering applications, some even better than the All for Good site!<br /><br />And if you want to volunteer your video-creating skills to make a difference, check out <a href="http://www.youtube.com/videovolunteers">YouTube Video Volunteers</a>, a new platform designed to make connections between non-profits with video needs and skilled video makers who can help broadcast their causes through video.<br /><br />All for Good is a new kind of collaboration between the private, public and nonprofits sectors to build free and open technology to empower citizens. Similar to the Open Social Foundation, we helped create a new organization called Our Good Works to make sure that the API, the platform, and social innovation that they inspire are supported for the long term. The leadership includes Reid Hoffman, Chris DiBona, Arianna Huffington and Craig Newmark on the board, and the organization aims to build support volunteerism services like All for Good.<br /><br />Today the First Lady is in San Francisco calling on Americans to improve our communities by rolling up our sleeves and putting our time and talent towards doing good. You can learn more at <a href="http://serve.gov/">serve.gov</a>, where we're proud to power search.<br /><br /><span class="byline-author">Posted by Paul Rademacher and Adam Sah, Engineering Tech Leads</span>

All for Good: Bringing search, scale and openness to community service

While many organizations are doing great work to enable community service locally, it's not simple to search across opportunities from a...

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