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If The Military Can't Get Electronic Health Records Right, Why Would We Think Conflicted EHR Companies And IT-Backwater Hospitals Can?

The publication "<a href="http://www.washingtonpost.com/wp-dyn/content/article/2009/05/15/AR2009051503667.html?hpid=topnews">The Machinery Behind Healthcare Reform: How an Industry Lobby Scored a Swift, Unexpected Victory by Channeling Billions to Electronic Records</a>" on May 16 2009 in the Washington Post (my comments <a href="http://hcrenewal.blogspot.com/2009/05/machinery-behind-healthcare-reform-how.html">here</a>) exposes a massive lobby that has grossly over-represented the benefits of healthcare IT, committed a cross-disciplinary invasion of medicine, and created a myth about HIT's supposed transformative powers in curing healthcare's ills. Since its publication in the Post I have become concerned that the research literature that exists extolling healthcare IT may be tainted by corporate influence. The phenomenon of tainted biomedical literature is certainly familiar to readers of Healthcare Renewal and other medical blogs regarding pharmaceuticals and medical devices. Electronic health records systems can facilitate, not revolutionize, medicine when led by competent experts cross-trained to a meaningful extent (i.e., graduate level or beyond) in both clinical medicine and information science and technology, e.g., biomedical informatics professionals. Even these professionals must often expend much effort in "managing the mismanagement" by incompetent and/or conflicted IT and hospital leadership. (An example of a tightly run and highly specialized project in a high risk medical subspecialty that did have tangible clinical and some financial returns, via identification of poorly performing medical devices -- not something the medical device industry cares for -- is <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=Cardiology%20story">here</a>. This type of project is not easily portable.) Making yet another case for how the concept of national electronic health records is probably a bad idea at this point in time with respect to our understanding of health IT and its social-technical interactions and challenges, it appears the military's EHR system AHLTA is simply a disaster. [Note: this is not to denigrate the military, and I am very thankful to all who serve and defend our country and freedoms. HIT problems seem unfortunately universal - ed.] All of the preventable elements I've <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/">written about</a> are present: unreliability to due inadequate attention to resilience engineering, a <a href="http://www.tinyurl.com/hostileuserexper">mission hostile user experience</a>, time-wasting, demoralization of clinicians, and a cornucopia of other predictable (to informatics experts) consequences when health IT is managed by anyone other than experts. Just as our economy and culture are now falling apart at the seams as a result of decades of mismanagement and corruption, from micro to macro levels, in most domains (borrowing a phrase from Rev. Jeremiah Wright, "the chickens are coming home to roost"), so the wages of incompetence and corruption in healthcare and healthcare IT are rearing their ugly head. This is the situation in the setting of a relatively constrained patient population (primarily active military personnel and families): <blockquote><a href="http://www.usmedicine.com/articles/electronic-records-system-unreliable-difficult-to-use-service-officials-tell-congress.html">U.S. Medicine - the Voice of Federal Medicine</a>May 2009Electronic Records System Unreliable, Difficult to Use, Service Officials Tell Congress - By Sandra BasuWASHINGTON—AHLTA, the Department of Defense’s $4 million [sic - that should be $4 billion - ed.] electronic medical record system, continues to be difficult for military physicians to use, according to top military health leaders who spoke at a House Armed Services subcommittee hearing at the end of March. At a Congressional hearing titled “AHLTA is ‘Intolerable,’ Where do we go from here?” top Department of Defense and service leaders told members that medical personnel are hampered by an electronic medical record system that, among other issues, is slow, difficult to use, unreliable and frequently crashes.“Being the first service to vigorously support the fielding of AHLTA five years ago, we faced a near mutiny of our healthcare providers, our doctors, our nurse practitioners, physician assistants and others last summer,” Army Surgeon General Lt. Gen. Eric Schoomaker, MC, USA, told committee members at a joint hearing held by the Military Personnel Subcommittee and the Terrorism, Unconventional Threats and Capabilities Subcommittee. Committee members also voiced concern about how the system was impacting provider morale and patient care. “The committee has heard from military doctors and nurses who use AHLTA that it is unreliable, difficult to use and has decreased the number of patients they can see each day. We have also heard that medical professionals leave the military because of their frustration with AHLTA,” said Rep. Joe Wilson, R.-S.C., ranking member of the Military Personnel Subcommittee of the House Armed Services Committee. </blockquote> Difficult for physicians to use. Intolerable. Slow. Unreliable. Frequently crashes. Near mutiny. Morale. Affecting patient care, decreasing patient load. Can it get worse? Yes: <blockquote>A Troubled SystemAHLTA is currently deployed worldwide to 70 hospitals, 410 clinics and 6 dental clinics. In addition, the system is used in 14 theater hospitals and 208 forward resuscitative sites. While Army, Navy and Air Forcer medical leaders who testified all stressed the importance of an electronic medical record [perhaps due to lobby influence and myth-making? - ed.], they all expressed frustrations with AHLTA. Dr. Schoomaker told committee members that medical personnel, particularly specialists, often “spend as much or more time working around the system as they do with the system.” He said that the services are still not effectively able to seamlessly access complete data of patients from the battlefield between the military treatment facilities and the Department of Defense and the Veteran’s Administration. Last year he said he knew he had a problem when he asked a physician who is a self-described “super user” of the system whether she was a “super fan” of the system and she responded that she was not. “When our best and most faithful users of AHLTA could not admit to being fans of the system, I knew we were really having serious problems,” Dr. Schoomaker said.</blockquote> When the Army's Surgeon General observes that clinicians "spend as much or more time working around the system as they do with the system", and that the superusers are not enthusiastic about the system, and a Congressional hearing is held entitled "where do we go from here?" (it's clear to this author that they have no clue), one should start to very critically question basic assumptions about health IT. Who said it's a powerful tool to improve healthcare and reduce costs? Who said it's ready for national dissemination? What conflicts do such individuals have with the health IT industry? <blockquote>He blamed the system’s failures on a lack of a clear-cut strategy for implementing AHLTA—a problem he believes still exists. “In my opinion, the failures of AHLTA can be attributed to the overall lack of a clear, actionable strategy and poor execution from its genesis. As a result of the MHS’s lack of an information management/information technology strategy up to this point, theArmy Medical Department has been largely frustrated by a number of obstacles that continue to impede the system’s capabilities and functionality,” he said. He also said that the services should have a greater input in decision making regarding AHLTA. “Military health system information technology investments and solutions should be transparent to the services sitting here at the table and should be jointly governed, meaning that we with service input are treated as principal customer clients of the system and that we are heard and acted upon promptly,” he said.</blockquote> As a faculty member in a College of Information Science and Technology where undergraduates and graduate students are taught the importance of information science and consideration of the needs of end users as a primary enabler of IT success, how can there be a "lack of an information management/information technology" strategy in this national health IT project? How can there have been a lack of input into decision making by the services in the development and deployment of AHLTA? <blockquote>Leaders from the Navy and Air Force detailed the challenges that their personnel face in using AHLTA. “Almost all of the providers I spoke to relate to the system going down unexpectedly, recently at least once a week,” Navy Deputy Surgeon General Rear. Adm. Thomas R. Cullison, MC, USN, told committee members. He added that while no one would like to return to paper records, providers are “largely dissatisfied” with the system and that the system slows down their clinic time. “Most of our providers say they have to stay later in the afternoon to finish up notes simply because it slows down clinic time,” he said. Air Force Deputy Surgeon General Maj. Gen. Charles Bruce Green, USAF, MC, told the committee that Air Force primary care physicians spend about 40 percent of their time working with AHLTA versus 60 percent of their time with patients. On the other hand, specialists are “working around the system trying to find new solutions,” since the system does not address the needs unique to their practices. In his written testimony, Dr. Green said that the problems associated with AHLTA have resulted in “low productivity and provider morale.” </blockquote> Forty percent of clinician time spent tinkering with balky computers? This should be astonishing to any reader unfamiliar with these issues, and an eye opener to our governmental representatives not just regarding the military, but regarding the entire lobby-promoted scheme to force clinicians to adopt HIT by 2014 or suffer financial penalties. Specialists "working around" the system (thus risking the <a href="http://hcrenewal.blogspot.com/2008/06/business-v-clinical-computing.html">dangers of workarounds</a> of HIT deficiencies observed by Koppel and others) because it does not meet the needs of their subspecialties? No surprises here. After reading about issues in development of domain specific healthcare information systems for high risk subspecialties (such as <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/?loc=cases&sloc=Cardiology%20story">here</a>), it should be obvious that the business IT-dominated health IT industry as it currently exists cannot fill such needs. More importantly, I feel the AHLTA project is an illustration of what will be reproduced, thousands or tens of thousands of times over, in hospitals and physician practices all over this country as we proceed in a national EHR initiative based on false premises borne of the health IT lobby. <blockquote>The Problem Then-Assistant Secretary of Defense for Health Affairs S. Ward Casscells, M.D., told committee members that many of the problems that AHLTA has suffered have been “self-inflicted wounds,” due to software contracts with vendors that were “poorly written.” “We have had, over the past decade, contracts that were poorly written from the standpoint of performance, they have loopholes in them that permitted delays. We have, in some instances, lax oversight of some of these contracts,” he said.</blockquote> Unbelievable. Hospitals sign HIT contracts putting all liability for system defects on clinicians, and that gag them from disclosing defects outside their organizations. The military's HIT contracts apparently had additional flaws that are probably pervasive in the commercial sector as well. <blockquote>... In moving forward to rectify AHLTA problems, DoD has adopted a Unified Strategy Regional Distribtion Approach, a three-phased plan for reshaping the electronic health system. In written testimony, Dr. Casscells explained this strategy seeks to “improve provider satisfaction, improve reliability and strengthen data sharing throughout DoD and Department of Veterans Affairs healthcare delivery continuum and with private healthcare providers.” The first phase of the approach will focus on “stabilizing performance, reliability and the core infrastructure,” of the system according to Casscell’s written testimony. "I want to be wary of overpromising. We have done that in the past [indeed, the entire HIT industry has massively overpromised for decades - ed.], but I am excited about this. I think there is a chance here that we can once again be leaders for the nation in electronic health records, as was the case several decades ago. I would like to think that a year or two from now, you will agree with me that AHLTA has gone from intolerable to indispensible,” Dr. Casscells told committee members. Tommy J. Morris, acting director in DoD’s office of the Deputy Assistant Secretary of Defense for Force Health Protection and Readiness Programs, said that the only service that nonconcurred with their proposed blueprint to overhaul AHLTA was the Army [not exactly an unimportant stakeholder - ed.] Dr. Schoomaker, on his part, challenged the notion that there was actually a “strategy” in place for rectifying AHLTA. “Mr. Morris has got a plan, he does not have a strategy. We asked for a strategy. A plan is just one element of a larger strategy. We asked for a strategy and our involvement in that strategy, so with respect, that is what we in a sense partially nonconcurred with,” Dr. Schoomaker said.</blockquote> "I've got a plan." How familiar a refrain that is in a time of mass societal mismanagement. If I were a politician examining health IT, I'd really start looking into how our government became convinced health IT was not only a worthwhile investment, but an "economic stimulus." As with our <a href="http://hcrenewal.blogspot.com/2009/05/canadian-health-it-ripoff-is-anyone-in.html">friends up north</a>, it seems to be primarily a stimulus for poseurs and dyscompetents to come out of the woodwork, disrupt healthcare providers, and then collect massive fees for the "favor." In consideration of the above, I ask: If the military, with its internal discipline and ability to take over entire modern countries with just a few thousand soldiers lost, and its constrained patient population (active military personnel and families generally free of complex and chronic illnesses) can't get electronic health records right, why would anyone think inept and sometimes corrupt EHR companies, dyscompetent hospital IT departments, and <a href="http://hcrenewal.blogspot.com/2009/03/health-it-hold-harmless-and-defects-gag.html">reckless and cavalier hospital executives</a> can? I reiterate my concerns that the "AHLTA experience" will become all too familiar to hospitals and physician practices throughout this country, unless sanity and rationality is restored to our thinking about health IT. -- SS

If The Military Can't Get Electronic Health Records Right, Why Would We Think Conflicted EHR Companies And IT-Backwater Hospitals Can?

The publication " The Machinery Behind Healthcare Reform: How an Industry Lobby Scored a Swift, Unexpected Victory by Channeling Billio...

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Square your search results with Google Squared

Some information is easy to find. If you want to learn the rules of golf, you can search Google for [golf rules] and we'll return a list of relevant web sites right at the top. But not all your information needs are that simple. Some questions can be more complex, requiring you to visit ten, perhaps twenty websites to research and collect what you need. For instance, I'm a big fan of roller coasters. In the past I've used Google to search for information about roller coasters, such as which ones are the tallest, fastest, and have the most loops. Finding this information used to take multiple searches — I'd find roller coaster sizes on one website, heights on another, and speeds on a third. By manually comparing the sites, I could get the information I was looking for, but it took some time. With <a href="http://www.google.com/squared">Google Squared</a>, a new feature just released in Google Labs, I can find my roller coaster facts almost instantly. <div> Google Squared is an experimental search tool that collects facts from the web and presents them in an organized collection, similar to a spreadsheet. If you search for [roller coasters], Google Squared builds a square with rows for each of several specific roller coasters and columns for corresponding facts, such as image, height and maximum speed. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKpXjS35u0BzResS4M6oNooL96fDQxu3myeneE1V16l3ZxGLWhuFCuWGK34cOxM_RGcovwL_DNUI2momghoQYmIC5kYtmqOJ1BH2KgsZmUXoF7PsfBNlY5ACj1gtDb2s0r_67932wQkehq/s1600-h/RollerCoastersSquare.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5343231429610916146" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKpXjS35u0BzResS4M6oNooL96fDQxu3myeneE1V16l3ZxGLWhuFCuWGK34cOxM_RGcovwL_DNUI2momghoQYmIC5kYtmqOJ1BH2KgsZmUXoF7PsfBNlY5ACj1gtDb2s0r_67932wQkehq/s400/RollerCoastersSquare.png" style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 280px;" /></a> </div><div>While gathering facts from across the Internet is relatively easy (albeit tedious) for humans to do, it's far more difficult for computers to do automatically. Google Squared is a first step towards solving that challenge. It essentially searches the web to find the types of facts you might be interested in, extracts them and presents them in a meaningful way. This technology is by no means perfect. That's why we designed Google Squared to be conversational, enabling you to respond to the initial result and get a better answer. If there's another row or column you'd like to see, you can add it and Google Squared will automatically attempt to fetch and fill in the relevant facts for you. As you remove rows and columns you don't like, Google Squared will get a fresh idea of what you're interested in and suggest new rows and columns to add. See it in action in the video below: <object height="295" width="480"><param name="movie" value="http://www.youtube.com/v/__INtIXNLmI&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/__INtIXNLmI&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="295"></embed></object> If you click on any fact, you'll see the sources Google Squared gathered it from as well as a list of other possible values that you can investigate. So even if your square isn't perfect at the beginning, it's easy to work with Google Squared to get a better answer in no time. Once you've got a square you're happy with, you can save it and come back to it later. To give Google Squared a whirl, try searching for [planets] or [romantic movies]. You can try out <a href="http://www.google.com/squared">Google Squared</a> now in Google Labs. Posted by Alex Komoroske, Associate Product Manager for Google Squared</div>

Square your search results with Google Squared

Some information is easy to find. If you want to learn the rules of golf, you can search Google for [golf rules] and we'll return a list...

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Tour the homepages of your favorite celebrities

Have you ever wondered what celebrities do when they use the web? Today, we're announcing the new <a href="http://www.google.com/igshowcase">iGoogle Showcase</a>, which allows you to see and share the homepages of some of your favorite icons. These 30 preeminent people, including <a href="http://www.google.com/intl/en_us/help/ig/showcase/dave_matthews.html">Dave Matthews</a>, <a href="http://www.google.com/intl/en_us/help/ig/showcase/rachael_ray.html">Rachael Ray</a> and <a href="http://www.google.com/intl/en_us/help/ig/showcase/katie_couric.html">Katie Couric</a>, are sharing their iGoogle pages with you in full so you can get a glimpse into their interests and how they experience the web. The iGoogle Showcase allows you to either add a celebrity's entire iGoogle page to your own, or browse through the collection and choose different gadgets and themes from several pages. For example, you might select <a href="http://www.google.com/intl/en_us/help/ig/showcase/al_gore.html">Al Gore's iGoogle page</a> for his preferred theme and gadgets for keeping up on the latest media news, supporting the Alliance for Climate protection cause or browsing through photos from National Geographic. <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/TAEXRq9wlhY&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/TAEXRq9wlhY&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object> In addition, many of our celebrity partners have created their own custom iGoogle gadgets to easily connect with their fans every day. If you're a <a href="http://www.google.com/intl/en_us/help/ig/showcase/ryan_seacrest.html">Ryan Seacrest</a> fan, his new gadget can help you keep up with all the latest entertainment news. You can follow his tweets, watch exclusive videos, listen to radio interviews, and view his photo albums. <a href="http://www.google.com/intl/en_us/help/ig/showcase/donald_trump.html">Donald Trump</a> offers advice to entrepreneurs, <a href="http://www.google.com/intl/en_us/help/ig/showcase/martha_stewart.html">Martha Stewart</a> shares recipes and tips, and <a href="http://www.google.com/intl/en_us/help/ig/showcase/anderson_cooper.html">Anderson Cooper</a> delivers headline news and extras from his CNN show AC360. To get any one of our celebrity themes or gadgets on your own iGoogle page, visit the <a href="http://google.com/igshowcase">iGoogle Showcase</a>. We've all heard about "six degrees of separation," but now, some of your favorite stars are just a few clicks away. Posted by Marissa Mayer, Vice President, Search Products and User Experience

Tour the homepages of your favorite celebrities

Have you ever wondered what celebrities do when they use the web? Today, we're announcing the new iGoogle Showcase , which allows you t...

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"Man's Best Hospital," Run by the Boss of a MECC (Medical Education and Communications Company)?

In January, 2009 we <a href="http://hcrenewal.blogspot.com/2009/01/to-whom-did-scorpions-in-bottle-owe.html">posted</a> about how the CEO of Blue Cross Blue Shield (BCBS) of Massachusetts and of Partners HealthCare, made a secret oral agreement that BCBS would pay Partners at a higher rate than that given to other hospitals. Why BCBS would want to pay so much to this one hospital system was never clear. Partners does include some extremely prestigious hospitals, including the Brigham and Womens Hospital, and the Massachusetts General Hospital, ("Man's Best Hospital" in the House of God), but there are some other very prestigious teaching hospitals in Boston that were not blessed by BCBS' largess. We speculated about one possible cause: the leadership of the two organizations may have felt they had more in common with each other than with the constituencies of their own organizations. A few leaders of each organization had direct ties to the other. Many leaders of both organizations were simultaneously leaders of finance, the same sector that has brought us what is now called the Great Recession. Leadership of both organizations had conflicted loyalties. The organizations' CEOs at the time, and many members of their boards had divided loyalties and apparent conflicts of interest. For example, Jack Connors, the chair of the Partners HealthCare board, <a href="http://www.adclub.org/2008_Legends/jack.html">is also </a>the Chairman Emeritus of marketing communications company Hill, Holliday, Connors, Cosmopoulos Inc, whose clients include pharmaceutical and pharmacy benefits manager CVS / Caremark, and is also a member of the board of directors of Covidien, a medical device company. The Boston Globe just published <a href="http://www.boston.com/business/healthcare/articles/2009/05/31/partners_leader_questioned_on_outside_ties/">a report </a>that Mr Connors had even more intense conflicts that had not heretofore been made public. <blockquote>He's chairman of New England's largest healthcare company, and that position atop Partners HealthCare has tested the limits of Jack Connors's considerable corporate dexterity. Though he has no background in medicine, Connors has been Partners' chief overseer, champion, and its most public face for 13 years. [One board member] is the cofounder and chairman emeritus of Partners' advertising firm. That would be Jack Connors. And that potential point of conflict has been disclosed.... But to the chagrin of some former board members, never brought up for board review was Connors's stake in a leading medical education firm whose sale in 2004 made Connors a very wealthy man. Nor has the board notified public officials of Connors's ownership of a fledgling home healthcare firm that has directly solicited Partners' hospitals for business. Connors and top Partners officials defended the decision not to publicly disclose Connors's potential conflicts, saying that because Partners did not directly contract with either of Connors's firms there were no conflicts to report. Connors also defended his right to be an entrepreneur in the healthcare business while also chairing Partners' board, and strongly denied ever using his position for personal or financial advantage. The larger company, M/C Communications, grew to become the biggest commercial provider of continuing education to physicians in the decade between its inception in 1994 and when Connors sold it in 2004. It profited hugely from an exclusive commercial relationship it maintained with Harvard Medical School, whose faculty teach at seminars the company holds. Partners' signature institutions, Massachusetts General Hospital and Brigham and Women's Hospital, are major teaching affiliates of Harvard Medical School. In addition, M/C Communications benefited financially from millions of dollars in sponsorship revenue paid it from major pharmaceutical firms eager to play to this professional audience. Connors said he was under no obligation to disclose his ownership of M/C Communications to the Partners board. He said that while there is an 'affiliation' between Harvard Medical School and the two Partners hospitals, there is no formal contract between them. Connors said he informed Partners executives of his ownership of M/C Communications, and that they determined it did not warrant disclosure to the full Partners board. 'There is no contract between Partners and Harvard,' Partners said in a statement to the Globe. Connors made a name for himself as an executive with Hill, Holliday, Connors, Cosmopulos, the Boston advertising company that he helped found and guided throughout a long career. Less well known is that he made most of his fortune from M/C Communications, which he sold to Bain Capital for $450 million in 2004. The sale was the largest of a private healthcare-related company in Massachusetts that year, according to TM Capital Corp., an investment banking company. Connors, who led an investor group that bought the firm outright for $13 million in 2000, made about $250 million from its sale. After his 2004 windfall, he founded a company that helps elderly patients readjust to life at home after a hospitalization. That company, Dovetail Health, has - Connors acknowledged - solicited business from hospitals owned by Partners. And Connors confirmed that after Dovetail executives failed to convince Blue Cross Blue Shield of Massachusetts to contract with the firm, he personally spoke to the giant insurer's president, Cleve L. Killingsworth, on Dovetail's behalf. Partners and Blue Cross Blue Shield regularly negotiate over $2.5 billion worth of medical business a year. Connors acknowledged in an interview that it might have appeared 'inappropriate' to some for him to pitch Killingsworth. But he said the conversation stemmed from a shared belief that new ways must be found to reduce frequent return trips of elderly patients to the hospital. More recently, however, he said he does not believe his approach to Killingsworth was inappropriate. </blockquote>So let's try to recap this. While Jack Connors has been chairman of the board of Partners HealthCare, the largest and most prestigious hospital system in Massachusetts, he also ran an advertising agency that did business with Partners, and has been on the board of Covidien, a medical device company. Both of these relationships he disclosed to his fellow board members, although no one seemed troubled by them. However, while a Partners board member, Connors was also the founder, and ultimately profited very handsomely from the sale of M/C Communications. M/C Communications apparently begat <a href="http://www.mc-comm.com/live/MCHCGateway.html">M/C Holding Corporation</a>, which in turn owns M/C Communications and Pri-Med Institute LLC. M/C Communications now <a href="http://www.mc-comm.com/live/MC/">describes itself </a>as " established in 1994 and has become a leading provider of medical education event management solutions for health care professionals and others around the globe." M/C Communications runs <a href="http://www.pri-med.com/pmo/Home.aspx">Pri-Med</a>, which is <a href="http://www.pri-med.com/industry/">described</a> thus: "Pri-Med is a platform for science and medicine that includes meetings, resources, online, and new media tools designed to meet the information and education needs of today’s practicing physician." Pri-Med <a href="http://www.pri-med.com/industry/conference.htm">markets itself to industry</a>, presumably the pharmaceutical, biotechnology, and device industry, "Sixty percent of doctors’ offices restrict rep access, making it more challenging than ever to get in front of your customers. But with Pri-Med, you get to meet clinicians in a professional environment where they seek you out. More than 66% of attendees say they come to Pri-Med events to meet you, industry representatives." So Connors' company was a medical education and communication company (MECC), which provided what appeared to be educational programs to physicians that in fact were also sold to the health care industry as marketing opportunities. So Partners HealthCare, which includes two of the world's most prestigious teaching hospitals, has been run by the boss of a MECC? Say it ain't so. Not only did Connors own a company that had an exclusive contractual relationship (as described above) with the Harvard faculty who staff the main Partners HealthCare hospitals, that company was engaged in marketing the products of sponsoring drug and device companies disguised as education. Finally, Connors denied that this presented any kind of conflict of interest, because Partners HealthCare has no explicit contract, just an "affiliation" with Harvard Medical School. Finally, just to ice the cake, Connors' latest venture is a home health care company that did business with Partners, and tried to do business with BCBS, spearheaded by Connors' direct conversations with the BCBS CEO. Jack Connors thus seems to have just become the latest poster boy for leaders of health care organizations who put their personal financial interests ahead of their responsibilities to those organizations, and function as a power elite whose collective interests trump those of the constituents of the organizations they run. Quoting <a href="http://www.boardsource.org/Knowledge.asp?ID=3.364">from BoardSource</a>, the main duties of the leader of any US not-for-profit are: <blockquote> Duty of Care The duty of care describes the level of competence that is expected of a board member, and is commonly expressed as the duty of 'care that an ordinarily prudent person would exercise in a like position and under similar circumstances.' This means that a board member owes the duty to exercise reasonable care when he or she makes a decision as a steward of the organization. Duty of Loyalty The duty of loyalty is a standard of faithfulness; a board member must give undivided allegiance when making decisions affecting the organization. This means that a board member can never use information obtained as a member for personal gain, but must act in the best interests of the organization. Duty of Obedience The duty of obedience requires board members to be faithful to the organization's mission. They are not permitted to act in a way that is inconsistent with the central goals of the organization. A basis for this rule lies in the public's trust that the organization will manage donated funds to fulfill the organization's mission. </blockquote> By leading companies that did direct business with Partners and its staff, and failing to disclose that he was doing so to his fellow Partners board members, Connors appeared to have violated the Duty of Loyalty. By running a MECC that helps drug and device companies market to physicians in the guise of education, using faculty from the academic teaching hospitals that he lead, Connors seems to have mocked the mission of the academic hospitals within Partners, and thus appeared to violate the Duty of Obedience. This episode certainly does suggest that health care, and the organizations involved in this case, are lead by an "old-boy network," as one person interviewed for the Globe article suggested. More than just an old-boy network, they seem to be lead by chummy members of the power elite whose collective personal interests supersede the missions of the organizations they are supposed to steward. When this happens, is it any surprise that health care becomes less accessible, more expensive, and of lower quality? Yet challenging the power elite that are increasingly revealed as controlling much of health care seems to be something that one cannot talk about when discussing health care reform. However, failing to address this problem will likely doom any effort, no matter how well intentioned, to improve health care. Hat tip to and see <a href="http://alison-bass.blogspot.com/2009/06/fish-rots-from-top-conflicts-of.html">comments</a> by Alison Bass on the Alison Bass Blog. ADDENDUM (3 June, 2009) - See also <a href="http://carlatpsychiatry.blogspot.com/2009/06/harvard-med-school-jack-connors-and.html">comments</a> by Dr Daniel Carlat on the Carlat Psychiatry Blog.

"Man's Best Hospital," Run by the Boss of a MECC (Medical Education and Communications Company)?

In January, 2009 we posted about how the CEO of Blue Cross Blue Shield (BCBS) of Massachusetts and of Partners HealthCare, made a secret or...

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Search billions of documents with the Google Search Appliance 6.0

It's hard to conceptualize the number 1,000,000,000. One billion sheets of paper could circle the earth at the equator well over five times. Counting to one billion would take about 30 years of your life, even if you never stop to sleep. And if you had to find a single piece of information by sorting through a billion documents it would take you, on average, about 2000 years. Businesses and large organizations have tons of documents and other types of data — some even have a billion documents that need searching, and it's unlikely that employees have 2000 years to dedicate to the hunt. Figuring out how to navigate the complex content systems of large organizations is a tough problem, one we've dedicated years to solving. Today we're releasing the newest version of our solution, the <a href="http://google.com/gsa">Google Search Appliance 6.0 (GSA)</a>, which has the capacity to search billions of documents. So whether you own a small business with a few thousand docs or belong to a huge organization with a billion, the GSA can search them all. Even if the content you need lives in a bunch of different departments or locations, in all kinds of formats, languages and repositories, the GSA makes searching within your organization as simple as searching on Google.com. It also has helpful features like user-added results and query suggestions, so over time your coworkers' input improves search results. The GSA 6.0 also is full of customization features, as well as flexible security policies so that each enterprise or large organizations can tweak the settings to suit its needs. We believe that setting your enterprise up with the GSA can save you tons of employee hours spent looking for data — letting you focus on the actual work to be done. We demonstrated the infrastructure you'd actually need to search a billion docs — check it out in the video below. To learn more about the GSA 6.0 or our search solutions for businesses, check out the <a href="http://googleenterprise.blogspot.com/2009/06/introducing-google-search-appliance-60.html">Google Enterprise Blog</a> or our <a href="http://www.google.com/enterprise/search.html">website</a>. <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/rE0KNvECG2s&hl=en&fs=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/rE0KNvECG2s&hl=en&fs=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="560" height="340"></embed></object> Posted by Cyrus Mistry, Product Manager

Search billions of documents with the Google Search Appliance 6.0

It's hard to conceptualize the number 1,000,000,000. One billion sheets of paper could circle the earth at the equator well over five ti...

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The Local Business Center dashboard opens its doors

If you're a local business owner, it's likely that Google plays a role in helping customers find you. And we're not just talking about your website — thanks to <a href="http://maps.google.com/">Google Maps</a> and <a href="http://www.google.com/">Google Search</a>, you may also be getting a lot of online traffic to your business listing. You've probably seen one of these listings before: <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjaVd0nTAs4MV9X_IWq-gCms_NL2adm9aLYX1HxrIJqzFv2zNFsHgzo6R2i6hpCyHWtYVg2rvSl5S2Qq112W6TngtZcOeObDYiK4mGapkcR-E1yNZ-zPeexR48A30tgY7cg9K2WO5G-i45g/s1600-h/OGB+post.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5342583973125746738" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjaVd0nTAs4MV9X_IWq-gCms_NL2adm9aLYX1HxrIJqzFv2zNFsHgzo6R2i6hpCyHWtYVg2rvSl5S2Qq112W6TngtZcOeObDYiK4mGapkcR-E1yNZ-zPeexR48A30tgY7cg9K2WO5G-i45g/s400/OGB+post.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 395px;" /></a>You also probably know how they tend to work: A potential customer does a search on Google.com or in Google Maps, comes across your listing, clicks on it to see your reviews and details, and then gets directions to your location. Now, imagine if there were a way for you to get a better understanding of how those customers are finding you. Did they search for "pizza" or "pasta" to get to the listing for your Italian restaurant? Do they live across town, but drive miles for your great selection of camping gear? What happens to traffic to your new dental practice when you start advertising in the local paper? With information like that, you'd be able to make better informed decisions on how to drive more traffic to your listing and attract more customers. Later today, you'll be able to do just that, thanks to a new dashboard feature we're launching in the Local Business Center (<a href="http://www.google.com/local/add/businessCenter?gl=US&hl=en-US&service=lbc&hl=en-US&gl=US&utm_campaign=en&utm_source=OGblog&utm_medium=et&utm_term=%7Bkeyword%7D">www.google.com/lbc</a>). The LBC is a free tool that enables business owners to control the content of their business listings as they appear in Google Search and Google Maps. All you have to do is <a href="http://maps.google.com/support/bin/answer.py?hl=en&answer=15391">claim your listing</a> in the LBC and go through a quick verification process to get access to the following kinds of data: <ul><li>Impressions: The number of times the business listing appeared as a result on a Google.com search or Google Maps search in a given period.</li><li>Actions: The number of times people interacted with the listing; for example, the number of times they clicked through to the business' website or requested driving directions to the business.</li><li>Top search queries: Which queries led customers to the business listing; for example, are they finding the listing for a cafe by searching for "tea" or "coffee"?</li><li>Zip codes where driving directions come from: Which zip codes customers are coming from when they request directions to your location.</li></ul>The new dashboard will also let you dig into that data using all kinds of lists, maps, and graphs like this one, which measures impressions and actions for a hotel's business listing: <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtlL6Vziv_XkaAYges4l9VXlwdyoMM04dBizmUvq3suk9aFW38ESD77up4ioHJWYpLQmmt9KvtibBmxGz57JT5ql7wZiWnShU0B9vX-aE8L2AaqdHukaRaCzPx6EpKvzwCZe3MW3mGFmvf/s1600-h/OGB+Graph.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5342583771477620370" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtlL6Vziv_XkaAYges4l9VXlwdyoMM04dBizmUvq3suk9aFW38ESD77up4ioHJWYpLQmmt9KvtibBmxGz57JT5ql7wZiWnShU0B9vX-aE8L2AaqdHukaRaCzPx6EpKvzwCZe3MW3mGFmvf/s400/OGB+Graph.jpg" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 178px;" /></a> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1TXJls_4HAEkEAxwRwkD_C7zmquF7elVV25sh-SIjgohWVLh0vSUWG7ckUm2XQOI9FbukdhVgLfNwJD6WmEU7gIsjp747fkWmW06kImlJpmE1j6LdMwMAU1aKD8Z4wo7adUIsUj7xP7RN/s1600-h/totals.png" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5342733529161453554" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg1TXJls_4HAEkEAxwRwkD_C7zmquF7elVV25sh-SIjgohWVLh0vSUWG7ckUm2XQOI9FbukdhVgLfNwJD6WmEU7gIsjp747fkWmW06kImlJpmE1j6LdMwMAU1aKD8Z4wo7adUIsUj7xP7RN/s400/totals.png" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 110px;" /></a> When you sign in to the LBC today, you'll find that we've already populated the dashboards for claimed listings with data from the last 30 days. After that, new information will be added every day, so you can check in often to see how things are going. We're also working hard to add more historical information, and to make this available for businesses outside the U.S. All the data we share through the dashboard will be anonymous and aggregated, to protect the privacy of Google users. We're really excited to be able to open up this data to local business owners. Before now, you could track usage metrics on your website using a tool like <a href="http://www.google.com/analytics/">Google Analytics</a>, but data about how customers found you in other ways never got back to you. That all changes today, and we think business owners will really get a lot out of this new information. So if you're a local business owner and you feel the same way, be sure to check out this new dashboard. To learn more about accessing and using the dashboard, take a look at the video below and then visit the <a href="http://google-latlong.blogspot.com/2009/06/bringing-power-of-googles-data-to-local_02.html">Lat Long Blog</a> for a more in-depth overview. <object height="340" width="560"><param name="movie" value="http://www.youtube.com/v/hjeCmHwqVpU&hl=en&fs=1&rel=0&hd=1"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/hjeCmHwqVpU&hl=en&fs=1&rel=0&hd=1" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" height="340" width="560"></embed></object> Posted by Amer Shahnawaz, Software Engineer, Local Business Center

The Local Business Center dashboard opens its doors

If you're a local business owner, it's likely that Google plays a role in helping customers find you. And we're not just talking...

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Blog search and beyond

Since <a href="http://bloggerindraft.blogspot.com/2007/07/new-feature-search-box.html">we launched</a> the Custom Search AJAX gadget for Blogger on our <a href="http://draft.blogger.com/">experimental site</a>, we've gotten some great feedback. Now, the tuned-up search gadget is available to all <a href="http://buzz.blogger.com/2009/06/search-box-gadget-available-to-all.html">Blogger users</a>. You can configure this gadget to help your readers search all the information that's relevant to your blog — your posts, webpages that you link to, and sites that you link to from the sidebar — all in one shot. When your readers search using this gadget, the results are displayed with the look and feel of your blog. And they show up inline, so readers don't have to leave your blog. After they're done, they can quickly dismiss the results and go back to reading your blog posts. Take a look at how <a href="http://www.skrishnasbooks.com/">S. Krishna's Books</a> uses the gadget. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRqlT5-6b4bE1AkOLI6xuvg3NKQvMYq0iwkoqESZiUM-U04FDMrPBOC01qGwIeBlObBTVfRxtjW4den9gD-KIa3xOo1KaaDjiQDfF7mpCP0gyyyijHR9VnqCkM27r5Hzo1H6AX8UmonWoc/s1600-h/Books.gif" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5342405162847376402" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRqlT5-6b4bE1AkOLI6xuvg3NKQvMYq0iwkoqESZiUM-U04FDMrPBOC01qGwIeBlObBTVfRxtjW4den9gD-KIa3xOo1KaaDjiQDfF7mpCP0gyyyijHR9VnqCkM27r5Hzo1H6AX8UmonWoc/s400/Books.gif" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 343px;" /></a> You can configure the gadget on your blog with just a few clicks: <ul><li>Edit your blog's layout, and click "Add a Gadget"</li><li>Select and configure the search box gadget</li></ul>The search box will then show up on the sidebar on your blog. <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOrbH_pLmDEtke2p3q15DiX9Vi6mOjwgpj5WVOtWLXmCn6xD6-9QHUSfd18gz09ZJAKnATvxDvaPTefDVOKxdKMcDcWJuBAIVX0tovY1huxYa5KK0gEqNafEdzOIkinctFXvBA9uN4KmqL/s1600-h/blogger_gadget_add.gif" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5342404152935327858" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgOrbH_pLmDEtke2p3q15DiX9Vi6mOjwgpj5WVOtWLXmCn6xD6-9QHUSfd18gz09ZJAKnATvxDvaPTefDVOKxdKMcDcWJuBAIVX0tovY1huxYa5KK0gEqNafEdzOIkinctFXvBA9uN4KmqL/s400/blogger_gadget_add.gif" style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 225px;" /></a> By default, the following 3 search tabs are configured: <ul><li>This blog: searches across your blog posts</li><li>Linked from here: searches blog posts, webpages linked from your posts, blog lists, and link lists</li><li>The web: searches across all pages on the web</li></ul>The gadget also provides an option that lets you restrict search results to pages linked from a specific blog list or link list. For example, if you have many link lists on your sidebar, you can choose to surface only the most important ones in specific search tabs. "Linked from here" includes pages from all of them. The goal of this gadget is to expand the search capabilities of your blog and give your readers a better search experience. If you're using it, we'd love to hear your <a href="http://groups.google.com/group/blogger-help?pli=1">feedback</a> on other improvements we can make. Learn more at the <a href="http://googlecustomsearch.blogspot.com/2009/05/search-box-for-blogger.html">Custom Search Blog</a>. Posted by Rajat Mukherjee, Group Product Manager

Blog search and beyond

Since we launched the Custom Search AJAX gadget for Blogger on our experimental site , we've gotten some great feedback. Now, the tuned...

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