Business in the cloud

There's a lot of interest in understanding cloud computing these days, so we thought we'd share some thoughts. If you're interested in hearing what we talk about when we talk about the role of cloud computing in business, check out our <a href="http://googleenterprise.blogspot.com/2009/04/what-we-talk-about-when-we-talk-about.html">post</a> on the Google Enterprise Blog.<br /><br /><span class="byline-author">Posted by Rajen Sheth, Senior Product Manager, Google Apps</span>

Business in the cloud

There's a lot of interest in understanding cloud computing these days, so we thought we'd share some thoughts. If you're intere...

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Hospital Board Members with "the Juice" in New Jersey

We recently <a href="http://hcrenewal.blogspot.com/2009/04/new-jersey-legislator-found-guilty-of.html">commented</a> on the conviction of a state legislator charged with selling his influence to a powerful local medical center. NorthJersey.com has a <a href="http://www.northjersey.com/news/njpolitics/humc042609.html">follow-up </a>on this story which shows how health care leaders are often members of the power elite, if not quite of the superclass, and how their machinations put this group's interests ahead of the mission of their health care organizations.<br /><br /><br /><strong>The General Overview</strong><br /><br /><blockquote><br />The trial of former state Sen. Joseph Coniglio, convicted in a bribery scandal involving Hackensack University Medical Center [<a href="http://humed.com/index.php?page=about">affiliated with UDMNJ</a>, which has had its own issues, e.g., <a href="http://hcrenewal.blogspot.com/2008/11/yet-more-investigations-of-umdnj.html">here</a>], <em>exposed the hospital’s reach into the State House — and put a spotlight on the wealthy, influential men who serve as the hospital’s power brokers.<br /></em><br /><em>Hackensack’s board members have connections and political muscle that extend far beyond the hospital</em>. At black-tie fund-raisers and dinners at board member Joseph Sanzari’s Stony Hill Inn, business — hospital and otherwise — is on the agenda.<br /><br /><em>Various board members help to underwrite Bergen County’s Democratic machine and powerful lawmakers in Trenton. They’re awarded many of the region’s public construction contracts. They have the network — and the money — to smooth over zoning issues for the hospital</em>. Testimony at the trial this month showed they supported the hiring of Coniglio, who was convicted of steering millions in grants to Hackensack while on the hospital’s payroll.<br /><br />'A political machine' is how Assistant U.S. Attorney Thomas R. Calcagni described the hospital as he told jurors about Hackensack’s relationships with former acting governor and Senate President Richard Codey, state Sen. Paul Sarlo, Coniglio and others during the trial. </blockquote><br /><strong>Board Members' Self-Dealing</strong><br /><br />There are several results. One is that "some [board members] are also <em>making money off the hospital</em>." The article gave several examples of such conflicts of interest.<br /><br /><blockquote><br />A few examples from the hospital’s federal tax filings for 2007, the latest available:<br /><br />* Companies owned by Sanzari and Creamer are building a 975-car garage as part of the $135 million cancer center now under construction. Creamer was paid more than $475,000 by the hospital for construction services.<br /><br />* The hospital paid more than $2 million to Progenitor Cell Therapy, a private stem cell research company owned in part by Ferguson; Dr. Andrew Pecora, director of the cancer center; board members Peter C. Gerhard, George T. Croonquist and Samuel Toscano Jr.; and the hospital’s chief operating officer, Robert C. Garrett.<br /><br />* The hospital paid $2.5 million to lease space from Sanzari 2001, where board member David Sanzari — Joseph’s cousin — is a managing member with an ownership stake. It also spent $68,000 at the Marriott at Glenpointe hotel, which is owned by David Sanzari’s family.<br /><br />* The DeCotiis law firm, one of the most influential in the state, made more than $1 million from the hospital. It is representing the hospital in the Coniglio case and guiding its campaign to reopen Pascack Valley Hospital in Westwood. During that time, Frank Huttle III, a partner, served on the board. He said Friday that he resigned recently.<br /><br />* Universal Health, which operates a retail pharmacy at the hospital, received $200,000. At the time, Toscano was the company’s chief executive officer.<br /></blockquote><br /><br /><strong>Political Influence Disadvantages the Competition</strong><br /><br />The membership of the hospital's leaders in the power elite could be used to advance the hospital against less-connected competitors.<br /><br /><blockquote><br />The Coniglio trial served as a primer on the backroom politics of New Jersey, where certain grants, known as 'Christmas tree items,' were doled out based on who has 'the juice.' By all accounts, Hackensack mastered the game and loomed large in Trenton. From 2004 to 2006, the hospital received $17.4 million for its cancer center, an extra $9 million in charity care above the millions it was already getting and $250,000 for the Joseph M. Sanzari Children’s Hospital. A $900,000 research grant was awarded to the private stem cell firm at the hospital and $70,000 went for a seat belt study.<br /><br />Those awards dwarf the grants given to Hackensack’s competitors.<br /><br /></blockquote><br /><strong>Connectedness of the Hospital's Board Members</strong><br /><br />The article gave further examples of how connected were the board members, and how they used their connections.<br /><br /><blockquote><br />At Hackensack, a few names — Simunovich, Ferguson, Sanzari, Creamer — keep showing up in influential roles on key boards. They serve as trustees of the Hackensack University Medical Center Foundation, the hospital’s fund-raising arm, as well as the hospital’s board of governors and Hillcrest Health Service System, the hospital’s parent corporation. Leading contractors and developers — Sanzari, Creamer and John C. Fowler — are on the building committee.<br /><br />Simunovich is the former chairman of the board of governors and current chairman of the board of trustees for the Hackensack University Medical Center Foundation, the hospital’s fund-raising arm.<br /><br />Governor Corzine did not reappoint Simunovich to the Turnpike Authority in 2007 after he was investigated by the State Ethics Commission; as chairman, he had voted on millions in public contracts that were awarded to Sanzari while he accepted free rides on the contractor’s private jet. Simunovich paid a $50,000 fine, which was not an admission of guilt.<br /><br />'Mr. Simunovich’s actions do not reflect the standards demanded by the governor for those who serve in his administration,' Corzine’s then-spokesman Anthony Coley said.<br /><br />Joseph Sanzari serves as first vice chairman, the No. 2 position on the hospital’s board of governors.<br /><br />Sanzari is part owner of both the Stony Hill Inn in Hackensack and the New Bridge Inn in New Milford, popular hangouts for Bergen County’s political elite. Sanzari, his companies and employees have contributed more than $100,000 to political campaigns and political action committees in the past three years, according to data the company provided to state elections regulators.<br /><br />Among his top employees is state Sen. Paul Sarlo, also the mayor of Wood-Ridge. Sarlo oversees billions in public spending as a lead member of the Senate Budget and Appropriations Committee. As chairman of the Senate Judiciary Committee, he also controls key appointments to state agencies that have awarded millions in contracts to Sanzari’s firms.<br /><br />Sarlo, chief operating officer for Sanzari’s construction company, testified at the trial that he was largely responsible for getting the $900,000 grant for the hospital’s cancer center. He said he also lobbied Codey for the $9 million cancer center grant and played a role in the $900,000 grant for stem cell research at the hospital. </blockquote><strong>Conclusions<br /></strong><br />Hospitals often have sterling reputations within their communities as selfless organizations devoted to improving the health of the people. As we have noted, hospitals and other health care organizations have come to be run more often by people with managerial background than those with health care experience. Not-for-profit hospitals have boards of trustees who are supposed to exercise stewardship, making sure the organization upholds its mission. But as we have noted before, e.g., <a href="http://hcrenewal.blogspot.com/2009/04/investment-bankers-strike-back.html">here</a>, boards of health care and related organizations may put their own agendas ahead of the mission. Furthermore, boards of big hospitals and other health care organizations seem to be increasingly composed of the well-connected, often to the point that they can be regarded as members of the power elite, if not the superclass. There may be some short term benefits to having such people on the boards. In the long run, however, is it any surprise that their missions may give way to other interests?<br /><br />Hat tip to <a href="http://www.margaretsoltan.com/?p=12174">University Diaries</a>.<br /><br />ADDENDUM (4 May, 2009) - Hackensack University Medical Center's <a href="http://www.politickernj.com/wallye/29412/humc-bans-record">response</a> to the news story discussed above was apparently first to stop advertising in the offending newspaper, and ban its sales in the hospital. Another example, almost laughable, of a health care organization's leadership trying to shoot the messenger, and of how the anechoic effect may be generated. Hat tip to the <a href="http://blog.lib.umn.edu/schwitz/healthnews/178972.html">Schwitzer Health News Blog</a>.

Hospital Board Members with "the Juice" in New Jersey

We recently commented on the conviction of a state legislator charged with selling his influence to a powerful local medical center. NorthJ...

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Listening to Google Health users

At Google, we believe that consumers should have convenient and secure access to all their health data so that they can be better informed and be more involved in their care. Recently, a data-savvy patient known as e-Patient Dave <a title="blogged" href="http://patientdave.blogspot.com/2009/04/imagine-someone-had-been-managing-your.html" id="lc:c">blogged</a> about data that was imported into his Google Health Account from his hospital in Boston, <u><a id="o5rs" href="https://www.google.com/health/directory?url=www.patientsite.org" title="Beth Israel Deaconess Medical Center">Beth Israel Deaconess Medical Center</a></u>. Once he saw his data in Google Health, he saw diagnoses that were both alarming and wrong. Where did they come from?<br /><br />It turns out that they came from the billing codes and associated descriptions used by the hospital to bill the patient's insurance company. These descriptions, from the <a id="w_s." href="http://www.cdc.gov/nchs/icd9.htm" title="International Classification of Diseases (ICD9)">International Classification of Diseases (ICD-9)</a>, often do not accurately describe a patient because the right ICD-9 code may not exist. So the doctor or hospital administrator chooses something that is "close enough" for billing purposes. In other cases, the assigned code is precisely what the doctor is trying to rule out, and if the patient turns out not to have that often scary diagnosis, it is still associated with their record. Google Health faithfully displayed the data we received on Dave's behalf. We and Beth Israel knew that this type of administrative data has its limitations but felt that patients would find it a good starting point. Too often, this is wrong.<br /><br />At Google, we are constantly learning important lessons from our users. Two days after we learned about this issue, I met with Beth Israel <u><a id="fds_" href="http://geekdoctor.blogspot.com/" title="CIO John Halamka">CIO John Halamka</a></u>, the patient's physician <a href="http://services.bidmc.org/Find_a_doc/doc_detail.asp?sid=41414547464148">Dr. Danny Sands</a>, and e-Patient Dave himself. We agreed on a reasonable plan: Beth Israel will stop sending ICD-9 billing codes and will instead only send to Google Health the free text descriptions entered by doctors. Beth Israel is also working with the <a id="rg-q" href="http://www.nlm.nih.gov/" title="National Library of Medicine (NLM)">National Library of Medicine (NLM)</a> to associate those free text descriptions with a more clinically useful coding system called <a id="iwwf" href="http://www.nlm.nih.gov/research/umls/Snomed/snomed_main.html" title="SNOMED-CT">SNOMED-CT</a>, so that we can offer patients useful services like automatic drug interaction checking. The result will be more accurate and useful information in patients' Google Health profiles.<br /><br />This week, all four of us were also at a conference called <a title="Health 2.0" href="http://health2con.com/" id="vbuo">Health 2.0</a> in Boston. Dave's story, and the lessons we all learned, were the focus of much discussion. We are grateful to Dave for his openness and passion for making things right. We're also glad this happened because we and many others now better understand the limitations of certain types of health data and we are working with partners to improve the quality of the data before it gets to Google Health and our users. We look forward to sharing what we learn with the broader community. We also learned that the patient community is surprisingly interested in understanding these data issues. Dave and his doctor Danny Sands collaborated on an <a title="informative post" href="http://e-patients.net/archives/2009/04/part-of-it-is-encoding-information.html" id="jj7s">informative post</a> about different data vocabularies used in different aspects of healthcare. The patient-controlled "data liquidity" that Google Health supports is clearly an important part of the future of health care. We are more committed than ever to putting consumers in charge of their own health information.<br /><br /><span class="byline-author">Posted by Roni Zeiger, M.D., Product Manager, Google Health</span>

Listening to Google Health users

At Google, we believe that consumers should have convenient and secure access to all their health data so that they can be better informed a...

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Coming soon to YouTube: Besson's and Bertrand's environmental film project

Today we're pleased to share an exciting new project that taps into the power of YouTube and Google Maps to spread the word about the state of our planet. <a href="http://en.wikipedia.org/wiki/Luc_Besson">Luc Besson</a>'s and <a href="http://www.yannarthusbertrand.org/index_new.htm">Yann-Arthus Betrand</a>'s 90 minute full-length film "Home" will exclusively be available online on YouTube for English, French, Spanish and German–speaking countries beginning June 5 — just in time for the 37th <a href="http://www.unep.org/wed/2009/english/">World Environment Day</a>.<br /><br />Through stunning displays of aerial camerawork, the film will give people from all corners of the world a glimpse of our planet like never before and visually demonstrate the urgency for preservation efforts. In addition to its Internet premiere, "Home" will be shown in movie theaters and outdoors on big screens at key locations around the globe. It will also air on TV stations around the world. Using this unique distribution model, one with a massive online and offline effort, the film creators are able to reach the widest audience possible. So whether you'd prefer to head to the theaters, watch it under the stars, or just stay put on the couch — the way you view "Home" is up to you.<br /><br />And starting today, YouTube channels in English, French, Spanish and German will feature behind-the-scenes looks from the making of the film, as well as interviews, and extras. To add even more dimension, Google Maps is featuring specially created layers that shed more light on some of the material covered in the movie. You can also use Maps to find a theater location near you.<br /><br />To get a preview of what you can expect on June 5, check out some of the spectacular footage in the <a href="http://www.youtube.com/homeproject">Home YouTube channel</a>, like the video below of the Arctic world and its wild terrain that's essential to preserve. Or <a href="http://www.youtube.com/watch?v=0rET3CvmyD4&feature=channel">this one</a> of Los Angeles exclusively seen from the sky, giving us a new perspective of the cityscape at night. And please respond and react to the film via video responses, comments, and ratings and share links via email with your friends.<br /><br /><object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/sLbHicGdXvw&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/sLbHicGdXvw&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="340" width="560"></embed></object><br /><br /><span class="byline-author">Posted by Mats Carduner, Head of Google France and Southern Europe</span>

Coming soon to YouTube: Besson's and Bertrand's environmental film project

Today we're pleased to share an exciting new project that taps into the power of YouTube and Google Maps to spread the word about the st...

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BusinessWeek on Health IT: "The Dubious Promise of Digital Medicine"

While I would have used the title "The Dubious Promise of Digital Medicine When Led By Amateurs in the Health IT Industry", the following Business Week article is one of the better and more realistic appraisals of the current state of Health IT.<br /><br />Business Week, April 23, 2009<a href="http://www.businessweek.com/magazine/content/09_18/b4129030606214.htm?campaign_id=rss_daily"><br /><span style="font-weight: bold;">The Dubious Promise of Digital Medicine</span></a><span style="text-decoration: underline;"><br /></span>Chad Terhune, Keith Epstein and Catherine Arnst<br /><br />Recommended reading for anyone interested in improving healthcare via information technology. (Full disclosure: MedInformaticsMD was a contributor to the article.)<br /><br />I will be commenting in upcoming posts on the article's points and HIT industry's customary, self serving and unscientific counterpoints. The article's thrust is that a HIT remains an experimental technology with a mixed history, which like any societal-level experiment (HIT representing a form of social engineering) carries individual and public risk. The risk is that when misled, any social experiment can and will lead to serious unintended consequences, which in this case ultimately means patient harm.<br /><br />The first counterpoint that struck me in the article was this one:<br /><br /><blockquote>Allscripts CEO Glen Tullman [a non-clinician businessman and an advisor to the Obama campaign on HIT] ... compares the <span style="font-weight: bold;">skeptics of health info tech </span>to doctors who questioned the introduction of the stethoscope in the 19th century: "There have been <span style="font-weight: bold;">Luddites in every industry</span>." </blockquote><br />This profoundly unscientific, ad hominem dismissal represents the poster example of what I call a <span style="font-weight: bold;">cross-occupational invasion of medicine by the IT industry</span>. The attitude represents the antithesis of medical and scientific culture.<br /><br />It simpy dismisses with a wave of the hand a growing body of authoritative literature going back decades. A small sample of that literature can be <a href="http://hcrenewal.blogspot.com/2009/04/health-it-vendor-blames-hit-problems-on.html">seen here</a>, and anyone in HIT is grossly negligent to dismiss, or worse, not to be aware of such findings. There's really not much more to say on this issue.<br /><br />This is an example of the attitudes of HIT industry leaders who believe they will "revolutionize" medicine via IT. Health IT with appropriate leadership can do quite well for healthcare. In the wrong hands, I'm sorry to say, the opposite is true.<br /><br />It is, in fact, Mr. Tullman and like minded others in the IT industry, who make similar statements about those with the ultimate responsibility and liability for patient care, physicians (as Koppel and Kreda point out, the vendors have none), who are the Luddites. They are Luddites through their dismissal of the best thinking in modern IT and in biomedical information science.<br /><br />On second thought, it might be more accurate to say they leverage their Luddism and willful ignorance in an opportunistic manner. <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/DUCOM_EMR_Complaint.pdf">Caveat emptor</a>.<br /><br />-- SS

BusinessWeek on Health IT: "The Dubious Promise of Digital Medicine"

While I would have used the title "The Dubious Promise of Digital Medicine When Led By Amateurs in the Health IT Industry", the fo...

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Engineering a healthier diet

Back in 2007, the cafes at our Mountain View campus started color-coding menu items according to healthfulness. The healthiest items are colored green ("go ahead, pile it on!"), foods you should portion-control are yellow, and foods you should eat sparingly -- in the words of my favorite <a href="http://en.wikipedia.org/wiki/Cookie_Monster#Evolution">recently reformed</a> <a href="http://www.google.com/search?q=cookie+monster">blue monster</a>, "sometimes foods" -- are red.<br /><br />While the whole point of the color-coding was to encourage healthy eating, and Google certainly makes it very easy for one to do that, I quickly realized that all of my favorite food items were colored red on the menus. Since all of the cafe menus are posted to separate pages of our intranet, it took too long to look through them to find the one or two items that would hook me into eating at a particular cafe for the day. So I decided to write a script that scans all the pages and creates a single unified menu of just the "heart-stoppingly good" food in all of the Mountain View cafes. (The nutritionist at Google at the time called them "least healthy" rather than "heart-stoppingly good.")<br /><br />It took only a few minutes to write the script for the menus as they existed on the first day I ran it, but there were complications as each following day's menus started rolling in. Not all the chefs were using the same programs to create HTML menus, so the colors were all marked up differently in each. Every morning, I found I needed to add special cases to handle the various HTML variations to the original <a href="http://en.wikipedia.org/wiki/AWK">awk</a> script that I'd started with. Every chef had a different idea of which color should be used for red items, green items and yellow items (the favored color for "yellow" text on white background is actually orange), so I ended up having to write a formula to perceptually classify the colors (by hue angle). Plus, I started to learn how hard things must be for someone who is blind or colorblind when reading web pages. To solve that problem, I had the program generate well-structured HTML with CSS classes applied to each menu item to handle things in a consistent way that was easy to filter by <a href="http://en.wikipedia.org/wiki/XPath">XPath</a>.<br /><br />After I finished the script, I sent a link to the new web page to an internal food discussion mailing list, and soon enough I was receiving fan mail. What I'd intended to be a tool for my own personal use proved so popular that, early this year, the chefs at Google asked if I could expand the tool to include support for historical statistics. They wanted to keep track of which cafes had the greenest menus over time. The result is a tool that tracks the healthiness of all menu items at Google cafes around the world. You can see every color menu item in a single menu and toggle colors on and off as desired, depending on how you want to browse the menus. So I can look only at red items if I'm in the mood for pepperoni pizza or roasted garlic mashed potatoes. And if I want leafy greens, I can limit the menu to show only the healthiest dishes. It has other uses, too: a cafe in Switzerland, for example, could use the stats page (filled with graphs generated using the <a href="http://code.google.com/apis/chart/">Google Chart API</a>) to compete with a cafe in Mountain View for the title of "healthiest cafe." In fact, all the Google cafes worldwide are now in a heated competition now for this very title.<br /><br />If you suspect I've gone "green," and if my mom is reading this: I have. I'm eating healthier, I've had my cholesterol checked, and I walk at least three miles every day. For everyone else, don't worry -- after I produced the healthiest cafe statistics page, I also made another set of graphs that ranks by red items. If you see me eating red items at Google, please don't tell my mom.<br /><br /><span class="byline-author">Posted by Nathan Laredo, Software Engineer</span>

Engineering a healthier diet

Back in 2007, the cafes at our Mountain View campus started color-coding menu items according to healthfulness. The healthiest items are col...

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Project Spectrum: recognizing the talents of children with autism

A couple of years ago, the <a href="http://sketchup.google.com/">Google SketchUp</a> team began hearing from a new group of users -- people on the autism spectrum. After consulting with some experts, we learned the connection between autism and SketchUp isn't particularly surprising. Many people on the autism spectrum have visual and spatial strengths, and 3D design software plays to them. With this in mind, we started a program called <a href="http://sketchup.google.com/spectrum.html">Project Spectrum</a>.<br /><br />As part of <a href="http://www.autism-society.org/site/PageServer?pagename=research_awareness">Autism Awareness Month</a> in April, we've launched a new <a href="http://sketchup.google.com/spectrum.html">webpage</a> showcasing some great SketchUp artists (Rachel, Jeremy, JP and others). We've also created a <a href="http://www.youtube.com/watch?v=gsfH_cyXa1o">Getting Started with Google SketchUp video</a> for anyone who wants to learn the basic tools to start modeling. More of the Project Spectrum models can be seen in the Google 3D Warehouse <a href="http://sketchup.google.com/3dwarehouse/cldetails?mid=be3de3be31be4d088aee1e8fa383e7d3&prevstart=0">collection</a>. Watch the video below to hear the story behind Project Spectrum and meet some of the kids involved:<br /><br /><object height="344" width="425"><param name="movie" value="http://www.youtube.com/v/Jw_ZW1NCQgY&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/Jw_ZW1NCQgY&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="425" height="344"></embed></object><br /><br />Googlers around the world are working with the autism community to introduce kids, teachers, parents and adults to SketchUp, and we've been inspired by the results. We hope you take the time to look at Project Spectrum and share it with others in your community. For more detail, check out the <a href="http://sketchupdate.blogspot.com/2009/04/strengths-of-autism-continue-to-shine.html">Google SketchUp blog</a>. <br /><br /><span class="byline-author">Posted by Tom Wyman and Chris Cronin, Project Spectrum Team</span>

Project Spectrum: recognizing the talents of children with autism

A couple of years ago, the Google SketchUp team began hearing from a new group of users -- people on the autism spectrum. After consulting ...

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