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HealthSouth's "Digital Hospital," from the "Era of Cyber Hospitals" to an Unfinished "Pipe Dream"

The trial for a civil law-suit against Richard Scrushy, the former CEO of for-profit rehabilitation hospital chain HealthSouth, is currently in progress. One bit of testimony provided a reminder about how supposed "innovations" in health care are uncritically accepted. As <a href="http://blog.al.com/businessnews/2009/05/us_280_hospital_made_no_sense.html">reported by the Birmingham (Alabama, US) News</a>: <blockquote> HealthSouth Corp. Chief Executive Jay Grinney has concluded his testimony in the Richard Scrushy civil trial, ending with a devastating critique of the so-called 'digital hospital.' 'It was a very bad business decision that made no sense,' Grinney said of the half-completed Scrushy brainchild on U.S. 280 he inherited when he took over in 2004. Ending his sixth hour of testimony over two days, Grinney said the hospital had an original budget of $200 million, and that much had already been spent when the the project was stopped halfway through. Another $200 million was required, he said. When it came time to cut the $3.5 billion of debt that was burdening the company, Grinney said he had no hesitation about selling the building. Scrushy had envisioned the medical center as a 200-bed centerpiece of the HealthSouth empire, and called it the 'digital hospital' because of its planned technology component. The building has been sold to real-estate developers,.... Scrushy is on trial in Jefferson County Circuit Court after being sued by HealthSouth shareholders. They are seeking $2.6 billion in damages from him for costs related to accounting fraud, corporate waste and insider stock trading while he ran the physical therapy company from 1996 through 2002 The 56-year-old Selma native is in the Shelby County Jail awaiting his court appearance in the case. He was brought to Birmingham from federal prison in Texas, where he is two years into a seven-year sentence for bribing former Alabama Gov. Don Siegelman. </blockquote> In additional <a href="http://www.nbc13.com/vtm/news/local/article/healthsouth_ceo_calls_digital_hospital_a_pipe_dream/72296/">coverage by a local television station (NBC13.com)</a>, <blockquote> When asked about the unfinished digital hospital on Highway 280, Grinney said, 'It was a pipe dream and a figment of the imagination. It never had a chance.' Grinney testifed on Wednesday that HealthSouth would have had to forego investments in all of the company’s other 93 hospital for 2 to 3 years to finish the digital hospital. </blockquote> What a contrast this was to the hype that surrounded the announcement of Scrushy's intention to build the "digital hospital." Let me provide some samples. <a href="http://www.computerworld.com/action/article.do?command=viewArticleBasic&articleId=59000">ComputerWorld</a> allowed Scrushy to wax eloquent: <blockquote> Hospital chain HealthSouth Corp. and software manufacturer Oracle Corp. are teaming to build what they say is the world's first all-digital, automated hospital. The technological features will include patient beds with display screens connected to the Internet; electronic medical records storage; digital imaging instead of traditional X-ray film; and a wireless communications network that will allow doctors, nurses and other health care professionals to securely update and access patients' medical records using handheld devices. 'This will be the hospital model for the world,' HealthSouth Chairman and CEO Richard Scrushy said in the statement. 'By creating the first automated hospital ... we will demonstrate how technology can lower health care costs, greatly reduce human errors and provide patients with the best medical care available.' </blockquote> <a href="http://www.bio-medicine.org/medicine-news/Oracle-Corp--to-help-build-worlds-first--22Digital-Hospital-22-145-1/">Bio-Medicine gushed</a>: <blockquote> The project will be fast tracked and hopefully completed by 2003. From the moment a patient registers at the hospital, every blood test and MRI will be recorded in a central patient record, and pharmacy visits will be tracked. All charting will be done at the patient's bedside, 'getting the nurses' back to the patient's side' and making doctors more efficient. Oracle will provide the technology that will allow Health South to improve record-keeping and patient care, officials of the two companies said in a briefing on Monday. Ultimately, they said, the improvements will reduce the overall cost of care. It was also added at the briefing that another 10 sites where the hospital can be duplicated have been identified. Its now the era of cyber hospitals!!! </blockquote> <a href="http://www.managedcaremag.com/archives/0106/0106.tech.html">Managed Care Magazine </a>was only somewhat more measured: <blockquote> The promise of HealthSouth's digital hospital is great. By planning for integration on a common platform with all suppliers involved from the start, HealthSouth is maximizing the likelihood of success. Also, HealthSouth is attempting to make the physical facility as flexible as possible to allow for the adoption of additional new technologies as they become available. If this hospital works, it is likely to set standards for a high level of patient care. HealthSouth is anticipating that the increased efficiency of the new facility will translate into a decrease in overall length of stay. On the other hand, everything is still in the planning stages, and details are scarce. HealthSouth has no agreements in place with insurers. Of course, the paperless hospital evokes memories of the heralded paperless office of a generation ago — and we're still waiting. The cutting edge can be painful. But the concept of the digital hospital, automating care and administrative operations, is so appealing, we can only hope it will succeed. Time will tell. </blockquote> An <a href="http://www.technologyreview.com/biomedicine/12480/">article in the MIT Technology Review </a>was just a little bit skeptical: <blockquote> While others have previously failed to carry off such grand visions of high-tech medicine, the deep pockets of HealthSouth and Oracle could give them a fighting chance. </blockquote> But the article's conclusion was less cautious: <blockquote> Not only could electronic information management help eliminate errors, it could also eliminate two to three hours a day that nurses spend charting patient data, and dramatically improve communication between different departments. The bottom line: it could save lives. </blockquote> Finally, I was able to find some discussion of the proposed "digital hospital" in a scholarly publication, in fact, in probably the most authoritative and well-read journal on health care policy in the US, <a href="http://healthaff.highwire.org/cgi/content/full/21/4/128">Health Affairs</a>. [Burns LR, Pauly MV. Integrated delivery networks: a detour on the road to integrated health care? Health Affairs 2002; 21: 128-143.] I would not call it gushy, but it hardly seemed skeptical: <blockquote> The most radical development is the incorporation of all of these technological advances into newly designed and built 'digital hospitals.'HealthSouth, traditionally a provider of integrated rehabilitation services, has announced plans to build several digital acute care hospitals over the next decade (the first is now under way in Birmingham, Alabama). The publicity surrounding the new hospital and its partnership with Oracle not only has attracted other prominent product vendors but also has enabled HealthSouth to negotiate large discounts on all equipment supplied—in effect, lowering the cost of construction. What are the likely prospects for this intervention, either at these beta-test sites or diffused more generally? It is plausible (although difficult to demonstrate so far) that routine patient medical and billing records can be stored or exchanged electronically. It is less obvious that this technology should lead to changes in the cost of care or help to integrate different providers of service. Indeed, the biggest chasm to bridge may be the office systems of different physicians. Kaiser Permanente is reportedly struggling to develop a clinical information system that covers its thousands of physicians and other clinicians. The (as yet undocumented) benefits will likely depend on the ability to harness technological interventions with managerial innovations and interorganizational networks, in effect creating 'socio-technical systems of care.' </blockquote> So we have gone from "the hospital model for the world," with great "promise," which "could save lives," proclaiming the "era of cyber hospitals," to a "pipe dream," just the shell of half-finished building. So I wonder, if one were to identify every highly hyped, rapidly spun, magic new "innovation" promising to revolutionize patient care, and follow them forward in time, how many would even marginally improve health care, or provide benefits that marginally out-weighed their harms? How many would never come to be, or prove to be unworkable, useless, or even harmful? But the short-term incentives for leaders of health care organizations push them to announce innovation after innovation, collect their bonuses and perks, and be somewhere else by the time their wondrous innovations prove to be not so good. Keep in mind that some heavily promoted innovations, such as new pharmaceuticals, must be subject to randomized controlled trials and government approval. Yet, as perusing Health Care Renewal will show, many pharmaceutical companies have managed to make their glitzy innovations appear more efficacious and less hazardous by lavish, shrewd, and sometimes deceptive marketing, and by manipulating clinical research, and sometimes suppressing results. Medical devices are not subject to as much scrutiny. Health care information technology, and programmatic innovations by hospitals, health systems, managed care and health insurance companies can appear without any research evidence to support them. This is why we all should be extremely skeptical of whatever new "innovations" our multi-million dollar health care CEOs and their cronies are hawking these days.

HealthSouth's "Digital Hospital," from the "Era of Cyber Hospitals" to an Unfinished "Pipe Dream"

The trial for a civil law-suit against Richard Scrushy, the former CEO of for-profit rehabilitation hospital chain HealthSouth, is currently...

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Congratulations Eric Yang, winner of the 2008-2009 National Geographic Bee

1. Timis County shares its name with a tributary of the Danube and is located in the western part of which European country? 2. Name this eastern European capital city, where a ﬂight from the southeast would approach the city by ﬂying over the Rhodope Mountains. 3. Name this city in Oceania, the largest on South Island, where a ﬂight from the west would approach the city by ﬂying over the Southern Alps. If you're stumped, you're not alone! For 55 fourth- to eighth-graders, though, these sorts of questions represented the culmination of months of hard work studying maps and absorbing geographic knowledge.<div> </div><div>Earlier today I had the honor of speaking at the championship round of the <a href="http://www.nationalgeographic.com/geographybee/">2008-2009 National Geographic Bee</a> — moderated by Jeopardy!’s Alex Trebek for the 21st year. This year, <a href="http://earth.google.com/">Google Earth</a> is sponsoring the Bee in support of its mission to raise awareness and support of geography education. Held at National Geographic’s Washington, D.C. headquarters and broadcast on public television stations across the country, the competition inspires and challenges students to better understand the world around them. </div><div> </div><div>Eric Yang, who didn't miss a single question in the finals, won on the third question of a tiebreaker round by answering the first question above. Eric, a 7th grader from Texas, has already scored 2200 on his SATs! </div><div> </div><div>It wasn't just the students who came away from the day re-energized and excited about geography. I was also lucky enough to meet a number of passionate educators like Rebecca Montgomery, a teacher from Mississippi, who administered the state bee there this year and told me that "the bee had a tremendous impact on our schools this year and I know now what we need to do to get kids ready to learn geography."</div><div> Here at Google, we're always excited to see how innovative teachers are using tools like <a href="http://www.google.com/educators/geo.html">Google Earth and Maps</a> to engage students by putting the world's geographic information at their fingertips. I'm particularly happy to have been part of the Bee today because geography and mapping were such a big part of what led me to help create Google Earth. I'm not the only Googler who fell in love with maps at an early age, though. Check out this video to see how some of my fellow mapmakers started down the path that eventually brought them to their current profession: <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/RMm-OwKy5t4&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/RMm-OwKy5t4&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object> We'll be watching to see what lies ahead for today's passionate young geo whizzes. Congrats again to all the Bee competitors, and happy exploring! Answers: 1. ɐıuɐɯoɹ 2. ɐıɟos 3. ɥɔɹnɥɔʇsıɹɥɔ <div> <div><div>Posted by Brian McClendon, Director of Engineering, Google Earth and Maps</div></div></div></div>

Congratulations Eric Yang, winner of the 2008-2009 National Geographic Bee

1. Timis County shares its name with a tributary of the Danube and is located in the western part of which European country? 2. Name this ea...

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Announcing the 2009 Doodle 4 Google Winner

Nearly six million online votes helped us pick the winners of this year's Doodle 4 Google competition from a very creative pool of doodles. Today, we're pleased to announce the results. Congratulations to Christin Engelberth, a sixth grader at Bernard Harris Middle School in San Antonio, Texas. She titled her doodle "A New Beginning" to express her wish that "out of the current crisis, discoveries will be found to help the Earth prosper once more." <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5Vp4d7NlVm5Hst4U7QTFMzpvLxGTVXewDbmWje6DxI6uoozi178WGpahNjZU7qK2QPT_AWJNcRIltc7outrWX317EBtBsM00UzjagC2eiumCDVxTb971OmRICvQsb6uPFdpOOKHmjqJHr/s1600-h/Engelberth_1024x768_close.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5337924409467880434" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5Vp4d7NlVm5Hst4U7QTFMzpvLxGTVXewDbmWje6DxI6uoozi178WGpahNjZU7qK2QPT_AWJNcRIltc7outrWX317EBtBsM00UzjagC2eiumCDVxTb971OmRICvQsb6uPFdpOOKHmjqJHr/s400/Engelberth_1024x768_close.jpg" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 228px;" /></a> Christin will receive a $15,000 college scholarship, a laptop, and a $25,000 technology grant for her school. Her doodle will be featured on the Google.com homepage tomorrow for millions of people around the world to see. Our congratulations also go out to the <a href="http://www.google.com/doodle4google/press.html">three national finalists</a>. They were selected as having the best doodle in their grade groups and will each receive a laptop computer: Grades K-3 Miriam Elizabeth Lowery ~ Grade K, Austin Peay Elementary Covington, TN "Friendship Around the World" Grades 7-9 Blakely Linz ~ Grade 7, Indian Hill Middle School, Cincinnati, OH "Stop to Smell the Flowers" Grades 10-12 Emerald Lu ~ Grade 10, Covington Latin School Covington, KY "From the Ashes" Our four winners were announced at a special event today at the Smithsonian's Cooper-Hewitt, National Design Museum, where we also unveiled an exhibit of the top doodles that will be on view until July 5, 2009. The finalists were treated to a day in New York City that included activities which promote peace, sustainability and wellness — all inspired by this year's theme, "What I Wish for the World." And of course, Dennis Hwang and our doodle team led a doodling class for all top <a href="http://www.google.com/doodle4google/winners_region.html">regional finalists</a> in New York city. We have one more winner to announce: Clark County School District in Las Vegas, Nevada, is the recipient of the District Quality Participation Prize. They will receive a $10,000 technology grant for having the greatest quality participation. Thanks to all those who voted and helped us find this year's winners. And thank you to all the creative kids out there who submitted entries. We hope you'll doodle with us next year!<div> </div><div>Update @ 10:45 AM: We've posted <a href="http://www.google.com/doodle4google/winners_state.html">all of the state finalists</a> — several hundred doodles in all —on the Doodle 4 Google website and we encourage you to take a look at the beautiful artwork created by these very talented young artists. Posted by Marissa Mayer, Vice President of Search Products and User Experience, and Dennis Hwang, Webmaster Manager</div>

Announcing the 2009 Doodle 4 Google Winner

Nearly six million online votes helped us pick the winners of this year's Doodle 4 Google competition from a very creative pool of doodl...

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Energized about our first Google PowerMeter partners

Earlier this year I blogged about <a href="http://googleblog.blogspot.com/2009/02/power-to-people.html">energy information</a> and a tool our engineers developed called <a href="http://www.google.org/powermeter/howitworks.html">Google PowerMeter</a>, a <a href="http://www.google.com/webmasters/gadgets/">Google gadget</a> that can show consumers their personal electricity consumption right on a home computer. Our software relies on "<a href="http://en.wikipedia.org/wiki/Smart_meter">smart meters</a>" (or other metering devices) as a data source. Over the past several months we've been looking to partner with utilities that are installing (or have already installed) this equipment in their customers' homes. We're energized by our very first Google PowerMeter partners: <ul><li><a href="http://www.sdge.com/">San Diego Gas & Electric®</a> (California) </li><li><a href="http://www.txu.com/">TXU Energy</a> (Texas)</li><li><a href="http://www.jea.com/">JEA</a> (Florida)</li><li><a href="http://www.rel.co.in/Rel/default.jsp">Reliance Energy</a> (India)</li><li><a href="http://www.wisconsinpublicservice.com/">Wisconsin Public Service Corporation</a> (Wisconsin)</li><li><a href="http://www.whiteriver.org/highband.html">White River Valley Electric Cooperative</a> (Missouri)</li><li><a href="http://www.torontohydro.com/">Toronto Hydro–Electric System Limited</a> (Canada)</li><li><a href="http://www.glasgowepb.net/">Glasgow EPB</a> (Kentucky)</li></ul> Our initial partners include utilities with millions of customers as well as smaller ones. They are rural and urban, privately held and municipally run. Some are in the United States, others in Canada and India. They all have one thing in common — a desire to serve their customers by providing access to detailed information that helps <a href="http://www.eci.ox.ac.uk/research/energy/electric-metering.php">save energy and money</a>. For now, Google PowerMeter is only available to a limited group of customers, but we plan to expand our roll out later this year. Our utility partners are leading the charge to make the electricity grid smarter and we look forward to working with them and others. In addition to utilities, we're also seeking partnerships with companies that can enable the implementation of our software. Our first such partner is <a href="http://www.itron.com/">Itron</a>, a leading meter and data management company that serves over 8,000 utilities and is helping some of their customers, including San Diego Gas & Electric, integrate with Google PowerMeter. If you're a utility or company with a smart meter project that might be interested in plugging in to our efforts, visit our <a href="http://www.google.org/powermeter/contactus.html">website</a> for more information. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTtUOz_3_iO1p6lLXg7JGXwqkPtOPwqzE8GlvbciRxw9qrplYLeIIZiY6_-2QCWV95ngLCyzHke0Wm2GHFttVWw6hcVkhjy95QUyr2CFV4-ZyX4PC_ETvPhN8BO7-FrQyfMFBm2ViBpYCQ/s1600-h/PowerMeter+screenshot.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5337690276303748658" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTtUOz_3_iO1p6lLXg7JGXwqkPtOPwqzE8GlvbciRxw9qrplYLeIIZiY6_-2QCWV95ngLCyzHke0Wm2GHFttVWw6hcVkhjy95QUyr2CFV4-ZyX4PC_ETvPhN8BO7-FrQyfMFBm2ViBpYCQ/s400/PowerMeter+screenshot.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 387px;" /></a>Posted by Ed Lu, Engineering team

Energized about our first Google PowerMeter partners

Earlier this year I blogged about energy information and a tool our engineers developed called Google PowerMeter , a Google gadget that ca...

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Healthcare IT Timing "Cemented in Law?" A Healthcare Renewal Contest

I am quoted in the article "Liability an issue with health care software" in today's online edition of NextGov.com (<a href="http://www.nextgov.com/nextgov/ng_20090518_8824.php">link to article</a>). <blockquote>Nextgov.com is part of the <a href="http://nationaljournal.com/" style="color: rgb(102, 153, 0); text-decoration: underline;">National Journal Group Inc.</a> and the Atlantic Media Company. It is a spin off of Government Executive.com and provides coverage and commentary on the management of information technology in the federal government.</blockquote> Read the whole article. I reproduce a part of it below for the purposes of sponsoring the first ever Healthcare Renewal contest. The rules are simple. Add to the blog comments section your best explanation of the interesting phrase in the last sentence of the excerpt, bolded below. The best comment will get an honorable mention appended to the text of this posting. Keep in mind that the laws regarding health IT appeared in H.R. 1 EH, a.k.a. the Economic Recovery Act of 2009, with little or no public discussion regarding incentives, penalties or timing. See <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/TITLE%20IV_HEALTH%20INFORMATION%20TECHNOLOGY.doc">Div. B Title IV, Health Information Technology</a> (Word file extract of a version of the bill from a few months ago) to review the Act's text on HIT.With that in mind, here is the excerpt:<blockquote> ... Health IT provisions in the economic stimulus package are integral to Obama's overall health care agenda, and give doctors and hospitals incentives to adopt certified electronic records by 2014. The Recovery Act appropriates about $20 billion in Medicare and Medicaid incentives to meet that goal. Professionals who deploy certified electronic health records between 2011 and 2014 will be eligible for Medicare bonus payments, while hospitals that implement certified e-records by 2015 also will get bonuses. Scot M. Silverstein, a medical informatics consultant, adjunct professor at Drexel University and former director of Drexel's Institute for Healthcare Informatics, said the timeline for adoption should be extended. Starting in 2015, the administration plans to dock Medicare payments for professionals and hospitals that fail to use certified e-records. "I think the punitive aspects that kick in need to be eliminated," Silverstein said. "I think the government needs to re-examine its justifications for shoving IT down doctors' throats by 2014." David Blumenthal, Obama's national coordinator for health information technology, said the government will tighten oversight of the certification process to address such concerns. "Right now, we are reviewing that process to see how it can provide stronger guarantees that [products] will perform as they are promised to perform," he said. But the timelines for rollout of health IT are cemented in law, he noted.</blockquote> "Cemented in law?" Your comments, please. -- SS

Healthcare IT Timing "Cemented in Law?" A Healthcare Renewal Contest

I am quoted in the article " Liability an issue with health care software " in today's online edition of NextGov.com ( link to...

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Novo Nordisk Accepts Deferred Prosecution Agreement, Settles, Pays Fine

Back in early 2007, we <a href="http://hcrenewal.blogspot.com/2007/02/accusations-against-az.html">noted</a> that several large drug companies were under investigation for possible involvement in the Iraq oil-for-food sanctions scandal. More than two years later, a US Department of Justice <a href="http://www.usdoj.gov/opa/pr/2009/May/09-crm-461.html">press release </a>from last week includes the following: <blockquote> Novo Nordisk A/S (Novo), a Danish corporation based in Bagsvaerd, Denmark, has agreed to pay a $9 million penalty for illegal kickbacks paid to the former Iraqi government. Novo agreed to pay the fine as part of a deferred prosecution agreement with the Department. The matter is part of the Justice Department’s ongoing investigation into the U.N. Oil-for-Food program. A criminal information was filed today against Novo in U.S. District Court for the District of Columbia charging Novo with one count of conspiracy to commit wire fraud and to violate the books and records provisions of the Foreign Corrupt Practices Act (FCPA). Novo, an international manufacturer of insulin, medicines and other pharmaceutical supplies, has acknowledged responsibility for improper payments made by its agents to the former Iraqi government in order to obtain contracts with the Iraqi ministry of health to provide insulin and other medicines. The agreement requires the company and its subsidiaries to cooperate fully with the Justice Department’s ongoing Oil-for-Food investigation. According to the agreement and the information filed today, between 2001 and 2003, Novo paid approximately $1.4 million to the former Iraqi government by inflating the price of contracts by 10 percent before submitting the contracts to the United Nations for approval and concealed from the United Nations the fact that the price contained a kickback to the former Iraqi government. Novo also admitted it inaccurately recorded the kickback payments as 'commissions' in its books and records. In recognition of Novo’s thorough review of the illicit payments and its implementation of enhanced compliance policies and procedures, the Department has agreed to defer prosecution of criminal charges against Novo for a period of three years. </blockquote> Also, <blockquote> In a related matter, Novo reached a settlement today with the U.S. Securities and Exchange Commission (SEC) on a complaint and agreed to pay $3,025,066 in civil penalties and $6,005,079 in disgorgement of profits, including pre-judgment interest, in connection with contracts for which it paid kickbacks to the former Iraqi government. </blockquote> Note that so far I can only find coverage of this story in this <a href="http://www.reuters.com/article/rbssHealthcareNews/idUSN1154539220090511">brief piece </a>from Reuters. So here we go again. Yet another big health care corporation, in this case, an international pharmaceutical company, admits to criminal conduct, and agrees to operate under a deferred prosecution agreement, while also paying additional millions in a civil settlement. In this case, the amounts of money paid were not particularly large, but the nature of the conduct involved, involving paying to play with a particularly notorious dictator, was striking. Like most cases involving settlements for unethical behavior, or even deferred prosecutions or convictions for criminal behavior, this one has attracted almost no attention. Have such stories become like "dog bite man" stories, so commonplace that they deserve no notice from a public that has become cynical? As we have <a href="http://hcrenewal.blogspot.com/2009/05/synthes-settles-agrees-to-stop-giving.html">said before</a>, while human beings authorized or committed the acts that got the organization in trouble, rarely do these people seem to suffer any negative consequences. At most, the organization may pay a fine. In this case, the fine was, in corporate terms, tiny. However, even a large fine, however, may come out of dividends or the stock price, dispersing the cost to stock-holders, or out of salaries across the board. Thus, those who got the organization into trouble are unlikely to feel pain from it. Perhaps because of reverence for all organizations related to health care, and fear that the bankruptcy of any health care organization, even a health care insurance company, will leave patients in the lurch, prosecutors do not seem inclined to actually prosecute such organizations. The net effect, though, seems to be that dishonest executives of health care organizations can continue to act with impunity.Until bad leadership of health care organizations leads to negative consequences for those practicing it, health care leadership can be expected to continuously degrade. Hat Tip to the <a href="http://lawprofessors.typepad.com/whitecollarcrime_blog/2009/05/novo-nordisk-deferred-prosecution-agreement.html">White Collar Crime Prof Blog</a>.

Novo Nordisk Accepts Deferred Prosecution Agreement, Settles, Pays Fine

Back in early 2007, we noted that several large drug companies were under investigation for possible involvement in the Iraq oil-for-food s...

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A galactic mentor

This month marks the 30th anniversary of the final quarter being dropped into the world’s first commercial video game, for it was in May of 1979 that <a href="http://en.wikipedia.org/wiki/Galaxy_Game">Galaxy Game</a> was removed from the Coffee House café at Stanford’s Tresidder student union. I spent a good part of five years feeding coins into Galaxy’s wondrous console, and in return it taught me and several other Silicon Valley denizens valuable lessons that laid the groundwork for much of what we have done since. I met Galaxy Game in the Summer of 1974. My family had just moved to Palo Alto and I had no friends, so my brother and I rode our bikes around the Stanford campus looking for things to do. I was in 8th grade and the bowling alley got boring quickly, but next door, amidst students and lattes (also a novelty at the time) stood two large consoles, side by side, with odd-looking little black screens. Behind those screens sat a DEC PDP-11/20 powering a riveting game built on a simple concept: use a joystick and a couple of buttons (one for torpedoes, one for hyperspace) to destroy the other spaceships. Best of all, unlike its descendants such as Asteroids, Galaxy was a multi-player game. Those opposing spaceships were controlled by the people sitting next to you, and if you won the game you kept your quarter. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlU1QE1lYMovOBIiJ5LvB0v3HULshc_OSgY_nyIoVyKg5JHwN7lP0cmgXliyAPn34zqT_3mTRVim53Hm6Xr7tNg8gY3cwa7iJbA_CbM9yXNFwU_dBdv-m0rFHgdyV2N1coAb9nN4OMHjpN/s1600-h/Picture+1.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5337224008240126370" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlU1QE1lYMovOBIiJ5LvB0v3HULshc_OSgY_nyIoVyKg5JHwN7lP0cmgXliyAPn34zqT_3mTRVim53Hm6Xr7tNg8gY3cwa7iJbA_CbM9yXNFwU_dBdv-m0rFHgdyV2N1coAb9nN4OMHjpN/s400/Picture+1.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 293px; height: 221px;" /></a>I knew a good deal when I saw one, so I hung around the Coffee House and got to know the game’s co-creator, a Stanford grad named Bill Pitts. That's how I got my first job in high-tech: in exchange for keeping the consoles clean, I got a few dollars per day and a bunch of insider tips about how to play. For example, if your torpedo was on course to destroy an opponent’s ship and that opponent escaped into hyperspace, you could follow him there, shoot again, and destroy him. Imagine the face of a graduate student who thinks he has outwitted that annoying kid, only to find when he releases his finger from the hyperspace button that his ship is nothing but fragments of white floating randomly into the blackness of space. Nothing on Wii matches it! Galaxy's lessons have stayed with me. Its design was simple and easy to use but with the depth to satisfy the most committed players. Its on-screen dashboard fed players real-time information about fuel, torpedoes, and location, my first inkling that data is critical to making smart decisions. Finally, in Galaxy achieving your goals sometimes required a jump to hyperspace. My opponents thought hyperspace was a last resort, a refuge from a losing path. I discovered that it was a way to win — high risk and scary, but with a huge payoff. So when in doubt, press the button and make the jump! At worst you’ll lose a quarter, but at best you’ll rule the Galaxy. Posted by Jonathan Rosenberg, SVP, Product Management

A galactic mentor

This month marks the 30th anniversary of the final quarter being dropped into the world’s first commercial video game, for it was in May of ...

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