healthy4u

Healthcare IT: How Much More Out of Control Can An Industry Be?

In a <a href="http://hcrenewal.blogspot.com/2009/03/serious-leak-of-top-secret-classified.html">prior post</a> I had quoted a Healthcare IT News report on the <a href="http://www.healthcareitnews.com/news/docs-may-be-using-it-they-dont-love-it">healthcare IT user experience</a>: <blockquote style="font-family:arial;">Healthcare IT News (3/10, Merrill) reported, a survey conducted by the American College of Physician Executives found "that although more physician leaders are using healthcare information technology, they still find it clunky and unresponsive to their needs." The survey of 1,000 ACPE members "revealed that the biggest source of frustration is a lack of input from physicians when designing and implementing healthcare information technology systems. Many said involving clinicians at the planning stages would pre-empt many of the problems that crop up later." One respondent noted that "systems are chosen according to administrative criteria rather than what physicians need."</blockquote> These same observations have been made by the <a href="http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572">National Research Council</a> of the National Academies, and many others, in fact dating back decades as I've previously written on these pages, and as at my site on HIT difficulties <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/medinfo.htm">here</a> starting a decade ago. Several issues occur to me that need emphasis: <ul><li>How can it be that in 2009, 1,000 ACPE members opine that the biggest source of frustration is a lack of input from physicians when designing and implementing healthcare information technology systems but do little about this glaring defect in an industry touting itself as the savior of healthcare? </li></ul><ul><li>If the medical leadership notes that HIT is "clunky and unresponsive" to clinician needs, why are they not speaking out vociferously and seeking prolongation of the 2014 "deadline" for IT adoption?</li></ul><ul><li>If HIT is clunky and unresponsive to clinician needs, how can the technology actually do anything but make clinicians' work slower, harder (e.g., by exhausting 'cognitive capital' working around the problems) and less effective, thereby serving as an impediment to healthcare improvement and cost savings?</li></ul><ul><li>Why do grass roots "<a href="http://hcrenewal.blogspot.com/2009/03/disruptive-innovators-at-healthcare.html">disruptive innovators</a>", not the leadership, have to take up the mantle of opposition to an industry as primitive and backwaters as to allow a lack of physician input, and a customer base of healthcare organizations that mismanage what technology they do purchase from the HIT vendors? </li></ul><ul><li>How can the HIT industry continue to develop and push such products?</li></ul><ul><li>How can healthcare organizations still purchase it (at costs of tens of million to 100+ million dollars)? </li></ul><ul><li>How can clinicians and their leadership tolerate such a situation? </li></ul><ul><li>How can our society allow the HIT industry such latitude, without regulation and accountability?</li></ul><ul><li>How did the HIT and healthcare industries manage to fall behind in talent management, causing a lack of clinician leadership and input into HIT, and perhaps worse, causing neglect and underutilization of a growing pool of biomedical informatics expertise, thus exacerbating the noted deficiency of meaningful domain expert input at the critical planning stages? (See below.) </li></ul> Only an unregulated, unaccountable, poorly led industry that is out of control - the vendors and the consumers, i.e., healthcare organizations themselves - can be producing and marketing and acquiring HIT clinical devices that are clunky and unresponsive to clinician needs for a prolonged period dating back decades. Further, if my own personal experiences and that of a group of similarly experienced colleagues are a gauge, and I believe they are, then the HIT industry's talent management, and that of the healthcare organizations who purchase and implement this technology, are similarly out of control. Case in point, one of many dating to at least 1994 when I completed an NIH postdoctoral fellowship in Biomedical Informatics at Yale School of Medicine: About two years ago I had interviews with Siemens Healthcare in Malvern about a HIT leadership role. I presented state of the art information on best practices in HIT, including the critical need for physician input, as well as showed them some of my own work in use at major area medical centers and overseas as well. I did not have even the courtesy of a call back or email as to their decision. Simply silence. Sadly, a decade prior I'd had excellent, frank conversations about these HIT issues with Siemens personnel at their Healthcare headquarters in Erlangen, Germany that led to a position offer (I simultaneously received an offer from Merck & Co., Inc. in the U.S. and went that route). It was clear Siemens America and its American employees did not share the kultur and engineering insights of their German counterparts. The results with other HIT vendors have been similar, such as <a href="http://hcrenewal.blogspot.com/2009/02/nextgen-and-vendordoctor-dialog-yet.html">here</a> and <a href="http://hcrenewal.blogspot.com/2008/11/who-leads-in-intellectually-challenged.html">here</a> and numerous others. Further, my CV has been on all the major job boards for years, and I have almost never been contacted by an HIT vendor. What, exactly, are their HR departments doing if formal medical informatics credentials are either invisible or ignored? Further and perhaps worse, I and similarly experienced colleagues have had difficulty even being talked to by major healthcare organizations, such as outlined <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=leadership">here</a>, who appear to believe there's such a thing as "too much experience" in managing HIT investments of tens of millions of dollars and up, investments that impact patient lives. I have sprinkled this blog's pages with many such examples of vendor and provider organization talent management seemingly gone awry, a "wall" against informed clinical input in the form of shunning of those with actual clinical and biomedical informatics credentials in favor of cheaper technical labor. Such patterns should not be lightly ignored. (In actual fact, several members at House Energy & Commerce were simply incredulous when told of this issue. 'Why are hospitals and the HIT companies not actively running after people of your backgrounds?' was their question.) The health IT pioneers noted these same patterns forty years ago. As far back as 1969, EMR and Medical Informatics pioneer Donald A. B. Lindberg, M.D., now Director of the U.S. National Library of Medicine at NIH, made the observation that <blockquote face="arial">"... computer engineering experts per se have virtually no idea of the real problems of medical or even hospital practice, and furthermore have consistently underestimated the complexity of the problems…in no cases can [building appropriate clinical information systems] be done, simply because they have not been defined with the physician as the continuing major contributor and user of the information" (Lindberg DAB: Computer Failures and Successes, Southern Medical Bulletin 1969;57:18-21).</blockquote> Other pioneers in EMR such as Morris Collen, Octo Barnett, and others published guidelines on how to best implement clinical IT that warned against the cornucopia of problems that plague the HIT industry today. Sadly, they did so starting in -- and perhaps even before -- the 1960's. A good source on references to the wisdom of the pioneers is "<a href="http://www.amazon.com/exec/obidos/tg/detail/-/0964774305/qid=1111634652/sr=8-1/ref=sr_8_xs_ap_i1_xgl14/002-5628970-2983252?v=glance&s=books&n=507846">A History of Medical Informatics in the United States 1950-1990</a>", by Morris Collen MD, section 3.4. For example, Octo Barnett's clinical IT "10 Commandments" (written in 1970) as reproduced in Collen's book on page 169, as well as 1960's and 70's material by Lindberg, Lamson, Collen, Davis, Baker, and numerous others address many of the substantial problems that plague health IT today. Yet, here we are in 2009, and we have an industry still mired in the problems noted forty years ago. How much more out of control can an industry be? The technology will only improve when those behind it have a better grasp of the complexities of medicine and end the lack of input from (and I might add, dearth of leadership by) physicians and physician informaticists. The only private response to these observations over more than a decade I've gotten is <a href="http://histalk2.com/2008/05/10/monday-morning-update-51208/">this foolishness</a> from a vendor sponsored gossip site that I: <blockquote face="arial">... don't usually have good things to say about CIOs and IT departments, so if you don’t want to start your Monday morning sputtering and flinging your coffee at your monitor, don’t click the link. He often makes harsh observations from the context of "the IT people didn’t hire me, so they must be insular fools who hate doctors" angle, but he does make an occasional point.</blockquote> I don't think the HIT vendors are fools who hate doctors, but I do believe they are indeed insular and the industry out of control, as any unregulated, unaccountable and lucrative industry might become after time - such as medicine itself prior to Flexner. Who needs smart, knowledgeable experts to reduce margins? About that insularity, at "<a href="http://hcrenewal.blogspot.com/2008/05/htrea-parallel-world-of-hit.html">Earthlings and Htraesians: The Parallel Worlds of Medicine and Healthcare Information Technology</a>" I wrote: <blockquote style="font-family: arial;"> ... In trying to unify my observations, I am postulating that HIT has created for itself its own closed society with its own value system, credentialing, culture, and power stuctures, which piggyback off the hard labor of clinicians. The culture of this closed society is at great odds with that of the community it ostensibly serves, medicine. </blockquote> To summarize, healthcare is in a sad - and may I say alarming - state when its executive leaders can opine that an entire industry's products now being mandated for use by the federal government on a short time frame are "clunky and unresponsive" due to a "frustrating lack of input from clinician endusers", and such a revelation is <a href="http://hcrenewal.blogspot.com/2006/07/anechoic-effect-explained.html">anechoic</a> and relegated to a small corner of the blogosphere. -- SS

Healthcare IT: How Much More Out of Control Can An Industry Be?

In a prior post I had quoted a Healthcare IT News report on the healthcare IT user experience : Healthcare IT News (3/10, Merrill) reported...

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Celebrating Mars, then and now

Today is the 174th birthday of the famous Italian astronomer and cartographer <a href="http://en.wikipedia.org/wiki/Giovanni_Schiaparelli" id="qi4y" title="Giovanni Schiaparelli">Giovanni Schiaparelli</a>. In 1877, Schiaparelli began producing some of history's most iconic planetary maps, and he single-handedly invented the naming scheme we use to identify features on Mars today. His maps are famous for their detail and beauty, as well as for showing many linear features he named canali (the Italian word for channel). <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIuMpUAusg9ZS7aYNua3m-sAAbQGHC568a5FyBX7GB3CmHFC0Y8tqF7phqewuBWJWceYCx37qJFEroJ9C3VdZPah_z6hk3NbEyNF2KeGeAhQaF2x1Y1QJI9pk1ohw_ag6D1fui5MWByE0j/s1600-h/chgfnmvw_28d7dgkxgz_b.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5312890873827468082" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiIuMpUAusg9ZS7aYNua3m-sAAbQGHC568a5FyBX7GB3CmHFC0Y8tqF7phqewuBWJWceYCx37qJFEroJ9C3VdZPah_z6hk3NbEyNF2KeGeAhQaF2x1Y1QJI9pk1ohw_ag6D1fui5MWByE0j/s400/chgfnmvw_28d7dgkxgz_b.jpg" style="margin: 0px auto 10px; cursor: pointer; display: block; height: 190px; text-align: center; width: 198px;" /></a>Martian canals, as imagined by Schiaparelli</div> A combination of translation error and overactive imaginations caused some of Schiaparelli's contemporaries, including astronomer <a href="http://en.wikipedia.org/wiki/Percival_Lowell" id="rep7" title="Percival Lowell">Percival Lowell</a>, to re-label these features as canals, suggesting that Mars was home to both an advanced <a href="http://en.wikipedia.org/wiki/The_War_of_the_Worlds" id="qt9b" title="Martian civilization">Martian civilization</a> and abundant water bodies. Of course, further study of Mars has revealed neither water bodies nor any signs of intelligent life on the planet, and Schiaparelli's 'canali' were shown to be nothing more than an optical illusion. Yet, our study of the planet has only increased, and our curiosity has only deepened, as countless images and numerous space missions have been dedicated to the Red Planet since Schiaparelli's time. But don't just take my word for it. Instead, you can fly all the way there yourself with <a href="http://earth.google.com/mars" id="aiwk" title="Mars in Google Earth 5.0">Mars in Google Earth 5.0</a>. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7NUfpsObwi6RFnsk49wfnzVXmIVtHy1tfuZrEugdhGc9Id-ZuMM0tdCE39CivEE7C1SqjTUIak59bmVAbJ8E2IKG6KqUBhKHsevEz120zzBF2Pf2QyRRStuI3RzjY_71mvZ_8d79_78KG/s1600-h/ahdxcwpmmt_5fqmjjvdt_b.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5312891235493260354" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7NUfpsObwi6RFnsk49wfnzVXmIVtHy1tfuZrEugdhGc9Id-ZuMM0tdCE39CivEE7C1SqjTUIak59bmVAbJ8E2IKG6KqUBhKHsevEz120zzBF2Pf2QyRRStuI3RzjY_71mvZ_8d79_78KG/s400/ahdxcwpmmt_5fqmjjvdt_b.png" style="margin: 0px auto 10px; cursor: pointer; display: block; height: 91px; text-align: center; width: 400px;" /></a> New features released on Friday give you a glimpse into the evolution of our knowledge of Mars over the course of history. You can travel back in time to see the sketches of early astronomers like Schiaparelli and Percival Lowell in the 'Historical Maps' layer. You can also fast-forward more than a century with the 'Live from Mars' layer to view the latest images from NASA's <a href="http://themis.asu.edu/" id="rjfk" title="THEMIS">THEMIS</a> camera on board the Mars Odyssey spacecraft, sometimes just hours after NASA receives them. <a href="http://www.billnye.com/" id="gyd4" title="Bill Nye">Bill Nye</a> the Science Guy and Public Radio's <a href="http://www.sciencefriday.com/" id="ziq-" title="Ira Flatow">Ira Flatow</a>, host of Science Friday, have also recorded narrated tours of Mars — together they'll walk you through some of the most interesting geology in the solar system and show off mankind's most advanced robotic planetary explorers. For more information about the new features added to Mars in Google Earth, check out the <a href="http://google-latlong.blogspot.com/" id="bn4:" title="LatLong Blog">Google LatLong Blog</a>, or view the tutorial video below. To explore Mars on your own, <a href="http://earth.google.com/mars" id="qqut" title="download Google Earth 5.0">download Google Earth 5.0</a>. <object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/GjcCF6cIlPw&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/GjcCF6cIlPw&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="295" width="480"></embed></object> Posted by Noel Gorelick, Chief Extraterrestrial Observer

Celebrating Mars, then and now

Today is the 174th birthday of the famous Italian astronomer and cartographer Giovanni Schiaparelli . In 1877, Schiaparelli began producing...

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The magic number

Here at Google, we're getting ready to celebrate <a href="http://www.piday.org/">Pi Day</a>, which culminates tomorrow, March 14 at 1:59pm, a date and time that correspond to the first six digits of pi: 3.14159. (Some people celebrate at 1:59am.) Of course, since pi is a member of a select group of <a href="http://en.wikipedia.org/wiki/Irrational_number">irrational numbers</a>, meaning they can't be expressed as a fraction, there are an infinite number of digits in pi. You can even set a <a href="http://www.google.com/search?q=recite+pi+world+record">world record</a> for reciting pi from memory if you have the spare brain cells to remember 100,000 or so digits. Odds are, you certainly won't remember the one trillion digits past the decimal point that computers have <a href="http://en.wikipedia.org/wiki/Chronology_of_computation_of_%CF%80">calculated</a>. <a href="http://en.wikipedia.org/wiki/Pi">What is pi</a>, anyway? It's a mathematical constant representing the ratio of any circle's circumference to its diameter. It sounds abstract, but there's a real-world example right under your feet: the <a href="http://www.google.com/search?&q=circumference+of+the+earth">circumference of the earth</a> equals the <a href="http://www.google.com/search?&q=diameter+of+the+earth+times+pi">diameter of the earth times pi</a>. And pi is all over the place in math, science and engineering. It's even part of Einstein's <a href="http://en.wikipedia.org/wiki/Einstein_field_equations">theory of relativity</a>, which is fitting since March 14 also happens to be <a href="http://www.google.com/logos/einstein.gif">Einstein's</a> <a href="http://www.google.com/search?&q=when+is+einstein%27s+birthday">birthday</a>. Maybe pi's essential place in our world is why every March around Pi Day searches for [pi] <a href="http://www.google.com/insights/search/#q=pi&cmpt=q">spike upwards</a>. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTMo2XYySz3tJrQYc3zbvSJMMGGxMN2FWjypyYTzwpsMwatV6LjykEjaUol4AsZL06g-PdnvFmv6t4GxB2fAC8sX2bIEm2sSeTX9hvPh46KFnBDHbvi2ek-0mhUh3aUz-uahNumg_gh463/s1600-h/pi+march.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5312745992947083346" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTMo2XYySz3tJrQYc3zbvSJMMGGxMN2FWjypyYTzwpsMwatV6LjykEjaUol4AsZL06g-PdnvFmv6t4GxB2fAC8sX2bIEm2sSeTX9hvPh46KFnBDHbvi2ek-0mhUh3aUz-uahNumg_gh463/s400/pi+march.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 148px;" /></a>A quick <a href="http://www.google.com/search?q=how+to+celebrate+pi+day&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a">Google search</a> reveals a lot of options for celebrating this "nerd holiday." For starters, you could do some <a href="http://www.google.com/search?&q=1+/+%28pi+*+phi+/+speed+of+light+*+planck%27s+constant+/+e+*+the+golden+ratio%29">math</a> (now that's an irrational number!). If you're at the <a href="http://press.exploratorium.edu/pi-day-march-2009/">Exploratorium in San Francisco</a>, where Pi Day began in 1987, you might be circumnavigating a "Pi Shrine" or singing a Pi Day song. Others suggest watching the movie π or going on a "pi run" (you can stop at 3.14 miles). You can hold your own pi recitation contest, or mix it up and make it tougher by asking people to recite <a href="http://www.google.com/search?q=pi+in+binary">pi in binary</a> (hint: it's a lot of ones and zeros). Finally, don't forget the best part of Pi Day: eating pie! Either <a href="http://www.google.com/search?q=pie+recipes">make your own</a>, or, if you're too dizzy to bake after circumnavigating Pi Shrines all day, find one to buy <a href="http://maps.google.com/maps?&q=pie">nearby</a>. I'll have apple. Posted by Emily Wood, Google Blog team

The magic number

Here at Google, we're getting ready to celebrate Pi Day , which culminates tomorrow, March 14 at 1:59pm, a date and time that correspond...

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Introduction to the ad auction

(Cross-posted from the <a href="http://adwords.blogspot.com/2009/03/introduction-to-ad-auction.html">Inside AdWords Blog</a>) When we go to conferences or read posts in forums, we find that advertisers sometimes know more about advanced features than about the basics of how AdWords works. So, we've decided to take some time to get back to basics and talk about how the AdWords auction actually works. To help you, we've brought along our Chief Economist, Hal Varian, to walk you through the auction and explain how your maximum cost-per-click (CPC) bid and <a href="http://adwords.google.com/support/bin/answer.py?hl=en&answer=10215">Quality Score</a> determine how much you actually pay for an ad click on Google's search results pages. When people think of an auction, they often think of a prize being sold for the highest bid. But the AdWords auction works a little differently, where the winner only pays the minimum amount necessary to maintain their position on the page. That means you'll only pay the minimum necessary to beat the person below you. In fact, our quality-based pricing system ensures that you'll often pay less than your maximum bid. How exactly does this work? We'll leave that to Hal to explain. <object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/K7l0a2PVhPQ&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/K7l0a2PVhPQ&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="295" width="480"></embed></object> If you have trouble viewing this video, you can <a href="http://www.youtube.com/watch?v=K7l0a2PVhPQ">watch it here</a>. Posted by Austin Rachlin, Inside AdWords crew

Introduction to the ad auction

(Cross-posted from the Inside AdWords Blog ) When we go to conferences or read posts in forums, we find that advertisers sometimes know more...

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Schools get the "App"titude across the globe

Since the launch of <a href="http://www.google.com/a/edu">Google Apps Education Edition</a> in October 2006, millions of people at thousands of schools in more than 100 countries have been using our free email and collaboration tools. We love hearing from newly deployed schools like <a href="http://www.lmu.edu/">Loyola Marymount University</a>, <a href="http://www.westmont.edu/">Westmont College</a>, <a href="http://www.njit.edu/">New Jersey Institute of Technology</a>, <a href="http://www.kpbsd.k12.ak.us/">Kenai Peninsula Borough School District</a>, <a href="http://www.chapman.edu/">Chapman University</a>, <a href="http://www.ignatius.edu/s/237/home.aspx">Saint Ignatius High School</a>, and <a href="http://www.csuchico.edu/">California State University, Chico</a> (to name a few) about how they're now able to use Apps in teaching, learning, and researching on campus, while also saving time and money. While we continue to see more and more U.S. schools moving to Google Apps, we find it especially exciting to see that the trend of outsourcing online communication and collaboration needs is catching on in other parts of the world. In Australia, for example, the New South Wales Department of Education <a href="http://www.australianit.news.com.au/story/0,24897,24966636-15318,00.html">recently migrated</a> 1.5 million students to Google Apps. The University of Adelaide also just <a href="http://www.adelaide.edu.au/news/news31901.html">announced</a> that it is offering to its 16,000 students email services and other online tools as part of the Apps suite, at no cost to the university. Many other schools and colleges in this region have also recently deployed Google Apps, including <a href="http://www.hsc.edu.tw/">Hsin Sheng College of Medical Care and Management</a> in Taoyuan County Taiwan, <a href="http://www.au.edu.pk/">Air University</a> in Islamabad Pakistan, <a href="http://www.uph.edu/">Univesitas Pelita Harapan</a> in Indonesia, the <a href="http://www.icms.edu.au/">International College of Management</a> in Sydney, and schools across New Zealand like <a href="http://www.fendalton.school.nz/">Fendalton School</a>. To help spread the word about Apps, the team in India came up with the <a href="http://www.google.co.in/apps/gottheapptitude/index.html">Got the "App"titude Challenge</a>, which encouraged students, faculty members and alumni from all engineering and management schools throughout India to move their institutions to Google Apps. The challenge created quite a stir, and after launching in August, we received almost 6,000 sign-ups. Each college team consisted of students, alumni and faculty who worked closely with IT staff to identify challenges in their existing email and collaboration solutions. Working with a Googler, the teams then demonstrated ways Google Apps could be used to address these challenges. The performance of each team was evaluated by measuring product usage after their deployment. We'd like to extend our congratulations to the XL CONNECT team from <a href="http://www.xlri.ac.in/">Xavier Labour Relations Institute (XLRI), Jamshedpur</a>, who won the challenge by demonstrating the highest usage of Google Apps products. As a result of the challenge, more than 100 colleges across India are now in the process of implementing Apps in their institutions. And we look forward to seeing more and more schools all over the world adopt Google Apps. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMFPjvBD5h1TIRmAl9tyqe6UYRKLCz3a9SY2QnclEN6Gkd0GlxR6D8PR0ABUmCo5XZhjjl0VNkBuR50e20N37EkNehNQ0uMZJEWTD5SWtpTxxNIYOV-qDtVX-WqG-fZKfLDSYlE9RqSZ2k/s1600-h/Picture+12.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5312368619552880722" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMFPjvBD5h1TIRmAl9tyqe6UYRKLCz3a9SY2QnclEN6Gkd0GlxR6D8PR0ABUmCo5XZhjjl0VNkBuR50e20N37EkNehNQ0uMZJEWTD5SWtpTxxNIYOV-qDtVX-WqG-fZKfLDSYlE9RqSZ2k/s400/Picture+12.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 197px;" /></a><div style="text-align: center;">Countries shaded in blue represent active Apps users in that area. </div> Posted by Amarpreet Singh, Online Sales and Operations Manager, and Andrew Mitchell, Senior Strategist

Schools get the "App"titude across the globe

Since the launch of Google Apps Education Edition in October 2006, millions of people at thousands of schools in more than 100 countries ha...

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A Health Care CEO Who Didn't Put His Own Pay First

We recently posted about executives at two different not-for-profit health care insurance companies/ managed care organizations whose pay seemed to keep levitating, despite organizational financial losses, and commented on how the compensation of top executives of health care organizations seems always to go up, regardless of the financial fortunes, or quality of the products or services provided by their organizations. (Posts <a href="http://hcrenewal.blogspot.com/2009/03/more-gravity-defying-compensation-for.html">here</a> and <a href="http://hcrenewal.blogspot.com/2009/03/43-million-dollar-ceo-for-not-for.html">here</a>.) Today's Boston Globe, however, <a href="http://www.boston.com/news/local/massachusetts/articles/2009/03/12/a_head_with_a_heart/">provided a contrast</a>. The background is that the Beth Israel Deaconess Medical Center (BIDMC), a renowned Harvard teaching institution, is facing a budget shortfall. <blockquote> Paul Levy, the guy who runs Beth Israel Deaconess Medical Center, was standing in Sherman Auditorium the other day, before some of the very people to whom he might soon be sending pink slips. In the days before the meeting, Levy had been walking around the hospital, noticing little things. He stood at the nurses' stations, watching the transporters, the people who push the patients around in wheelchairs. He saw them talk to the patients, put them at ease, make them laugh. He saw that the people who push the wheelchairs were practicing medicine. He noticed the same when he poked his head into the rooms and watched as the people who deliver the food chatted up the patients and their families. He watched the people who polish the corridors, who strip the sheets, who empty the trash cans, and he realized that a lot of them are immigrants, many of them had second jobs, most of them were just scraping by. And so Paul Levy had all this bouncing around his brain the other day when he stood in Sherman Auditorium. He looked out into a sea of people and recognized faces: technicians, secretaries, administrators, therapists, nurses, the people who are the heart and soul of any hospital. People who knew that Beth Israel had hired about a quarter of its 8,000 staff over the last six years and that the chances that they could all keep their jobs and benefits in an economy in freefall ranged between slim and none. 'I want to run an idea by you that I think is important, and I'd like to get your reaction to it,' Levy began. 'I'd like to do what we can to protect the lower-wage earners - the transporters, the housekeepers, the food service people. A lot of these people work really hard, and I don't want to put an additional burden on them.' 'Now, if we protect these workers, it means the rest of us will have to make a bigger sacrifice,' he continued. 'It means that others will have to give up more of their salary or benefits.' He had barely gotten the words out of his mouth when Sherman Auditorium erupted in applause. Thunderous, heartfelt, sustained applause. </blockquote> The editorialist's conclusion was: <blockquote> Paul Levy is trying something revolutionary, radical, maybe even impossible: He is trying to convince the people who work for him that the E in CEO can sometimes stand for empathy. </blockquote> Note that Levy is one of the few health care CEOs who <a href="http://runningahospital.blogspot.com/">blogs</a>, and he appears to write his blog on his own, unfettered by public relations flacks or risk-averse lawyers. His discussion of his revolutionary plan is <a href="http://runningahospital.blogspot.com/2009/03/town-meetings-bidmc.html">here</a>. Further note the context in which he is working. While his medical center does not seem to receive particularly payments from insurance companies and managed care organizations, a previously secret agreement between the previous CEO of Partners Healthcare, another renowned, but competing Harvard-affiliated medical system and the previous CEO of Blue Cross and Blue Shield of Massachusetts, the state's biggest, and not-for-profit health care insurer/ managed care organization awarded much higher payments to that health care system (see posts <a href="http://hcrenewal.blogspot.com/2009/01/scorpions-in-bottle-shook-hands-secret.html">here</a> and <a href="http://hcrenewal.blogspot.com/2009/01/to-whom-did-scorpions-in-bottle-owe.html">here</a>). And the current CEO of that Blue Cross and Blue Shield of Massachusetts just received (see this <a href="http://hcrenewal.blogspot.com/2009/03/43-million-dollar-ceo-for-not-for.html">post</a>) a substantial raise, enough to make him the best paid health care CEO in the state, while his organization's revenues and membership decreased. This case shows it is possible for a health care CEO to put the organization's mission, and the welfare and morale of its hard working staff ahead of his own remuneration. If only this example were not so rare.

A Health Care CEO Who Didn't Put His Own Pay First

We recently posted about executives at two different not-for-profit health care insurance companies/ managed care organizations whose pay se...

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Former Rosalind Franklin University of Medicine and Science Board Member Pleads Guilty

The Chicago Tribune<a href="http://www.chicagotribune.com/news/local/chi-weinstein-guilty-plea-11-mar11,0,3203453.story"> published </a>a reminder about a scandal from a few years ago that got little other than local attention at the time, <blockquote> Dr. Robert Weinstein, 63, of Northbrook faces 2 to 3 years in prison in connection with a complex fraud scheme in which he and Levine cheated Northshore Supporting Organization, a charity the two controlled. The charity supported the work of the Rosalind Franklin University of Medicine and Science, which lost a combined $6 million in the scheme. Both men sat on the board of the North Chicago medical school. Weinstein, a self-described private investor for the last decade, admitted that he understated his income by $3 million on his 2003 tax return when he actually made $9.2 million. Weinstein, who is scheduled to be sentenced on July 1, didn't agree to cooperate in the federal probe. Weinstein was indicted last June on charges of wire and mail fraud and making false statements. But last week prosecutors charged him with a single tax fraud count after he agreed to plead guilty. The Tribune first reported in 2004 that the $6 million was missing from the charity. Not only did the school lose scholarship money but it also unknowingly paid a school construction contractor $1 million in kickbacks, according to court records. That money allegedly went to Sven Philip-Sorenson, a European businessman who paid it to the medical school as part of the scheme. Philip-Sorenson, who has not been charged, was a director of a Chicago-based health maintenance organization when Levine was a major stockholder of the company. </blockquote> I would submit that in retrospect, having two convicted felons on a medical school's board of trustees suggests a major governance problem. Yet this case, like others we have discussed involving very bad behavior by leaders of academic health care organizations, caused nary an echo outside its local area. Until we acknowledge that bad, sometimes horribly bad leadership and governance of respected health care organizations is possible, little will be done to prevent more bad leaders from damaging more organizations.

Former Rosalind Franklin University of Medicine and Science Board Member Pleads Guilty

The Chicago Tribune published a reminder about a scandal from a few years ago that got little other than local attention at the time, Dr. R...

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