healthy4u

EHR's and Scarcity of Public Reviews of the User Experience

I recently downloaded the public beta (incomplete trial version) of Apple's new web browser <a href="http://www.apple.com/safari/">Safari 4</a>. I like its <a href="http://www.interaction-design.org/encyclopedia/user_experience_or_ux.html">user experience</a> and features, presenting a main page "posterboard" of most visited or user-selected sites, a searchable, flip-panel history of visited pages (using the Macintosh OS X Spotlight and Cover Flow paradigms), top located tabs, and other useful features. (Note: I use both Macs and PC's, and hold no financial stakes in Apple whatsoever.) What struck me was the vociferous online discussions and debates about every facet of the new browser version, down to the level of minutiae. The following review particularly struck me for its level of detail - <a href="http://daringfireball.net/2009/03/safari_4_public_beta">Observations, Complaints, Quibbles, and Suggestions Regarding the Safari 4 Public Beta Released One Week Ago, Roughly in Order of Importance</a> by John Gruber. It includes minutiae such as this: <blockquote>... THE TABS Safari’s new tab layout, placing the tabs directly in the window title bar, is a radical change. There’s no use addressing the specific details — good and bad — of this new arrangement, without first trying to figure out why Apple did this. Again, the designers are behind Apple’s wall of silence, so we’re left to speculate. Rule out the notion that Safari’s designers undertook this change lightly. This is a major change to an important feature that many users feel strongly about. My guess is that this is an attempt to bring tabbed browsing to the masses. The biggest and most important change is that the interface for the tabs is now far more prominent. In fact, previously, the entire interface for tabbed browsing was not visible in Safari by default — in a window with just one tab, Safari’s default settings were such that the tab bar was not shown. In Safari 4, there’s a prominent and unique “+” button that is always visible in the top right corner of every window, where the standard tic-tac button for toggling the display of the toolbar usually resides.1 Because the interface to create new tabs is now obvious, I can only assume that the point of this redesign is to encourage more people to use, or at least try, tabbed browsing. But the problems with this new tab layout are significant. Conceptually, the basic idea is sound. Browser tabs are, effectively, a collection of separate browser windows grouped together in a single parent window. Safari’s new tab layout makes this a tab is like a sub-window metaphor more explicit. The anchor, the conceptual root, of a standard Mac OS window is the title bar, and in Safari 4, the tabs aren’t just in the title bar, they are the title bar ... </blockquote> Etcetera and so forth, on and on, as in other reviews easily found online. In Electronic Health Records and other clinical IT, by way of contrast, reviews at this level of detail are ... nearly nonexistent (I use the term "nearly" because I authored such a review, in general terms, <a href="http://hcrenewal.blogspot.com/2009/02/are-health-it-designers-idiots-part-1.html">starting here</a>). One reason EHR and other clinical IT user experience and performance debates are so rare is because customers are contractually forbidden to engage in them publicly. Koppel's and Kreda's JAMA paper makes that clear: <a href="http://jama.ama-assn.org/cgi/content/extract/301/12/1276"></a><blockquote><a href="http://jama.ama-assn.org/cgi/content/extract/301/12/1276">Health Care Information Technology Vendors' "Hold Harmless" Clause - Implications for Patients and Clinicians</a>, Ross Koppel and David Kreda, Journal of the American Medical Association, 2009; 301(12):1276-1278 </blockquote> Vendors claim they are protecting their "intellectual property." I'm not exactly sure what IP they are holding as closely as the crown jewels. Is it their: <ul><li>Earth shaking, 22nd century user interfaces?</li><li>Secretive and ingenious widgets that revolutionize user selection from choice lists?</li><li>Hyper-efficient, never before seen data structures and algorithms?</li><li>Artificial intelligence routines that would make Captain Picard and his android sidekick Mr. Data envious?</li></ul> In other words, what, exactly, is being protected by shielding commercial EHR's from external scrutiny and debate? <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgczlrzMT49uJ_QJkT2wm8vN33hCwIzyXC1ucci8-l4iQcivM6j1rjbPhjqOrMsMQHoUrMBsPrNqjcb0lbKKzzbGpeexZbilOno9aLu2hrW3NtnnVPeuNkDP9c42CenvQwZYIknDxwMa8Kz/s1600-h/m5.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5332415104338254930" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgczlrzMT49uJ_QJkT2wm8vN33hCwIzyXC1ucci8-l4iQcivM6j1rjbPhjqOrMsMQHoUrMBsPrNqjcb0lbKKzzbGpeexZbilOno9aLu2hrW3NtnnVPeuNkDP9c42CenvQwZYIknDxwMa8Kz/s320/m5.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 260px; height: 195px;" /></a>Is this the Secret Sauce the commercial EHR vendors seek to conceal? </div> The loss engendered by such policies is the reduced feedback from, and reduced interaction among endusers. This interaction occurs commonly on the Internet in 2009 on a great number of topics, but EHR user experiences are not one of them. Companies like Apple and Microsoft, strongly user centric, encourage such debates through release of their beta's, both of enduser tools and of operating systems e.g., Windows 7 Beta. I should note that with these pieces of software, lives are not at stake, unlike with electronic health records systems. The Veterans Health Administration makes a full working copy of VistA Computerized Patient Record System (CPRS) available as a free public download to anyone in the world <a href="http://www1.va.gov/cprsdemo/">here</a>. I use it in my teaching (and am forced to do so, as commercial EHR demos are as available as, say, demos of the National Security Agency's spy and decryption software). What, exactly, is the commercial EHR vendors' real excuse for the levels of product secrecy they maintain? Could it be embarrassment and fear of exposure of defects, ill conceived design features and a mission hostile user experience? -- SS

EHR's and Scarcity of Public Reviews of the User Experience

I recently downloaded the public beta (incomplete trial version) of Apple's new web browser Safari 4 . I like its user experience and f...

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More ways to share your Google Latitude location

A few months ago, we introduced <a href="http://www.google.com/latitude/intro.html">Google Latitude</a>, a new feature for mobile and iGoogle that lets you share your location with your friends. Since the launch, a lot of you have asked "What if I want to share my location with people who are not my Latitude friends?" Today, we're happy to release two applications that make that possible. <a href="http://www.google.com/latitude/apps/status">Google Talk location status (beta)</a> automatically updates your Google Talk or Gmail chat status message with your Latitude location. With this application enabled, all of your chat buddies can see your most recent city-level location. The <a href="http://www.google.com/latitude/apps/badge">Google Public Location Badge</a> lets you publish your Latitude location on your blog or website. You can choose to show just the city that you are in or you can have your device's location detected automatically, using GPS, Wi-Fi, or cell tower ID, which provides a more specific location. To read more about these new features, visit the <a href="http://googlemobile.blogspot.com/2009/05/do-more-with-google-latitude.html">Google Mobile Blog</a>. If you're already a Latitude user, give the <a href="http://www.google.com/latitude/apps">new apps</a> a try. If you don't have a Google Latitude account, sign up and start sharing your location now. We take your privacy very seriously and you can read the privacy notice on the application pages for more information. In the near future, we hope to offer a way to share your location in even more applications. If you have any suggestions or comments, please visit our <a href="http://productideas.appspot.com/#16/e=cf">Product Ideas page</a>. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoN_ctzAp6ALJxq2phBgn7O9b3F9s5kp0LCEKOHRWD4Tz0fBgBztnl2cnjgRRyvRQVKIcT9fDZI2iXobGqyGr56w4qOJ5Sl8vwwjrSqgJ0ifsL3XsnvJqx6itT3pTcjFV1BO9bUwf2DWNq/s1600-h/badge-large.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5332008432911207586" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgoN_ctzAp6ALJxq2phBgn7O9b3F9s5kp0LCEKOHRWD4Tz0fBgBztnl2cnjgRRyvRQVKIcT9fDZI2iXobGqyGr56w4qOJ5Sl8vwwjrSqgJ0ifsL3XsnvJqx6itT3pTcjFV1BO9bUwf2DWNq/s400/badge-large.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 300px; height: 240px;" /></a>Posted by Rohan Seth & Chris Lambert, Software Engineers, Google Mobile

More ways to share your Google Latitude location

A few months ago, we introduced Google Latitude , a new feature for mobile and iGoogle that lets you share your location with your friends. ...

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Bio-Tech U

The San Francisco Chronicle just <a href="http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/05/01/BA7517D185.DTL">reported</a> that a new Chancellor has been nominated for the <a href="http://www.ucsf.edu/">University of California - San Francisco </a>(UCSF). UCSF is functionally a health sciences university, and its Chancellor functions as its president. The UCSF medical school is generally considered one of the elite US academic medical institutions. <blockquote> Genentech executive Susan Desmond-Hellmann has been nominated to be the next chancellor of UCSF, making her the first woman or biotech leader ever asked to run the research campus and hospital system that is San Francisco's second-largest employer. Desmond-Hellmann has served most recently as president of drug development at Genentech, the South San Francisco biotech firm that was recently acquired by Swiss drugmaker Roche. She was trained as a physician, did her internship at UCSF and has taught there recently as an adjunct associate professor while working at Genentech. Although prior UCSF chancellors have come from more academic or scientific backgrounds, [Dr Holly] Smith said Desmond-Hellmann's biotech connections would be an advantage as the university tries to translate scientific discoveries into medical treatments. </blockquote> Dr Desmond-Hellmann is, in my humble opinion, a very unusual candidate to be Chancellor of one of the country's premier academic medical institutions. According to her official Genentech bio (taken off the Genentech server, but transiently available in the Google cache <a href="http://74.125.95.132/search?q=cache:9WvMoqIzF38J:www.gene.com/gene/about/management/exec/desmond-hellman.html+Desmond-Hellmann&cd=3&hl=en&ct=clnk&gl=us">here</a>), and a <a href="http://www.nature.com/drugdisc/nj/articles/nrd1794.html">biography in Nature Drug Discovery</a>, Dr Desmond-Hellmann, after getting both an MD and an MPH, spent two years doing AIDS research in Uganda as a UCSF junior faculty member, and then spent a few years in private practice hematology-oncology. She published few articles (5, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&term=Desmond-Hellmann[author]">according to Medline</a>, last in 1995), and by 1993 went to work in industry, first for Bristol-Myers-Squibb. She started at Genentech in 1995, and worked her way up to her current position, "president, Product Development. In this role, Hellmann is responsible for Genentech's Development, Process Research & Development, Business Development, Product Portfolio Management, Alliance Management and Pipeline Planning Support functions. Hellmann is a member of Genentech's executive committee." Before her nomination to be Chancellor, Dr Desmond-Hellmann was <a href="http://www.epibiostat.ucsf.edu/general/people/affilfac.html">"affiliated" faculty </a>of the Department of Epidemiology and Biostatistics at UCSF, apparently with the rank of adjunct associate professor. In that capacity, she apparently <a href="http://www.epibiostat.ucsf.edu/general/events/seminar_archives.html">gave a single seminar in 2007,</a> and lectured in the <a href="http://www.epibiostat.ucsf.edu/courses/clin_research/2003/">Designing Clinical Research course in 2003</a>. So, on one hand, Dr Desmond-Hellmann, to be charitable, does not have much of an academic track record, at best approximating that of a very junior medical faculty member. She also certainly has no experience in academic administration. In general, people who lead academic medicine often have substantial track records in academics and in academic administration. So, in some sense, Dr Desmond-Hellmann's appointment seems to based on the theory of the generic manager. That is, the popular notion in the business world managers can manage anything, any organization, with any mission, in any context. Managing in the complex health care context, especially managing large, complex academic medical institutions, may not be easy for those used to managing elsewhere, even in the health care corporate world. Furthermore, the complex mission of academic medicine, which includes providing excellent care of individual patients, while discovering and disseminating the truth in a spirit of free enquiry, is very different from the mission of a for-profit biotechnology company. How well someone used to the bottom-line mentality of the corporate world would uphold the academic mission is not clear. Dr Desmond-Hellmann came from a company known for charging very high prices for the drugs it marketed, and Dr Desmond-Hellmann was on record personally defending this practice. Quoting from a <a href="http://jnci.oxfordjournals.org/cgi/content/extract/djm031v1">news article </a>in the Journal of the National Cancer Institute [McNeil C. Sticker shock sharpens focus on biologics. JNCI 2007; 99: 910-914.] <blockquote> Never mind their novel targets and mechanisms. It's the cost of new biologic agents that's creating a buzz these days. At thousands of dollars a month, which can mean many tens of thousands for some regimens, sticker shock has generated recent, prominent articles in both the national and trade press. On one level, the argument is about macroeconomics. Neal Meropol, M.D., of Fox Chase Cancer Center in Philadelphia, pointed out that cancer drugs account for 40% of all Medicare drug expenditures. That makes them a major contributor to the country's high health care costs, now about 17% of our gross domestic product (GDP) and growing. That percentage is much higher than in other developed countries with higher life expectancies, he said at a forum on cancer care costs at the American Association of Cancer Research annual meeting. On the other side of the macroeconomic debate, experts point out that the U.S. has a high GDP to begin with and so can afford to spend more on health. And cancer biologics, though among the most costly drugs, are still only a tiny fraction of total GDP, said Genentech's Susan Desmond-Hellmann, president for product development, at AACR. Hellmann and others argue that with these drugs’ potential to alleviate the huge societal burden of cancer, biologics are worth the cost. The industry has responded to concerns about costs by putting more resources into patient assistance programs. When Genentech received U.S. Food and Drug Administration approval for bevacizumab in lung cancer last October, it also announced a cap on expenditures for the drug for patients with family incomes less than $100,000 a year. In 2005, the median household income was $46,326. Originally announced as $55,000, the cap actually doesn't kick in until after a patient has received 10,000 mg. At the wholesale acquisition cost, 10,000 mg is about $55,000, said Genentech spokesperson Edward Lang. What the companies have not done so far is reduce prices. The reason, industry representatives say, is the need to recoup massive research and development costs, including high manufacturing costs for biologics. These costs have long kept biotech companies from making much of a profit overall, Hellmann said. She noted that profit levels of publicly held biotech firms have "hovered close to zero" throughout the life of the industry. </blockquote> But, while Dr Desmond-Hellmann was defending pricing drugs that at more than $55,000 a year, and complaining about low industry profits, she was pocketing lavish rewards. According to <a href="http://www.sec.gov/Archives/edgar/data/318771/000095013408004633/0000950134-08-004633-index.htm">Genentech's 2008 proxy statement</a>, (the last available, since the company has been bought out by Roche), her total compensation was $8,361,348 in 2007 and $7,820,142 in 2006. In 2007, her total compensation was equal to 0.3% of the firm's total net income, and the top five company executives' total compensation was equal to about 1.5% of the firm's total revenues. In 2007, the firm's stock price declined from 91.30 on 6 January 2007 to 66.38 on 4 January, 2008, or 27%, <a href="http://www.google.com/finance?q=NYSE%3ADNA">according to Google Finance</a>. In 2007, she held 1,616,383 shares of stock, or stock options exercisable within 60 days of January 31, 2008. In 2007 she exercised 170,000 stock options, realizing $11,556,663. So perhaps those high drug prices were needed not only to pay for research, but to make top executives, including Dr Desmond-Hellmann, very rich. This raises further questions about her inclination to uphold the <a href="http://www.ucsf.edu/about-ucsf/">university's mission </a>in the future. <blockquote> University of California, San Francisco is a leading university dedicated to defining health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. </blockquote> In any case, hiring a lavishly compensated top executive from a biotech firm known for its high drug prices to run a public health sciences university does considerably blur the line between academic medicine and the health care industry. In the Chronicle article, Dr Desmond-Hellmann declared, "I began my career at UCSF and my heart has never left it." If she does become Chancellor, let us hope that her heart will speak louder than all those millions she used to make by, among other means, charging more than $55,000 a year for bevacizumab.

Bio-Tech U

The San Francisco Chronicle just reported that a new Chancellor has been nominated for the University of California - San Francisco (UCSF)....

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BLOGSCAN - At UMDNJ, Lose Your Job, Keep Your Cell Phone

We have frequently discussed the plight of the University of Medicine and Dentistry of New Jersey (UMDNJ), the largest health care university in the US. Facing indictment for federal crimes, the university operated under a deferred prosecution agreement and the supervision of a federal monitor from 2005 to 2007. We most recently blogged about UMDNJ <a href="http://hcrenewal.blogspot.com/2008/11/politician-medical-school-dean.html">here</a>, and see links backward to previous posts from <a href="http://hcrenewal.blogspot.com/2008/03/money-for-nothing-more-guilty-pleas-at.html">here</a>. On the University Diaries blog, Prof Margaret Soltan <a href="http://www.margaretsoltan.com/?p=12392">discussed</a> the latest aspect of mismanagement at UMDNJ to be uncovered.

BLOGSCAN - At UMDNJ, Lose Your Job, Keep Your Cell Phone

We have frequently discussed the plight of the University of Medicine and Dentistry of New Jersey (UMDNJ), the largest health care universit...

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BLOGSCAN - Merck Hired Elsevier to Create Fake Peer-Reviewed Medical Journal

You just can't make this stuff up. <a href="http://scienceblogs.com/insolence/2009/05/when_big_pharma_pays_a_publisher_to_publ.php">On the Respectful Insolence blog</a>, Orac recounted how pharmaceutical giant Merck hired medical publishing giant Elsevier to create what appeared to be a peer-reviewed journal, but theAustralasian Journal of Bone and Joint Medicine really was just a marketing outlet. The goal was to market Fosamax and Vioxx. This is another bizarre variant on the stealth marketing theme, taken to quite an extreme. And the pharmaceutical companies wonder why people don't trust them? ADDENDUM (4 May, 2009) - Dr Aubrey Blumsohn is <a href="http://scientific-misconduct.blogspot.com/2009/04/fake-editorial-board-of-mercks-fake.html">back online </a>on his Scientific Misconduct Blog, and noted the academic luminaries who were willing to serve on the editorial board of this fake peer-reviewed journal. ADDENDUM (11 May, 2009) - See also <a href="http://laikaspoetnik.wordpress.com/2009/05/08/mercks-ghostwriters-haunted-papers-and-fake-elsevier-journals/">comments</a> on Laika's MedLibBlog.

BLOGSCAN - Merck Hired Elsevier to Create Fake Peer-Reviewed Medical Journal

You just can't make this stuff up. On the Respectful Insolence blog , Orac recounted how pharmaceutical giant Merck hired medical publis...

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Was Google lobbying Washington for HIPAA exclusion of their PHR effort?

At "<a href="http://hcrenewal.blogspot.com/2009/04/should-google-seek-resignations-of.html">Should Google Seek the Resignations of Those Responsible for This Healthcare IT Debacle?</a>" I expressed great concern about what I term the cross occupational intrusion of the IT industry into healthcare. My major concern in that post was how the information technologists at Google, even with nearly unlimited access to capital (and therefore to the world's informatics expertise) badly mismanaged a Personal Health Records (PHR) project through commission of a most fundamental biomedical information science blunder (quite distinct from IT; most IT technologists and MIS personnel really stink at biomedical information science). They tried to map relatively ungranular, imprecise, and often misused billing codes back to enduser-viewable diagnoses, resulting in easily predictable patient panic and mayhem. As usual in HIT: it's possibly even worse. I am quite concerned about a letter from the consumer education and advocacy organization <a href="http://www.consumerwatchdog.org/about/" target="blank">Consumer Watchdog.org</a> and their allegations that Google has been lobbying Congress to be excluded from HIPAA provisions on privacy and forbidding sales of medical records. The letter, dated April 22, is <a href="http://www.consumerwatchdog.org/resources/LtrSchmidt042209.pdf" target="blank">here</a> (<a href="http://www.consumerwatchdog.org/resources/LtrSchmidt042209.pdf" target="blank">http://www.consumerwatchdog.org/resources/LtrSchmidt042209.pdf</a>). Considering that Google is heavily into the PHR space, and even worse, considering they made an Informatics 101 error in attempting to map billing codes into user-viewable diagnostic data, I would (and I'm sure others would as well) view such attempts if they indeed occurred as ominous, a true heavy handed intrusion of the IT industry not only into the affairs of medicine but into what really is another human rights issue. (I'd pointed out another potential HIT-related human rights issue at the post "<a href="http://hcrenewal.blogspot.com/2009/04/upmc-pioneers-in-health-it-or-pioneers.html" style="font-family: arial;">UPMC as Proving Ground for IT Tests On Children</a>".) I would be interested in additional information on the Google lobbying issue, especially from those at Harvard and other academic centers who have been involved in the Google PHR initiative. I have shared these concerns with the American Medical Informatics Association (<a href="http://www.amia.org/">AMIA</a>) clinical information systems workgroup (cis-wg) and the people & organizational issues workgroup (poi-wg) as well. I hope the Consumer Watchdog allegations are not accurate, because if they are valid, the implications of national EHR grow increasingly unsettling.

Was Google lobbying Washington for HIPAA exclusion of their PHR effort?

At " Should Google Seek the Resignations of Those Responsible for This Healthcare IT Debacle? " I expressed great concern about wh...

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Mowing with goats

At our <a href="http://maps.google.com/?q=Google%20Inc.@37.423156,-122.084917&hl=en">Mountain View headquarters</a>, we have some fields that we need to mow occasionally to clear weeds and brush to reduce fire hazard. This spring we decided to take a low-carbon approach: Instead of using noisy mowers that run on gasoline and pollute the air, we've rented some goats from <a href="http://californiagrazing.com/">California Grazing</a> to do the job for us (we're not "kidding"). A herder brings about 200 goats and they spend roughly a week with us at Google, eating the grass and fertilizing at the same time. The goats are herded with the help of Jen, a border collie. It costs us about the same as mowing, and goats are a lot cuter to watch than lawn mowers. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSD-jalYioSSGyYgIJvTNhyh0can8_pK-wSVCRnvhJzwQJHa6J7eW1xJrrmxytFmvZfxp0N8qcTAeKfv8ccJf1psXdcBCSQe48guSVYSjC9OV6FVcE72QaHo80CtMWReuwRoiL6M4BRUmC/s1600-h/Goats.JPG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5330894068972928818" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSD-jalYioSSGyYgIJvTNhyh0can8_pK-wSVCRnvhJzwQJHa6J7eW1xJrrmxytFmvZfxp0N8qcTAeKfv8ccJf1psXdcBCSQe48guSVYSjC9OV6FVcE72QaHo80CtMWReuwRoiL6M4BRUmC/s400/Goats.JPG" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 240px;" /></a> Posted by Dan Hoffman, Director Real Estate and Workplace Services

Mowing with goats

At our Mountain View headquarters , we have some fields that we need to mow occasionally to clear weeds and brush to reduce fire hazard. Thi...

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