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Walmart to Become the Healthcare IT Punching Bag?

At "<a href="http://hcrenewal.blogspot.com/2009/03/wal-mart-to-market-ehr-system-to-small.html">Wal-Mart to market Electronic Medical Records? Has Medicine Gone Bananas?</a>" I noted the entry of Walmart into the healthcare IT fray. As I <a href="http://hcrenewal.blogspot.com/2005/03/wash-post-on-cedars-sinai-cpoe-failure.html">observed here</a> in early 2005, HIT is a field where angels fear to tread. Or should fear to tread. Walmart is <a href="http://www.google.com/search?client=firefox-a&rls=org.mozilla%3Aen-US%3Aofficial&channel=s&hl=en&q=walmart+opposition&btnG=Google+Search">not exactly popular</a> in numerous circles, so let me state I buy from them (most recently my Acer Netbook, clothing and various Christmas gifts) and am neutral on most of the issues that create the opposition. My father ran a business, after all. However, he at least stuck to his core expertise, pharmacy. Walmart is trying to market EMR's, a product far beyond their core competencies. The HIT market and "ecosystem" is also far beyond their competencies, and it's not hard to predict they are going to have a rapid and quite unpleasant learning experience about the dark corners of this industry. Felix Fulmer, a correspondent with longstanding expertise in academic and pharmaceutical research environments conveyed to me the following observations about this arrangement: Deficient as its products often are, the HIT industry was built up by entrepreneurs over many years and by much hard work. They are now being challenged by a very large and very powerful entity. The entry of Walmart into EMR represents a tremendous threat to the HIT industry status quo. This initiative is likely to help doctors and patients at the very least by reducing the cost of EMR (even if not improving the performance), putting downward price pressure on the entire industry. It is also likely to change the marketing and consulting practices in the HIT industry as well, driving wages down among other factors. If successful, Walmart's initiative could in fact cause the extinction of the current monopolistic and parasitical HIT establishment. [In my estimate, a 33% - 50% reduction in companies, revenues and personnel in three or four years would not be an unreasonable figure - not that I would be sad to see some of them go - ed.] Mr. Fulmer continues: The HIT industry must realize this and, based on Walmart's history of capturing other markets and putting smaller competitors out of business, the captains of this industry must be quaking in their boots. These entrepreneurs will fiercely act to defend their territory, using every trick in the book [knowing the industry as well as I do, I cannot fail to agree with that assessment - ed.] Walmart is going to be severely punished. The pushback from the HIT establishment will likely consist of three phases: subversion, obstruction, and agitation for litigation (in a collusive manner) to challenge the newcomer. There will be technical, administrative and political angles. The first phase, subversion, will be the establishment's attempt to try to keep the Walmart arrangement from happening. It may occur through the press and through political means. Antitrust complaints, and a negative campaign of badmouthing and panning may occur. It will be insinuated or stated that Walmart doesn't have the required expertise, that they don't know what they're doing, among other claims to discredit, diminish and minimize the initiative. The second phase will likely be obstruction. HIT products Walmart will carry will be sabotaged by other vendors in terms of passive aggressive measures to complicate or prevent data interoperability. There may be issues such as constant "breakdowns" of interfaces, inexplicable technical glitches blamed on Walmart and its supplier, of course. Walmart's HIT products and services will be scrutinized under a microscope and deficiencies highlighted through the media and printed competitive materials. There may also be attempts to intimidate and misdirect physicians not to go with this product through the medical leadership, through back room paid sponsorship of "influential thought leaders" (as in pharma), through "detail people" (e.g., sales reps as in pharma) and other means. Hospital administrations and CIO's may also be influenced by various means to steer physicians away from this offering, perhaps to the level of marginalizing users or refusing to support this product. Finally, there will be litigation, especially regarding the inevitable medical errors that occur when this technology is pushed into small town physicians offices unused to technology of this complexity. Walmart may be shocked to find the "learned intermediary" principle suddenly and mysteriously not be applied. Why would this be a surprise, considering their immensely deep pockets and the disdain of the the left-leaning, anti-big business judiciary system? Mr. Fulmer concludes with this thought: Walmart may think of their entry into the HIT marketplace as a great business plan, but their executives may need to partake of their own medical clinics to deal with the stress the HIT industry pushback will cause. -- SS

Walmart to Become the Healthcare IT Punching Bag?

At " Wal-Mart to market Electronic Medical Records? Has Medicine Gone Bananas? " I noted the entry of Walmart into the healthcare ...

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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 onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTMo2XYySz3tJrQYc3zbvSJMMGGxMN2FWjypyYTzwpsMwatV6LjykEjaUol4AsZL06g-PdnvFmv6t4GxB2fAC8sX2bIEm2sSeTX9hvPh46KFnBDHbvi2ek-0mhUh3aUz-uahNumg_gh463/s1600-h/pi+march.png"><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 onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgMFPjvBD5h1TIRmAl9tyqe6UYRKLCz3a9SY2QnclEN6Gkd0GlxR6D8PR0ABUmCo5XZhjjl0VNkBuR50e20N37EkNehNQ0uMZJEWTD5SWtpTxxNIYOV-qDtVX-WqG-fZKfLDSYlE9RqSZ2k/s1600-h/Picture+12.png"><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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